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Mood Disorders Screening

Please take a few minutes to complete the following statements. The answers may help your doctor to better understand your health. This questionnaire offers you choices. There are no right or wrong answers. Simply check the box next to the choice that best describes the way you felt during the past week. Take as long as you like to give the most honest answer.

Once you've answered the questions, please print this out and bring it to your next appointment.

 None or a little of the time Some of the time Good part of the time Most or all of the time
1. I feel downhearted, blue, and sad
2. Morning is when I feel the best
3. I have crying spells or feel like it
4. I have trouble sleeping through the night
5. I eat as much as I used to
6. I enjoy looking at, talking to, and being with attractive women/men
7. I notice that I am losing weight
8. I have trouble with constipation
9. My heart beats faster than usual
10. I get tired for no reason
11. My mind is as clear as it used to be
12. I find it easy to do the things I used to do
13. I am restless and can't keep still
14. I feel hopeful about the future
15. I am more irritable than usual
16. I find it easy to make decisions
17. I feel that I am useful and needed
18. My life is pretty full
19. I feel that others would be better off if I were dead
20. I still enjoy the things I used to do

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