Burns Depression Checklist

This questionnaire is not meant to diagnose but rather to help you understand whether a certain mental health or relationship issue may concern you. If you want to print this out for your healthcare provider, you may use the 'Print/Save to PDF' button at the end of the page.
Burns Depression Checklist

The following is a list of symptoms that people sometimes have. Put a check in the space to the right that best describes how much that symptom or problem has bothered you during the past week. Note: For best results, rotate your phone to view the questionnaire in landscape mode.

Category I: Thoughts and Feelings

Rows	Not at All	Sometimes	Moderately	A Lot	Extremely
1. Feeling sad or down in the dumps
2. Feeling unhappy or blue
3. Crying spells or tearfulness
4. Feeling discouraged
5. Feeling hopeless
6. Low self-esteem
7. Feeling worthless or inadequate
8. Guilt or shame
9. Criticizing yourself or blaming others
10. Difficulty making decisions

Category II: Activities and Personal Relationships

Rows	Not at All	Sometimes	Moderately	A Lot	Extremely
11. Loss of interest in family, friends, or colleagues
12. Loneliness
13. Spending less time with family or friends
14. Loss of motivation
15. Loss of interest in work or other activities
16. Avoiding work or other activities
17. Loss of pleasure or satisfaction in life

Category III: Physical Symptoms

Rows	Not at All	Sometimes	Moderately	A Lot	Extremely
18. Feeling tired
19. Difficulty sleeping or sleeping too much
20. Decreased or increased appetite
21. Loss of interest in sex
22. Worrying about your health

Category IV: Suicidal Urges

Rows	Not at All	Somewhat	Moderately	A Lot	Extremely
23. Do you have any suicidal thoughts?
24. Would you like to end your life?
25. Do you have a plan for harming yourself?