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Depression Screening

DASS-21
PATIENT HEALTH QUESTIONNAIRE (PHQ-9)
Generalized Anxiety Disorder 7-item (GAD-7) scale

DASS-21

NAME--AUTOFILL

The DASS 21 is a 21 item self-report questionnaire designed to measure the severity of a range of symptoms common to depression, anxiety and stress. While completing the DASS, you are required to indicate the presence of a symptom over the previous week.
Please read each statement and click the circle next to how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

I found it hard to wind down

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I was aware of dryness of my mouth

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I couldn't seem to experience any positive feeling at all

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I found it difficult to work up the initiative to do things

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I tended to over-react to situations

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I experienced trembling (e.g. in the hands)

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt that I was using a lot of nervous energy

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I was worried about situations in which I might panic and make a fool of myself

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt that I had nothing to look forward to

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I found myself getting agitated

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I found it difficult to relax

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt down-hearted and blue

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I was intolerant of anything that kept me from getting on with what I was doing

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt I was close to panic

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I was unable to become enthusiastic about anything

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt I wasn't worth much as a person

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt that I was rather touchy

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat)

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

I felt scared without any good reason I felt that life was meaningless

0::Did not apply to me at all - NEVER 1::Applied to me to some degree, or some of the time - SOMETIMES 2::Applied to me to a considerable degree or a good part of time - OFTEN 3::Applied to me very much or most of the time - ALMOST ALWAYS

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)

PATIENT HEALTH QUESTIONNAIRE (PHQ-9) - Over the last 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Feeling down, depressed, or hopeless

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Trouble falling or staying asleep, or sleeping too much

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Feeling tired or having little energy

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Poor appetite or overeating

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Feeling bad about yourself - or that you are a failure or have let yourself or your family down

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Trouble concentrating on things, such as reading the newspaper or watching television

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

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

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

Thoughts that you would be beter off dead of or hurting yourself in some way

0::Not at all 1::Several days 2::More than half the days 3::Nearly every day

If you checked off any problems on this questionnaire, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Thoughts that you would be beter off dead of or hurting yourself in some way

Not difficult at all Somewhat difficult Very difficult Extremely difficult

Generalized Anxiety Disorder 7-item (GAD-7) scale

Generalized Anxiety Disorder 7-item (GAD-7) scale - Over the last 2 weeks, how often have you been bothered by the following problems?

Feeling nervous, anxious, or on edge

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

Not being able to stop or control worrying

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

Worrying too much about different things

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

Trouble relaxing

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

Being so restless that it's hard to sit still

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

Becoming easily annoyed or irritable

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

Feeling afraid as if something awful might happen

0::Not at all sure 1::Several days 2::Over half the days 3::Nearly every day

If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?

Not difficult at all Somewhat difficult Very difficult Extremely difficult

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