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Mental Health Self Assessment

The following questions ask about your mental health. Answer the questions honestly to get the most accurate assessment.

Note: Error is possible in any assessment. Errors may indicate that no problem exists when one actual does or fail to identify a problem that does exist. For more accurate help in deciding if a problem needs attention, contact one of the services identified in these pages.



1. In the past year, have you had 2 weeks or more during which you felt sad, blue or depressed; or when you lost all interest or pleasure in things that you usually cared about or enjoyed?
Yes No

2. Have you had 2 years or more in your life when you felt depressed or sad most days, even if you felt okay sometimes?
Yes No

3. Have you felt depressed or sad much of the time in the past year?
Yes No

4. How much time during the past week did you feel depressed?
Less than one day
1-2 days
3-4 days
5-7 days


5. During the past 4 weeks, have you Accomplished less than you would like with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?
Yes No

6. During the past 4 weeks, You didn't do work or other activities as carefully as usual as a result of any emotional problems (such as feeling depressed or anxious)?
Yes No

7. How much time during the past 4 weeks, Have you felt calm and peaceful?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time
None of the time


8. How much time during the past 4 weeks, Did you have a lot of energy?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time
None of the time


9. How much time during the past 4 weeks, Have you felt downhearted or blue?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time
None of the time


10. How much time during the past 4 weeks, How much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
All of the time
Most of the time
A good bit of the time
Some of the time
A little of the time
None of the time


11. Do you see or hear things that others do not see or hear?
Yes No

12. How important is treatment for your mental health at this time?
Extremely Important
Very important
Moderately important
Slightly important
Not at all important


13. Sex?
Female Male

14. Age?
18 or younger Over 18


Sponsoring Agencies
BJC Health Care Mental Health Board MIMH UMC


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Last Updated: 04-Jan-2006

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