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Depression Risk Assessment

 

 

This questionnaire gives a sense of the likelihood of having or developing depression.

Do you feel sad a lot of the time?
Yes
No
Has your mood felt low enough for an extended period of time that it is affecting your quality of life? Yes No
Does low mood affect your energy levels such that you have had difficulty participating in normal activities? Yes No
Do you experience unexpected or sudden crying spells? Yes No
Have you lost interest in key types of pastimes or hobbies that until recently were important in your life? Yes No
Has your mood affected your ability to concentrate, remember things, or make decisions? Yes No
Do you have a general feeling of fatigue or a sense of being slowed down in physical movement or ability to think and work? Yes No

Do you have trouble falling asleep and staying asleep?

 Yes No
Are you persistently irritable, restless, or anxious? Yes No
Has your mood caused you to decrease your social activities? Yes No

Has your mood significantly decreased your interest in sexual activity?

 Yes No
Has your appetite significantly increased or decreased? Yes No
Do you have vague physical symptoms that don’t seem to go away or that you can’t find a reason for? Yes No
Do you tend to think of yourself as not very important or valuable? Yes No

Do you feel an overwhelming sense of helplessness or hopelessness?

 Yes No

Have loved ones expressed concern about your moods?

 Yes No

Have you experienced significantly stressful live events recently, such as divorce, death of a loved one, or loss of a job?

 Yes No
Do have an immediate family member (parent, sibling, or child) who has suffered from major depression? Yes No

Have you previously been diagnosed with depression?

 Yes No


The more often you answered “Yes” to the above questions, the greater your risk for developing or already having depression.  If you answered “Yes” to questions above, consider discussing depression with one of our Women’s Center healthcare providers.

Print this page and bring it with you, filled out, to your appointment.

 

>> See also the Depression Risk Assessment in Aria's Health Information Library.

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