Quick mild depression/anxiety and life impact screen

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Over the last two weeks, how often have you been bothered by:

Not at all
Several days
More than half the days
Nearly every day
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself – or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly so that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead or of hurting yourself in some way

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult

if your responses are several days or above, it sounds as though you may be having a difficult time at the moment. We recommend that a face to face consultation with a health professional may be a better option for you, and your GP is likely to be the best first treatment option. [for Australia only]

Further information about face to face health services in your area can be obtained from Lifeline’s Just Ask information line on 1300 13 11 14. Lifeline can be reached on 13 11 14, if you are troubled by thoughts that you might hurt yourself. If there is a supportive family member or friend you can talk to, this is likely to be a helpful.

Over the last two weeks, how often have you been bothered by:

Not at all
Several days
More than half the days
Nearly every day
Feeling nervous, anxious or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it is hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen

 

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Indicate the number that best describes your current situation.

1. Work

Because of my problems, my ABILITY TO WORK is impaired.

0
1
2
3
4
5
6
7
8
not at all slightly definitely markedly very severely
2. Home Management

Because of my problems, my HOME MANAGEMENT (cleaning, tidying, shopping, cooking, looking after home or children, paying bills) is impaired.

0
1
2
3
4
5
6
7
8
not at all slightly definitely markedly very severely
3. Social Leisure Activities

Because of my problems, my SOCIAL LEISURE ACTIVITIES (with other people, e.g. parties, pubs, clubs, outings, visits, dating, home entertainment) are impaired.

0
1
2
3
4
5
6
7
8
not at all slightly definitely markedly very severely
4. Private Leisure Activities

Because of my problems, my PRIVATE LEISURE ACTIVITIES (done alone, eg, reading, gardening, collecting, sewing, walking alone) are impaired.

0
1
2
3
4
5
6
7
8
not at all slightly definitely markedly very severely
5. Relationships

Because of my problems, my ability to FORM AND MAINTAIN CLOSE RELATIONSHIPS with others, including those I live with, is impaired.

0
1
2
3
4
5
6
7
8
not at all slightly definitely markedly very severely
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