Depression Questionnaire

This easy to use patient questionnaire has been validated for use in Primary Care.

It is used by your doctor to monitor the severity of depression and response to treatment.

It can also be used to make a tentative diagnosis of depression.

Non-urgent advice: Please Note

By using this form you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your information.

Personal Information

Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.

Contact Details

Home Address


Over the last two weeks, how often have you been bothered by any of the following problems?

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


Regarding the questions above, if you checked off “Several days”, “More than half the days” or “Nearly every day”; how
have these problems effected your ability to do your work, take care of things at home, or get along with other people?

The problems I've checked off above…