Self-Assessment Questionnaire for Depression Symptoms
Please answer the following questions honestly to assess your current mental health status.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Have you had little interest or pleasure in doing things you usually enjoy?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you been feeling down, sad, or hopeless?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you had trouble falling asleep, staying asleep or sleeping too much?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you felt tired or had little energy, even after resting?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you had poor appetite or been eating too much?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you felt bad about yourself - like you're a failure or you've let yourself or your family down?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you had trouble focusing on things like reading, watching TV, or having conversations?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you been moving or speaking so slowly that others have noticed? Or the opposite -- feeling restless and unable to sit still?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Have you had thoughts that you'd be better off dead or hurting yourself in some way?
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
Thank you for completing this self-assessment. Your mental health matters.
If you answered "More than half the days" or "Nearly very day" to several questions, or have thoughts of self-harm, consider speaking with our mental health professionals.
Contact Us
If you would like to get in touch with us for further assistance or questions, please contact our Happy Place HQ office. Email: happyplacehq@proton.me || Phone: 909-798-1841
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