Have you experienced some combination of the following emotional and physical symptoms for more than two weeks? Do these thoughts/feelings clearly interfere with your life?
Sadness throughout the day, nearly every day		Yes No
Loss of interest in or enjoyment of your favorite activities		Yes No
Feelings of emptiness or hopelessness		Yes No
Trouble concentrating or making decisions		Yes No
Feelings of worthlessness		Yes No
Irritability or restlessness		Yes No
Thoughts of death or suicide		Yes No
Fatigue or lack of energy		Yes No
Sleeping too much or too little		Yes No
Change in appetite or weight		Yes No