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Online Depression Assessment
A standardised test for symptoms of depression
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On a scale of 1-10 how much hope do you have for the future?
1 - Hopeless
2
3
4
5
6
7
8
9
10 - Hopeful
On a scale of 1-10 how highly do you think of yourself?
1 - Low opinion of self
2
3
4
5
6
7
8
9
10 - High opinion of self
When was the last time you felt happy?
a day
a week
a month
3 months
6 months
a year
longer than a year
I do not remember
Do you feel positive emotions - such as joy, love, pride or gratitude?
Never
Occasionally (1-2 times per month)
Sometimes (3-6 times per month)
Often (6 or more times per month)
Very often (more than once per day)
Do you think you have depression?
Yes
No
Maybe
Have you lost or gained significant weight since the start of your symptoms?
Yes
No
If you gained weight, approximately how much have you gained?
If you lost weight, approximately how much have you lost?
Have you hurt yourself on purpose since your symptoms started?
Yes
No
If you answered yes to hurting yourself how badly did you hurt yourself?
I needed to go to hospital
I did not need to go to hospital but I needed medical treatment
I did not need medical treatment but am left with permanent scarring
I did not need medical treatment and have no permanent scarring
Has your sleep pattern changed since your symptoms began?
Yes
No
Not sure
How many hours sleep do you get a night currently?
1
2
3
4
5
6
7
8
9
10
11+
How many hours sleep did you get before your symptoms started?
1
2
3
4
5
6
7
8
9
10
11+
Has any life event lead to you feeling as you currently do? For example have you lost a loved one, your job or had a relationship end?
Yes
No
Not sure
Do you feel guilty for no good objective reason?
Yes
No
Sometimes
Do you struggle to concentrate for longer than 15-20 minutes?
Yes
No
Sometimes
I cannot concentrate even that long
Do you have thoughts of death - either your own, those of loved ones or do you think of large scale disasters?
Yes
No
Sometimes
Have you thought about commiting suicide?
Never
Occasionally (1-2 times per month)
Sometimes (3-6 times per month)
Often (6 or more times per month)
Constantly (nearly every day)
Do you feel like a burden?
Yes
No
Sometimes
How long have you had these symptoms?
Less than a month
More than 1 month but less than 3 months
More than 3 months but less than 6 months
Longer than 6 months but less than 2 years
Longer than 2 years
Does low mood interfere with your ability to do normal tasks such as shopping?
Never
Occasionally (1-2 times per month)
Sometimes (3-6 times per month)
Often (6 or more times per month)
Always
Does low mood interfere with your ability to socialise?
Never
Occasionally (1-2 times per month)
Sometimes (3-6 times per month)
Often (6 or more times per month)
Always
Does low mood interfere with your ability to go to work?
Never
Occasionally (1-2 times per month)
Sometimes (3-6 times per month)
Often (6 or more times per month)
Always
If you have an existing physical health related diagnosis please let us know what it is below
If you have an existing mental health related diagnosis please let us know what it is below
Have you had therapy before? Please pick all that apply
CBT
Counselling
NLP (Neurolinguistic Programming)
DBT (Dialectic Behaviour Therapy)
Online CBT - Moodgym
Pyschodynamic
Psychiatric (In patient or out patient)
Person Centred Counselling
Psychotherapy
Cognitive Analytic Therapy
Family Therapy
Mindfulness
Specialist counselling
Psychoanalytic Therapy
Are you currently on any medication? If so please tell us what it is
Is there anything else you would like us to know? Please tell us your experience as best you can
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