This is a questionnaire about symptoms often associated with stress. Please put a check mark in the box that best answers the question:

Over the past 2 weeks, how often have you:None or little of the timeSome of the time Most of the timeAll of the time
Been feeling low in energy, slowed down?    
Been blaming yourself for things?    
Had poor appetite?    
Had difficulty falling asleep, staying asleep?    
Been feeling hopeless about the future?    
Been feeling blue?    
Been feeling no interest in things?    
Had feelings of worthlessness?    
Thought about or wanted to commit suicide?    
Had difficulty concentrating or making decisions?    


 YesNo
Have you ever had at least a 4-day period of sustained, excessively elevated mood, with rapid thinking, many new ideas, heightened interest in sex, or loss of sleep?  
Have you ever had at least a 4-day period of sustained, excessively irritable mood, with anger, arguments, or breaking things, that led to difficulties with others?  
Has any close blood relative ever had depression, manic-depression, alcohol abuse, or been psychiatrically hospitalized?