Epidemiologic Scale
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Name
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First Name
Last Name
Past week feedback
Below is a list of ways you might have felt or behaved. Please tell me how often you have felt this way during the past week.
During the past week
Rarely or none of the time (less than 1 day)
Some or a little of the time (1-2 days)
Occasionally or a moderate amount of time (3-4 days)
Most of the time (5-7 days)
1. I was bothered by things that usually don't bother me.
2. I did not feel like eating; my appetite was poor.
3. I felt that I could not shake off the blues even with help from family or friends.
4. I felt I was just as good as other people.
5. I had trouble keeping my mind on what I was doing.
6. I feel depressed.
7. I felt everything I did was an effort.
8. I felt hopeful about my future.
9. I thought my life had been a failure.
10. I felt fearful.
11. My sleep was restless.
12. I was happy.
13. I talked less than usual.
14. I felt lonely.
15. People were unfriendly.
16. I enjoyed life.
17. I had crying spells.
18. I felt sad.
19. I felt that people disliked me.
20. I could not get going.
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