Please check the one response to each item that best describes how you have felt for the past seven days.

Falling Asleep:
1. I never take longer than 30 minutes to fall asleep
2. I take at least 30 minutes to fall asleep, less than half the time
3. I take at least 30 minutes to fall asleep, more than half the time
4. I take at least 60 minutes to fall asleep, more than half the time

Sleep During the Night:
1. I do not wake up at night
2. I have a restless, light sleep with a few brief awakenings each night
3. I wake up at least once a night, but I go back to sleep easily
4. I awaken more than once a night and stay awake for 20 minutes or more, more than half the time

Waking Up Too Early:
1. Most of the time, I awaken no more than 30 minutes before I need to get up
2. More than half the time, I awaken more than 30 minutes before I need to get up
3. I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually
4. I awaken at least one hour before I need to, and can't go back to sleep

Sleeping Too Much:
1. I sleep no longer than 7-8 hours/night, without napping during the day
2. I sleep no longer than 10 hours in a 24 hour period including naps
3. I sleep no longer than 12 hours in a 24-hour period including naps
4. I sleep longer than 12 hours in a 24-hour period including naps

Feeling Sad:
1. I do not feel sad
2. I feel sad less than half the time
3. I feel sad more than half the time
4. I feel sad nearly all the time

Decreased Appetite:
1. My usual appetite has not decreased
2. I eat somewhat less often or lesser amounts of food than usual
3. I eat much less than usual and only with personal effort
4. I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat

Increased Appetite:
1. My usual appetite has not increased
2. I feel a need to eat more frequently than usual
3. I regularly eat more often and/or greater amounts of food than usual
4. I feel driven to overeat both at mealtime and between meals

Decreased Weight (Within the Last Two Weeks):
1. My weight has not decreased
2. I feel as if I've had a slight weight loss
3. I have lost 2 pounds or more
4. I have lost 5 pounds or more

Increased Weight (Within the Last Two Weeks):
1. My weight has not increased
2. I feel as if I've had a slight weight gain
3. I have gained 2 pounds or more
4. I have gained 5 pounds or more

Concentration/Decision Making:
1. There is no change in my usual capacity to concentrate or make decisions
2. I occasionally feel indecisive or find that my attention wanders
3. Most of the time, I struggle to focus my attention or to make decisions
4. I cannot concentrate well enough to read or cannot make even minor decisions

View of Myself:
1. I see myself as equally worthwhile and deserving as other people
2. I am more self-blaming than usual
3. I largely believe that I cause problems for others
4. I think almost constantly about major and minor defects in myself

Thoughts of Death or Suicide:
1. I do not think of suicide or death
2. I feel that life is empty or wonder if it's worth living
3. I think of suicide or death several times a week for several minutes
4. I think or suicide or death several times a day in some detail, or have actually tried to take my life

General Interest:
1. There is no change from usual in how interested I am in other people or activities
2. I notice that I am less interested in people or activities
3. I find I have interest in only one or two of my formerly pursued activities
4. I have virtually no interest in formerly pursued activities

Energy Level:
1. There is no change in my usual level of energy
2. I get tired more easily than usual
3. I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking or going to work)
4. I really cannot carry out most of my usual daily activities because I just don't have the energy

Feeling slowed down:
1. I think, speak, and move at my usual rate of speed
2. I find that my thinking is slowed down or my voice sounds dull or flat
3. It takes me several seconds to respond to most questions and I'm sure my thinking is slowed
4. I am often unable to respond to questions without extreme effort

Feeling Restless:
1. I do not feel restless
2. I'm often fidgety, wringing my hands, or need to shift how I am sitting
3. I have impulses to move about and am quite restless
4. At times, I am unable to stay seated and need to pace around.

Scoring Guide:
If you scored 10 or more questions with 1, your answers do not indicate depression.
If you scored 10 or more questions with 2 or higher, your answers indicate a mild possibility of depression.
If you scored 10 or more questions with 3 or higher, your answers indicate the possibility of depression.
If you scored 10 or more questions with 4 or higher, your answers indicate a high possibility of depression.

The DeKalb CSB's Central Access is available 24 hours per day, 7 days per week for crisis calls, assessments, appointment scheduling and referrals. To access the Central Access Line Call (404) 892-4646.