Nearly 20 million Americans experience depression, but many will never seek treatment. The Depression Self-Rating Test is a simple 16-question quiz that can help identify common symptoms of depression and their severity. Remember — depression is more than just feeling down –it is a real medical condition that can be effectively treated.
Please complete the following questionnaire and return it to your health care provider.
Name:___________________________________________Date of Birth: ___________ Today’s Date: __________
Instructions: Please CIRCLE the one response to each item that best describes you FOR THE PAST SEVEN DAYS.
I. Falling asleep:
0 I never take longer than 30 minutes to fall asleep.
1 I take at least 30 minutes to fall asleep, less than half the time.
2 I take at least 30 minutes to fall asleep, more than half the time.
3 I take more than 60 minutes to fall asleep, more than half the time.
II. Sleep during the night:
0 I do not wake up at night.
1 I have a restless, light sleep with a few brief awakenings each night.
2 I wake up at least once a night, but I go back to sleep easily.
3 I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.
III. Waking up too early:
0 Most of the time, I awaken no more than 30 minutes before I need to get up.
1 More than half the time, I awaken more than 30 minutes before I need to get up.
2 I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.
3 I awaken at least one hour before I need to, and can’t go back to sleep.
IV. Sleeping too much:
0 I sleep no longer than 7-8 hours/night, without napping during the day.
1 I sleep no longer than 10 hours in a 24-hour period including naps.
2 I sleep no longer than 12 hours in a 24-hour period including naps.
3 I sleep longer than 12 hours in a 24-hour period including naps.
V. Feeling sad:
0 I do not feel sad.
1 I feel sad less than half the time.
2 I feel sad more than half the time.
3 I feel sad nearly all of the time.
VI. Decreased appetite:
0 There is no change in my usual appetite.
1 I eat somewhat less often or lesser amounts of food than usual.
2 I eat much less than usual and only with personal effort.
3 I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat.
VII. Increased appetite:
0 There is no change from my usual appetite.
1 I feel a need to eat more frequently than usual.
2 I regularly eat more often and/or greater amounts of food than usual.
3 I feel driven to overeat both at mealtime and between meals.
VIII. Decreased weight (within the last two weeks)
0 I have not had a change in my weight.
1 I feel as if I’ve had a slight weight loss.
2 I have lost 2 pounds or more.
3 I have lost 5 pounds or more.
IX. Increased weight (within the last two weeks):
0 I have not had a change in my weight.
1 I feel as if I’ve had a slight weight gain.
2 I have gained 2 pounds or more.
3 I have gained 5 pounds or more.
0 There is no change in my usual capacity to concentrate or make decisions.
I I occasionally feel indecisive or find that my attention wanders.
2 Most of the time, I struggle to focus my attention or to make decisions.
3 I cannot concentrate well enough to read or cannot make even minor decisions.
XI. View of myself:
0 I see myself as equally worthwhile and deserving as other people.
1 I am more self-blaming than usual.
2 I largely believe that I cause problems for others.
3 I think almost constantly about major and minor defects in myself.
XII. Thoughts of death or suicide:
0 I do not think of suicide or death.
1 I feel that life is empty or wonder if it’s worth living.
2 I think of suicide or death several times a week for several minutes.
3 I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my life.
XIII. General interest:
0 There is no change from usual in how interested I am in other people or activities.
1 I notice that I am less interested in people or activities
2 I find I have interest in only one or two of my formerly pursued activities.
3 I have virtually no interest in formerly pursued activities.
XIV. Energy level:
0 There is no change in my usual level of energy.
1 I get tired more easily than usual.
2 I have to make a big effort to start or finish my usual daily activities (for example: shopping, homework, cooking, or going to work).
3 I really cannot carry out most of my usual daily activities because I just don’t have the energy.
XV. Feeling slowed down:
0 I think, speak, and move at my usual rate of speed.
1 I find that my thinking is slowed down or my voice sounds dull or flat.
2 It takes me several seconds to respond to most questions, and I’m sure my thinking is slowed.
3 I am often unable to respond to questions without extreme effort.
XVI. Feeling restless:
0 I do not feel restless.
1 I’m often fidgety, wringing my hands, or need to shift how 1 am sitting.
2 I have impulses to move about and am quite restless.
3 At times, I am unable to stay seated and need to pace around.
THIS SECTION IS TO BE REVIEWED BY YOUR HEALTH CARE PROVIDER
Enter the highest score on any 1 of the 4 sleep items (1-4) __________
Item 5 __________
Enter the highest score on any 1 appetite/weight item (6-9) __________
Item 10 __________
Item II __________
Item 12 __________
Item 13 __________
Item 14 __________
Enter the highest score on either of the 2 psychomotor items (15 and 16) __________
TOTAL SCORE (Range 0-27) __________
Scoring Criteria: Normal 0-5 Mild 6-10 Moderate 11-15 Severe 16-20 Very Severe 21+
Copyright 2000A.John Rush, MD. Quick Inventory of Depressive Symptomatology (Self-Report) (QIDS-SR).
Reference: National Institute of Mental Health website. Depression Research at the National Institute of Mental Health Fact Sheet.
Available at: http://www.nimh.nih.gov/publicatldepresfact.cfm.