Depression Evaluation
Depression Evaluation
Introduction: This Depression Evaluation Form is designed to assess and evaluate various aspects related to depression. Depression is a common mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest in activities. This evaluation aims to gather information to better understand and assess an individual's symptoms and severity of depression.
Background: Depression is a significant public health concern globally, affecting individuals of all ages and backgrounds. It can have a profound impact on an individual's quality of life, relationships, and overall well-being. Early detection and intervention are crucial in effectively managing depression and preventing potential complications.
Participant Information:
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Name: __________________________
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Age: ____________________________
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Gender: _________________________
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Date of Evaluation: _______________
Instructions: Please read each statement carefully and select the response that best reflects your experiences over the past two weeks. If you are unsure about a statement, select the option that seems most appropriate to you.
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Criteria |
Never |
Occasionaly |
Frequently |
Almost constantly |
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1.Persistent feelings of sadness or emptiness |
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2. Loss of interest or pleasure in activities |
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3. Changes in appetite or weight |
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4. Insomnia or excessive sleeping |
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5. Fatigue or loss of energy |
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6. Feelings of worthlessness or excessive guilt |
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7. Difficulty concentrating or making decisions |
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8. Thoughts of death or suicide |
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9. Irritability or restlessness |
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10. Physical symptoms without a clear cause |
Scoring:
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Not at all: 0 points
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Several days: 1 point
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More than half the days: 2 points
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Nearly every day: 3 points
Total Score: ___________
Interpretation:
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0-4: Minimal to no depression symptoms
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5-9: Mild depression symptoms
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10-14: Moderate depression symptoms
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15-19: Moderately severe depression symptoms
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20-27: Severe depression symptoms
Comment/Feedback:
Please use the space below to provide any additional comments or feedback regarding this evaluation form. Your input is valuable in improving our assessment process.
Comments/Feedback: ________________________________________
Thank you for completing the Depression Evaluation Form. Your responses will be kept confidential and used solely for evaluation purposes. Please return the form to the designated healthcare professional.
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Comments |
Notes |
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