Instructions: Please make a check next to the boxes that apply
1.
Sleep changes (Sleeping more or less than usual; Early morning waking; Difficulty falling asleep; Difficulty staying asleep)?
2.
Changes in appetite (Eating more or less than usual)?
3.
Feeling sadder than normal or lower mood?
4.
Feeling more irritable than normal?
5.
Feeling more tired than usual?
6.
Feeling more restless than usual?
7.
Feel less interested or find less pleasure in the things you normally enjoy?
8.
Crying more?
9.
Having more aches and pains than usual?
10.
Wanting to spend less time than normal with friends and family?
11.
Have you been thinking about suicide or been having thoughts about
death?
12.
Feeling guilty about things you are not responsible for?
13.
Are you having difficulty concentrating?
*If you are experiencing 3 or more of these symptoms, you may be depressed. It is recommended that you contact a mental health professional to discuss your concerns.
* American Psychiatric Association (2000). Diagnostic and Statistical Manual Mental Disorders IV (Text Revision). APA Press: Washington D.C.
**Disclaimer: This tool is not a substitute for psychological testing, a form of psycho-therapy or mental health treatment.
If you are depressed and would like help or more information,
please contact Susan Simon-Fleischer, MSW, LCSW (973) 535-3626
