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Self-Assessment Quiz

Self-Assessment Quiz

Below is a self-report questionnaire that allows you to assess the severity level of your mood/depressive symptoms to identify possible signs and symptoms of depression or bipolar disorder. Please provide your details at the end of the questionnaire and you will receive your results via email.

Name

Over the last two weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things?

Not at all Several days More than half the days Nearly every day

Feeling down, depressed, or hopeless?

Not at all Several days More than half the days Nearly every day

Trouble falling or staying asleep, or sleeping too much?

Not at all Several days More than half the days Nearly every day

Feeling tired or having little energy?

Not at all Several days More than half the days Nearly every day

Poor appetite or overeating?

Not at all Several days More than half the days Nearly every day

Feeling bad about yourself - or that you are a failure or have let yourself or your family down?

Not at all Several days More than half the days Nearly every day

Trouble concentrating on things, such as reading the newspaper or watching television?

Not at all Several days More than half the days Nearly every day

Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual?

Not at all Several days More than half the days Nearly every day

Thoughts that you would be better off dead, or of hurting yourself in some way?

Not at all Several days More than half the days Nearly every day

Total

Total:

You Name *

Your Email *

Your Phone Number *

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Self-Assessment Quiz

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Mood Disorders Clinic
Level 1
Suite 11, 33 Racecourse Road
Hamilton, Brisbane, QLD 4007

PO Box 772
Hamilton Central QLD 4007

Email: info@moodclinic.com.au

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