• Wellbeing Questionnaire

  • Date Completed*
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  • Below are a number of questions about how you have been feeling and how any difficulties may be affecting your day-to-day life.

    The questionnaire includes questions about symptoms of low mood, anxiety, and the impact these difficulties may be having on areas such as work, home life, social activities, and relationships.

    Please read each question carefully and select the option that best describes your experience over the past two weeks.

    There are no right or wrong answers. Your responses will help provide a clearer understanding of your current wellbeing and may help guide our work together.

    Please answer all questions as honestly and accurately as possible.

  • PHQ-9 Depression Questionnaire

  • Little interest or pleasure in doing things*
  • Feeling down, depressed, or hopeless*
  • Trouble falling or staying asleep, or sleeping too much*
  • Feeling tired or having little energy*
  • Poor appetite or overeating*
  • Feeling bad about yourself — or that you are a failure or have let yourself or your family down*
  • Trouble concentrating on things, such as reading the newspaper or watching television*
  • Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual*
  • Thoughts that you would be better off dead, or of hurting yourself in some way*

  • GAD-7 Anxiety Questionnaire

  • Feeling nervous, anxious, or on edge*
  • Not being able to stop or control worrying*
  • Worrying too much about different things*
  • Trouble relaxing*
  • Being so restless that it is hard to sit still*
  • Becoming easily annoyed or irritable*
  • Feeling afraid as if something awful might happen*

  • Work and Social Adjustment Scale

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  • Consent and Results

  • Please treat your scores on these or any other online questionnaires with caution. Questionnaires cannot be used to make a diagnosis of a mental health condition. Where a mental health condition has been diagnosed by a suitably qualified and experienced health professional, these questionnaires may be used as a guide to the current severity of your condition and to monitor change over time.

    The PHQ-9 has a score range of 0–27 and is used to monitor symptoms of depression. The GAD-7 has a score range of 0–21 and is used to monitor symptoms of anxiety. The WSAS has a score range of 0–40 and is used to understand how much difficulties are affecting work, home management, social leisure, private leisure, and close relationships.

    References: Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A measure for assessing generalised anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. H. (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. British Journal of Psychiatry, 180(5), 461–464.

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