DEPScreen

            Name:____________________________________

Answer Yes or No – then elaborate if needed!

       Return ASAP – next visit or mail back.

1.    Have you felt sad or tearful for a majority of the day for at
        least the last two weeks?

2.    Have you lost interest in activities which you used to enjoy?

3.    Is it difficult for you to fall asleep most nights to the point
        that you are always tired the next day?

4.    Do you sleep a lot more than you should because of being tired
        most of the day for at least the last two weeks?

5.    Have you noticed a change in your appetite - either not feeling hungry
        most days or eating more- with a significant change in your weight?

6.    Has your energy level decreased to the point that normal daily
        activities seem overwhelming?

7.    Have you noticed that it seems more difficult to stay focused on
        activities or to concentrate on complicated tasks?

8.    Have you thought about suicide or what it would be like if you
        were not around anymore?

9.     Do you find yourself getting angry easily or lashing out at
         people without a good reason?

10.    Do friends or family tell you that they are concerned about you because
          of your feelings of sadness, your sleep patterns, or your anger?

11.    Is it more difficult for you to make decisions, even about
          simple matters which used to be easy?

12.    Do you cry more easily than you used to?

13.    Do you often criticize yourself about things you have done in
          the past or about decisions you have made?

14.    Have feelings of sadness or anger, changes in your sleep pattern, or a lack of
           motivation and energy gotten in the way of achieving goals or performing work
           activities?

15.    Does the future look bleak or even hopeless to you?