Depression Questionnaire Printable

What is a Depression Questionnaire? A depression questionnaire is a set of depression screening questions asked to gather information that will give you insights into a person mental health and well being. Good mental health and well being improve the quality of life. The anxiety and depression checklist aims to measure how you may have been affected by depression and anxiety symptoms in the past four weeks. Visit the Coronavirus Mental Wellbeing Support Service. After taking the test, you can print the results for your records or to give to your GP.

At times everybody gets down in the dumps, but if life is consistently getting you down and your lows are making it hard to function, you may be depressed. Find out whether your slump is critical with this depression test.

This assessment is designed to determine whether you presently have, or are at risk for developing a depressive disorder, along with assessing whether your mindset makes you more prone to depression. Examine the following statements and indicate how well it describes you or how often you feel that way.

Screening Tools

Despite the high prevalence of mental health and substance use problems, too many Americans go without treatment — in part because their disorders go undiagnosed. Regular screenings in primary care and other healthcare settings enables earlier identification of mental health and substance use disorders, which translates into earlier care. Screenings should be provided to people of all ages, even the young and the elderly.

Resources

DSM - 5 Online Assessment Measures
For further clinical evaluation and research, the APA is offering a number of “emerging measures” in Section III of DSM-5. Guncraft holster. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress, thus serving to advance the use of initial symptomatic status and patient reported outcome (PRO) information, as well as the use of “anchored” severity assessment instruments.

The Healthy Living Questionnaire
Please note that the first 8 questions are taken from the SF-8 Health Outcomes Questionnaire, and require a license to be administered.

The Kessler 6& Kessler 10are mental health screening tools used with a general adult population.

Patient Stress Questionnaire is a tool used in primary care settings to screen for behavioral health symptoms. It was adapted from thePHQ-9, GAD-7, PC-PTSD, and AUDIT.

The Patient Satisfaction Survey, based upon the review of integration literature and input from demonstration site representatives, is a general satisfaction survey developed to improve consumer satisfaction with services and the model, as well as comfort levels with treatment and treatment setting.Sample satisfaction surveys from the Midwest Clinicians Network can be found below:

• Patient Satisfaction Survey - English & Spanish Translation

The M3 Checklist provides an individualized patient assessment geared toward early detection, co-morbid illness, and identifying people in distress irrespective of their particular diagnosis. It consists of 27 questions and the evidence-based web and mobile screening assessmentcan be completed in just three to five minutes. Once the assessment is completed, M3 Clinician algorithmically computes and assigns a numeric value, the M3 total score, which can be viewed in real time and used to provide clinical support at the point of care. The questionnaire is meant to be completed by a patient to help facilitate communication with a care team in a medical home environment. It is not a diagnostic instrument and is to be used solely within the context of medical treatment with a physician/nurse practitioner or other health care provider.

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SAMPLE SCREENING FORMS

The sample forms linked below have been provided by SAMHSA PBHCI Grantees and other integrated care facilities. These descriptions are provided as samples, and do not represent endorsement by CIHS.

• The Providence Center Medical Screening Form
  
• The Providence Center Mental Health Screening Form
  

DEPRESSION

• Patient Health Questionnaire (PHQ-9)is the most common screening tool to identify depression. It is available in Spanish, as well as in a modified version for adolescents.
• The MacArthur Foundation Initiative on Depression and Primary Care has created a Depression Tool kit is intended to help primary care clinicians recognize and manage depression.
• The Medicare Learning Network “Screening for Depression” Booklet is now available in hard copy format. This booklet is designed to provide education on screening for depression. It includes coverage, coding, billing, and payment information. To access a new or revised product available for order in hard copy format, go to MLN Products and click on “MLN Product Ordering Page” under “Related Links” at the bottom of the web page.

DRUG AND ALCOHOL USE

• “Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide” is designed to help health care professionals quickly identify youth at risk for alcohol-related problems. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) developed the guide in collaboration with the American Academy of Pediatrics, a team of underage drinking researchers and clinical specialists, and practicing health care professionals.
• Diagnosis and treatment of alcohol-related problems are time-intensive procedures that often are difficult to implement in busy clinical settings. The National Institute on Alcohol Abuse and Alcoholism's computer-based tools are one approach that may enhance the availability and cost-effectiveness of assessment and intervention and also may offer other advantages over face-to-face interventions.
• Substance Use Screening and Assessment Database
  This resource created by the Alcohol and Drug Abuse Institute Library at the University of Washington is intended to help clinicians and researchers find instruments used for screening and assessment of substance use and substance use disorders. Instruments whose validity and reliability have been well-studied are marked with a star.
• SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders for use in community settings. The SAMHSA SBIRT page also includes curricula, online resources, and publications designed to help implement SBIRT initiatives.
• AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire that screens for hazardous or harmful alcohol consumption. Developed by the World Health Organization (WHO), the test correctly classifies 95% of people into either alcoholics or non-alcoholics. The AUDIT is particularly suitable for use in primary care settings and has been used with a variety of populations and cultural groups. It should be administered by a health professional or paraprofessional.
• NIDAMED is a comprehensive Physicians' Outreach Initiative that gives medical professionals tools and resources to screen their patients for tobacco, alcohol, illicit drug, and nonmedical prescription drug use. Developed by the National Institute on Drug Abuse, NIDAMED resources include an online screening tool, a companion quick reference guide, and a comprehensive resource guide for clinicians.
• CAGE AID is a commonly used, 5- question tool used to screen for drug and alcohol use.The CAGE Assessment is a quick questionnaire to help determine if an alcohol assessment is needed. If a person answers yes to two or more questions, a complete assessment is advised.
• AUDIT-C is a simple 3-question screen for hazardous or harmful drinking that can stand alone or be incorporated into general health history questionnaires.
• DAST-10 (Drug Abuse Screen Test) is a 10-item, yes/no self-report instrument that has been condensed from the 28-item DAST and should take less than 8 minutes to complete. The DAST-10 was designed to provide a brief instrument for clinical screening and treatment evaluation and can be used with adults and older youth.

BIPOLAR DISORDER

• STABLE Resource Toolkit provides quality improvement resources to help clinicians identify and manage bipolar disorder.
• The Mood Disorder Questionnaire (MDQ) includes 13 questions associated with bipolar disorder symptoms.

SUICIDE RISK

• The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment. It is available in 114 country-specific languages. Mental health training is not required to administer the C-SSRS. Various professionals can administer this scale, including physicians, nurses, psychologists, social workers, peer counselors, coordinators, research assistants, high school students, teachers and clergy. Learn more about the C-SSRS and how it can be used.
• SAFE-T(Suicide Assessment Five-Step Evaluation and Triage) was developed in collaboration with the Suicide Prevention Resource Center and Screening for Mental Health.

Anxiety Disorders

• GAD-7 (Generalized Anxiety Disorder) is a 7-question screening tool that identifies whether a complete assessment for anxiety is indicated.
• PC–PTSD is a four-item screen designed for use in primary care and other medical settings to screen for post-traumatic stress disorder. It is currently used by the VA.

TRAUMA

• Life Event Checklist (LEC)
  A brief, 17-item, self-report measure designed to screen for potentially traumatic events in a respondent's lifetime. The LEC assesses exposure to 16 events known to potentially result in PTSD or distress and includes one item assessing any other extraordinarily stressful event not captured in the first 16 items.
• The Abbreviated PCL-C is a shortened version of the PTSD Checklist – Civilian version (PCL-C). It was developed for use with in primary care or other similar general medical settings. Professional judgment should be used in generalizing it to other settings or if using the Military or Specific versions of the PCL. The initial development of the measure is presented in: Lang, A.J., Stein, M.B. (2005) An abbreviated PTSD checklist for use as a screening instrument in primary care. Behaviour Research and Therapy, 43, 585-594
• For more information on the full array of screening and assessment instruments available to providers view SAMHSA's TIP on Trauma-Informed Care in Behavioral Health Services.