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Depression Monitoring Form

The following questionnaire is used to assess depressive symptoms by measuring them and monitoring their development. It may therefore prove useful in assessing the response to treatment for depression. To complete the questionnaire, the patient should answer each series of question by circling the statement that most closely applies to his/her situation. Then, the circled numbers are added to determine the patient's result.

1.
  1. I do not feel sad.
  2. I feel sad.
  3. I always feel sad and cannot pull through.
  4. I am so sad or discouraged that I cannot bear it.
 7.
  1. I am not disappointed in myself.
  2. I am disappointed in myself.
  3. I am disgusted by myself.
  4. I hate myself.
2.
  1. I do not feel discouraged when I think about my future.
  2. I feel discouraged when I think about my future.
  3. I feel like the future has nothing to offer.
  4. My future seems hopeless and nothing will change it.
 8.
  1. I feel I am no worse than others.
  2. I criticize myself for my weaknesses and faults.
  3. I constantly criticize myself for my faults.
  4. I am to blame for everything that goes wrong.
3.
  1. I do not feel I am a failure.
  2. I think I fail more often than most people.
  3. When I think about my past, all I can see are failures.
  4. I am a failure.
 9.
  1. I never think of suicide.
  2. I sometime think of committing suicide, but will probably never do it.
  3. I want to commit suicide.
  4. I would commit suicide if I had the chance.
4.
  1. I enjoy life as much as usual.
  2. I do not enjoy life as before.
  3. I do not enjoy life anymore.
  4. I get no enjoyment anymore, nothing satisfies me.
 10.
  1. I do not cry more often than usual.
  2. I cry more often than before.
  3. I cry all the time.
  4. I used to be able to cry, but I can no longer cry these days.
5.
  1. I do not feel guilty.
  2. I often feel guilty.
  3. I feel really guilty most of the time.
  4. I always feel guilty.
 11.
  1. I am no more irritated than usual.
  2. I am irritated more often than before.
  3. I feel annoyed or irritated most of the time.
  4. I used to get irritated for many things but I no longer do these days.
6.
  1. I do not feel like I am being punished.
  2. I sometimes feel like I am being punished.
  3. I feel I am being punished.
  4. I feel I deserve to be punished.
 12.
  1. I am interested in others.
  2. I am less interested in others than usual.
  3. I have lost a good part of my interest in others.
  4. I have lost all interest in others.
13.
  1. I can make decisions as I used to.
  2. I put decisions off to the next day more often than I used to.
  3. I find it very difficult to make a decision.
  4. I am incapable of making a decision.
 18.
  1. My appetite is the same as always.
  2. My appetite is not what it used to be.
  3. My appetite has significantly decreased.
  4. I have no appetite anymore.
14.
  1. I do not think that my appearance has changed for the worst.
  2. I fear I look older or less attractive.
  3. I think my appearance has irreversibly changed for the worst.
  4. I feel I am ugly.
 19.
  1. I do not think I have lost weight lately.
  2. I have lost at least 5 pounds.
  3. I have lost at least 10 pounds.
  4. I have lost at least 15 pounds.
15.
  1. I accomplish my work as well as before.
  2. I have to put in a lot of effort to initiate any work.
  3. I must push myself to accomplish anything.
  4. I can no longer work.
 20.
  1. I do not worry more than usual about my health.
  2. Certain health problems, such as pain, stomach upset or constipation, are worrying me.
  3. I feel very worried about my health problems and I find it difficult to think of other things.
  4. My health problems worry me so much that I can think of nothing else.
16.
  1. I sleep as well as I used to.
  2. I am not sleeping as well as I used to.
  3. I wake up one or two hours earlier than usual and I have difficulty going back to sleep.
  4. I wake several hours early and I fail to go back to sleep.
21.
  1. My interest in sex has not changed.
  2. I have lost some interest in sex.
  3. I have a lot less interest in sex.
  4. I have lost all interest in sex.
17.
  1. I am no more tired than usual.
  2. I get tired more easily than I used to.
  3. I get tired for no reason.
  4. I am too tired to do anything.
Adapted from Beck's Depression Inventory
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[UNIPRIX] © Copyright Vigilance Santé

The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.

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