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* 1. What gender are you?

2. Has anyone in your family been diagonsed with a mental illness? If yes, plese explain.

3. On average how much sleep do you get every night?

4. Have you ever experienced diminished interest or pleasure in all or almost all activities?

5. Have you ever had recurrent and persistant thoughts, impulses or images that cause increased anxiety or distress?

6. Do you have difficulty initiating projects, or doing things on your own? If so, please explain.

7. Have you experienced feelings of worthlessness or excessive or inappropriate guilt? If so, please explain how frequent.

8. Do you engage in repetitive behaviors or mental acts which you feel driven to perform? If yes, please explain.

9. Are you able to express disagreement with others, without fear of loss of support or approval?

10. What is your ethnicity?