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- Suicide first aid kit
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- Our Family
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Measure your Depression Level

Note, this form contains 21 questions. Select the option that feels most appropriate to you. While this form is a standardized psychological tool used to measure depression. It isn't meant for self-diagnosis and needs professional evaluation in a therapy session.

Name *

First

Last

Email *

Phone *

Age *

Mark whichever is most applicable *

I do not feel Sad
I feel Sad
I am sad all the time and I can't snap out of it.
I am so sad and unhappy that I can't stand it.

Mark whichever is most applicable *

I am not particularly discouraged about the future.
I feel discouraged about the future.
I feel I have nothing to look forward to.
I feel the future is hopeless and that things cannot improve.

Mark whichever is most applicable *

I do not feel like a failure.
I feel I have failed more than the average person.
As I look back on my life, all I can see is a lot of failures.
I feel I am a complete failure as a person.

Mark whichever is most applicable *

I get as much satisfaction out of things as I used to.
I don't enjoy things the way I used to.
I don't get real satisfaction out of anything anymore.
I am dissatisfied or bored with everything.

Mark whichever is most applicable *

I don't feel particularly guilty
I feel guilty a good part of the time.
I feel quite guilty most of the time.
I feel guilty all of the time.

Mark whichever is most applicable *

I don't feel I am being punished.
I feel I may be punished.
I expect to be punished.
I feel I am being punished.

Mark whichever is most applicable *

I don't feel disappointed in myself.
I am disappointed in myself.
I am disgusted with myself.
I hate myself.

Mark whichever is most applicable *

I don't feel I am any worse than anybody else.
I am critical of myself for my weaknesses or mistakes.
I blame myself all the time for my faults.
I blame myself for everything bad that happens.

Mark whichever is most applicable *

I don't have any thoughts of killing myself.
I have thoughts of killing myself, but I would not carry them out.
I would like to kill myself.
I would kill myself if I had the chance.

Mark whichever is most applicable *

I don't cry any more than usual.
I cry more now than I used to.
I cry all the time now.
I used to be able to cry, but now I can't cry even though I want to.

Mark whichever is most applicable *

I am no more irritated by things than I ever was.
I am slightly more irritated now than usual.
I am quite annoyed or irritated a good deal of the time.
I feel irritated all the time.

Mark whichever is most applicable *

I have not lost interest in other people.
I am less interested in other people than I used to be.
I have lost most of my interest in other people.
I have lost all of my interest in other people.

Mark whichever is most applicable *

I make decisions about as well as I ever could.
I put off making decisions more than I used to.
I have greater difficulty in making decisions more than I used to.
I can't make decisions at all anymore.

Mark whichever is most applicable *

I don't feel that I look any worse than I used to.
I am worried that I am looking old or unattractive.
I feel there are permanent changes in my appearance that make me look unattractive
I believe that I look ugly.

Mark whichever is most applicable *

I can work about as well as before.
It takes an extra effort to get started at doing something.
I have to push myself very hard to do anything.
I can't do any work at all.

Mark whichever is most applicable *

I can sleep as well as usual.
I don't sleep as well as I used to.
I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
I wake up several hours earlier than I used to and cannot get back to sleep.

Mark whichever is most applicable *

I don't get more tired than usual.
I get tired more easily than I used to.
I get tired from doing almost anything.
I am too tired to do anything.

Mark whichever is most applicable *

My appetite is no worse than usual.
My appetite is not as good as it used to be.
My appetite is much worse now.
I have no appetite at all anymore.

Mark whichever is most applicable *

I haven't lost much weight, if any, lately.
I have lost more than five pounds.
I have lost more than ten pounds.
I have lost more than fifteen pounds.

Mark whichever is most applicable *

I am no more worried about my health than usual.
I am worried about physical problems like aches, pains, upset stomach, or constipation.
I am very worried about physical problems and it's hard to think of much else.
I am so worried about my physical problems that I cannot think of anything else.

Mark whichever is most applicable *

I have not noticed any recent change in my interest in sex.
I am less interested in sex than I used to be.
I have almost no interest in sex.
I have lost interest in sex completely.

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