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QIDS-SREnglish16item STARD_QS_V3 (7133 - Activated,

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CHECK THE ONE RESPONSE TO EACH ITEM THAT BEST DESCRIBES YOU FOR THE PAST SEVEN DAYS.
Pg. 1 of 2
During the past seven days... During the past seven days...
8. Decreased Weight (Within the Last Two Weeks):
I have not had a change in my weight.
I feel as if I have had a slight weight loss.
I have lost 2 pounds or more.
I have lost 5 pounds or more.
0
1
2
3
I take more than 60 minutes to fall asleep, more than
half the time.
half the time.
I take at least 30 minutes to fall asleep, less than
half the time.
I never take longer than 30 minutes to fall asleep.
1. Falling Asleep:
0
1
2
3
5. Feeling Sad:
I do not feel sad.
I feel sad less than half the time.
I feel sad more than half the time.
I feel sad nearly all of the time.
0
1
2
3
0
1
2
3
I awaken more than once a night and stay awake
I wake up at least once a night, but I go back to
sleep easily.
I have a restless, light sleep with a few brief
awakenings each night.
I do not wake up at night.
2. Sleep During the Night
0
1
2
3
I awaken at least one hour before I need to, and
can't go back to sleep.
I almost always awaken at least one hour or so
before I need to, but I go back to sleep eventually.
More than half the time, I awaken more than 30
minutes before I need to get up.
Most of the time, I awaken no more than 30 minutes
before I need to get up.
3. Waking Up Too Early:
0
1
2
3
I sleep longer than 12 hours in a 24-hour period
including naps.
I sleep no longer than 12 hours in a 24-hour period
including naps.
I sleep no longer than 10 hours in a 24-hour period
including naps.
I sleep no longer than 7-8 hours/night, without
napping during the day.
4. Sleeping Too Much:
0
1
2
3
I eat much less than usual and only with personal effort.
I eat somewhat less often or lesser amounts of food than
usual.
There is no change in my usual appetite.
I rarely eat within a 24-hour period, and only with
extreme personal effort or when others persuade me to
eat.
6. Decreased Appetite:
0
1
2
3
I feel driven to overeat both at mealtime and between
meals.
I regularly eat more often and/or greater amounts of
food than usual.
I feel a need to eat more frequently than usual.
There is no change from my usual
appetite.
7. Increased Appetite:
9. Increased Weight (Within the Last Two Weeks):
I have not had a change in my weight.
I feel as if I have had a slight weight gain.
I have gained 2 pounds or more.
I have gained 5 pounds or more.
0
1
2
3
Please complete either 6 or 7 (not both)
Please complete either 8 or 9 (not both)
- OR -
- OR -
The Quick Inventory of Depressive Symptomatology (16-Item) (Self-Report) (QIDS-SR16)
Name or ID: _____________________________ Date: _____________________________
Pg. 2 of 2
I have impulses to move about and am quite restless.
During the past seven days... During the past seven days...
0
1
2
3
I cannot concentrate well enough to read or cannot
make even minor decisions.
Most of the time, I struggle to focus my attention or
to make decisions.
I occasionally feel indecisive or find that my attention
wanders.
There is no change in my usual capacity to
concentrate or make decisions.
10. Concentration / Decision Making:
0
1
2
3
I think almost constantly about major and minor
defects in myself.
I largely believe that I cause problems for others.
I am more self-blaming than usual.
I see myself as equally worthwhile and deserving as
other people.
11. View of Myself:
0
1
2
3
I think of suicide or death several times a day in
some detail, or I have made specific plans for
suicide or have actually tried to take my life.
I think of suicide or death several times a week for
several minutes.
I feel that life is empty or wonder if it's worth living.
I do not think of suicide or death.
12. Thoughts of Death or Suicide:
0
1
2
3
I have virtually no interest in formerly pursued
activities.
I find I have interest in only one or two of my
formerly pursued activities.
I notice that I am less interested in people or
activities.
There is no change from usual in how interested I
am in other people or activities.
13. General Interest
0
1
2
3
I really cannot carry out most of my usual daily activities
because I just don't have the energy.
I have to make a big effort to start or finish my usual daily
activities (for example, shopping, homework, cooking, or
going to work).
I get tired more easily than usual.
There is no change in my usual level of energy.
14. Energy Level:
0
1
2
3
I am often unable to respond to questions without
extreme effort.
It takes me several seconds to respond to most
questions and I'm sure my thinking is slowed.
sounds dull or flat.
I think, speak, and move at my usual rate of speed.
15. Feeling Slowed Down:
0
1
2
3
At times, I am unable to stay seated and need to pace
around.
I'm often fidgety, wringing my hands, or need to shift
how I am sitting.
I do not feel restless.
16. Feeling Restless:
The Quick Inventory of Depressive Symptomatology (16-Item) (Self-Report) (QIDS-SR16)
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Completed 3 July 2020

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