Depression Screening

1. Are you basically satisfied with life?

   Yes No
   

2. Have you dropped many of your activities and interests?

   Yes No
   

3. Do you feel that your life is empty?

   Yes No
   

4. Do you often get bored?

   Yes No
   

5. Are you in good spirits most of the time?

   Yes No
   

6. Are you afraid that something bad is going to happen to you?

   Yes No
   

7. Do you feel happy most of the time?

   Yes No
   

8. Do you often feel helpless?

   Yes No
   

9. Do you prefer to stay at home, rather than going out and doing new things?

   Yes No
   

10. Do you feel you have more problems with memory than most?

    Yes No
    

11. Do you think it is wonderful to be alive now?

    Yes No
    

12. Do you feel pretty worthless the way you are now?

    Yes No
    

13. Do you feel full of energy?

    Yes No
    

14. Do you feel that you situation is hopeless?

    Yes No
    

15. Do you think that most people are better off than you are?

    Yes No
    

If you would like to be contacted following the presentation/screening please complete the information below:

After hitting the Submit Form button, Add up your results. Although differing sensitivities and specificities have been obtained across studies, for clinical purposes a score less then 5 points is suggestive of depression and should warrant a follow-up interview. Scores grater then 10 are almost always depression.

Central Planes Area Agency on Aging.
Copyright � 1999 [Dept. on Aging]. All rights reserved.
Revised: December 15, 2005