Depression Self-Rating Test

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.

 

X.  Concentration/Decision-making:

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

To Score:

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.

 

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