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Are you experiencing symptoms of depression?
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1
Over the past 2 weeks, how often have struggled with the following symptoms?
Not at all
Several Days
More than half the days
Nearly every day
1. Decreased interest or pleasure in doing things
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2. Feeling down, depressed, or hopeless
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3. Trouble sleeping, or sleeping too much
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4. Feeling tired or having little energy
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5. Poor appetite or overeating
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6. Feeling bad about yourself
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7. Trouble concentrating
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8. Moving or speaking more slowly than usual. Or more restless and fidgety
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Thoughts that you would be better off dead or of hurting yourself
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1. Decreased interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble sleeping, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself
7. Trouble concentrating
8. Moving or speaking more slowly than usual. Or more restless and fidgety
Thoughts that you would be better off dead or of hurting yourself
Not at all
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Several Days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly every day
Row 0, Column 3
Not at all
Row 1, Column 0
Several Days
Row 1, Column 1
More than half the days
Row 1, Column 2
Nearly every day
Row 1, Column 3
Not at all
Row 2, Column 0
Several Days
Row 2, Column 1
More than half the days
Row 2, Column 2
Nearly every day
Row 2, Column 3
Not at all
Row 3, Column 0
Several Days
Row 3, Column 1
More than half the days
Row 3, Column 2
Nearly every day
Row 3, Column 3
Not at all
Row 4, Column 0
Several Days
Row 4, Column 1
More than half the days
Row 4, Column 2
Nearly every day
Row 4, Column 3
Not at all
Row 5, Column 0
Several Days
Row 5, Column 1
More than half the days
Row 5, Column 2
Nearly every day
Row 5, Column 3
Not at all
Row 6, Column 0
Several Days
Row 6, Column 1
More than half the days
Row 6, Column 2
Nearly every day
Row 6, Column 3
Not at all
Row 7, Column 0
Several Days
Row 7, Column 1
More than half the days
Row 7, Column 2
Nearly every day
Row 7, Column 3
Not at all
Row 8, Column 0
Several Days
Row 8, Column 1
More than half the days
Row 8, Column 2
Nearly every day
Row 8, Column 3
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First Name
Last Name
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Phone Number
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5
Score
1-4 Minimal
5-9 Mild
10-14 Moderate
15-19 Moderately Severe
20-27 Severe
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