Please consider your situation in the previous week and read and answer the questions carefully.  Note that the slider gives you a range of options.  For some questions the answer options display scores in reverse order.

Please remember to enter your ID and Zip or Postal Code at the end of this survey. 

Thank you!
Thank you for your ongoing participation.

Question Title

1. I feel down-hearted and blue.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

2. Morning is when I feel best.  (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

3. I have crying spells or feel like it.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

4. I have trouble sleeping at night.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

5. I eat as much as I used to.  (Required.)

MOST of the Time NONE of the Time
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

6. I still enjoy sex. (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

7. I notice that I am loosing weight.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

8. I have trouble with constipation.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

9. My heart beats faster than usual. (Required.)

None of the Time Most of the Time
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

10. I get tired for no reason.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

11. My mind is as clear as it used to be. (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

12. I find it easy to do things that I used to do. (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

13. I am restless and can't keep still. (Required.)

None of the Time Most of the Time
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

14. I feel hopeful about the future. (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

15. I am more irritable than usual.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

16. I find it easy to make decisions. (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

17. I feel that I am useful and needed.  (Required.)

MOST of the Time NONE of the Time
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

18. My life is pretty full. (Required.)

MOST of the time NONE of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

19. I feel that others would be better off if I were dead.  (Required.)

None of the time Most of the time.
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

20. I still enjoy things that I used to do.  (Required.)

MOST of the Time NONE of the Time
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

21. Your ID and postal code.  (Required.)

Question Title

22. Please enter today's date. (Required.)

Date
Thank you for your time and participation! 

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