ARE YOU DEPRESSED?

Please check the appropriate answers to the questions listed below:

  1. Do you feel uneasy, restless or irritable?

Never
Rarely
Sometimes
Very Often
Most of the Time

  1. Do you feel inadequate, like a failure or that nobody likes you anymore?

Never
Rarely
Sometimes
Very Often
Most of the Time

  1. Do you feel guilty without a rational reason or do you often put yourself down?

Never
Rarely
Sometimes

  1. Do you feel that things will usually go wrong, no matter how hard you try?

Never
Rarely
Sometimes
Very Often
Most of the Time

  1. Do you have trouble sleeping or eating too much or too little?

Never
Rarely
Sometimes
Very Often
Most of the Time

  1. Do you feel sad, blue or unhappy?

Never
Rarely
Sometimes
Very Often
Most of the Time

  1. Do you feel that you are not enjoying the activities that you used to enjoy?

Never
Rarely
Sometimes
Very Often
Most of the Time

  1. In your marriage, do you feel that you have lost interest in sex, or that you are experiencing sexual difficulties?

Never
Rarely
Sometimes
Very Often
Most of the Time

FOR A COMPLIMENTARY INITIAL CONSULTATION,
CONTACT DIANE LLOYD, M.A., LPC at
(336) 882-5003

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Cynthia Becker Poetry
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