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Center for Gynecology & Women’s Health at Frankford Hospitals

Depression Risk Assessment

Women can answer the following questions to get a sense of their
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.

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