Randi Fredricks, Depression Questionnaire

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Depression Screening Test

Everyone experiences "the blues" from time to time. But if you're clinically depressed, you are experiencing more than just the occasional bad mood or terrible day. This Depression Screening Test is not intended to be a diagnostic tool but instead is meant to give you and I a better idea as to the extent of your depression.

For each statement below, please indicate how often you feel that way.

Rate your answers as follows:

(1) Sometimes
(2) Often
(3) Never - or I don't know

1. In the past two weeks, I have had difficulty sleeping.

1	2	3

2. I've recently lost interest in the things that I used to enjoy.

1	2	3

3. My family has a history of depression.

1	2	3

4. In the past two weeks, I have had difficulty concentrating.

1	2	3

5. I've recently experienced a traumatic or life-changing event in my life.

1	2	3

6. Upon waking, I feel apathetic about how the day will turn out.

1	2	3

7. I've been more irritable than usual recently.

1	2	3

8. In the past two weeks, I have noticed a change in my weight.

1	2	3

9. Lately, I've felt restlessness, fatigued, or a lack of motivation at work.

1	2	3

10. I feel a sense of being overburdened with life and its activities.

1	2	3

11. For a while now, I've had feelings of felt despondency, despair, loneliness, or worthlessness for extended periods of time.

1	2	3

12. I've recently been isolating more than usual from my family or friends.

1	2	3

13. I've cried often in the past two weeks.

1	2	3

14. Flat and monotonous voice quality

1	2	3

15. I have no motivation to try new activities, contemplate new ideas, or enter into new relationships.

1	2	3

16. I feel a sense of being left out of life.

1	2	3

17. Sometimes I feel trapped by the day's activities.

1	2	3

18. I think my best days are behind me and the future holds little promise of change.

1	2	3

19. I've recently had sexual difficulties or a loss of interest in sexual activities.

1	2	3

20. I lack a feeling of spiritual peace or well-being.

1	2	3

Congratulations on completing this questionnaire. Enter your contact information below. I will contact you within the next day to discuss your results and the possibility of scheduling an appointment.

Name:
Telephone:
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Randi Fredricks is a Psychotherapist and Licensed as a Marriage Family Therapist MFC 47803 and not licensed with the California Bureau of
Naturopathic Medicine. © 2012 Randi Fredricks, Marriage and Family Therapist, Inc. All rights reserved. Serving San Jose, Sunnyvale,
Santa Cruz, Palo Alto, Monte Sereno, Los Gatos, Cupertino, Mountain View, Scotts Valley, Campbell, Willow Glen, and Milpitas CA.