Self-Rating Survey

Let's Start the survey!!!


Q1. I feel sad, down in the dumps or unhappy
Not at all
Rarely
Sometimes
Often
Most of the time

Q2. I can't concentrate or focus
Not at all
Rarely
Sometimes
Often
Most of the time

Q3. Nothing seems to give me much pleasure
Not at all
Rarely
Sometimes
Often
Most of the time

Q4. I feel tired; have no energy
Not at all
Rarely
Sometimes
Often
Most of the time

Q5. I have had thoughts of suicide
Not at all
Rarely
Sometimes
Often
Most of the time

Q6. Changes in sleeping patterns
Not at all
Rarely
Sometimes
Often
Most of the time

Q7. Change in appetite
Not at all
Rarely
Sometimes
Often
Most of the time

Q8. I feel tense, anxious or can't sit still
Not at all
Rarely
Sometimes
Often
Most of the time

Q9. I feel worried or fearful
Not at all
Rarely
Sometimes
Often
Most of the time

Q10. I have attacks of anxiety or panic
Not at all
Rarely
Sometimes
Often
Most of the time

Q11. I worry about dying or losing control
Not at all
Rarely
Sometimes
Often
Most of the time

Q12. I am nervous or shaky in social situations
Not at all
Rarely
Sometimes
Often
Most of the time

Q13. I have nightmares or flashbacks
Not at all
Rarely
Sometimes
Often
Most of the time

Q14. I am jumpy or feel startled easily
Not at all
Rarely
Sometimes
Often
Most of the time

Q15. I avoid places that strongly remind me of a bad experience
Not at all
Rarely
Sometimes
Often
Most of the time

Q16. I feel dull, numb, or detached
Not at all
Rarely
Sometimes
Often
Most of the time

Q17. I can't get certain thoughts out of my mind
Not at all
Rarely
Sometimes
Often
Most of the time

Q18. I feel I must repeat certain acts or rituals
Not at all
Rarely
Sometimes
Often
Most of the time

Q19. I feel the need to check and recheck things
Not at all
Rarely
Sometimes
Often
Most of the time

Q20. Had more energy than usual
Not at all
Rarely
Sometimes
Often
Most of the time

Q21. Felt unusually irritable or angry
Not at all
Rarely
Sometimes
Often
Most of the time

Q22. Felt unusually excited, revved up or high
Not at all
Rarely
Sometimes
Often
Most of the time

Q23. Needed less sleep than usual
Not at all
Rarely
Sometimes
Often
Most of the time

Q24. Interferes with work or school
Not at all
Rarely
Sometimes
Often
Most of the time

Q25. Affects my relationships with friends or family
Not at all
Rarely
Sometimes
Often
Most of the time

Q26. Has led to my using alcohol to get by
Not at all
Rarely
Sometimes
Often
Most of the time

Q27. Has led to my using drugs
Not at all
Rarely
Sometimes
Often
Most of the time