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| 1. Falling Asleep: |
| | I never take longer than 30 minutes to fall asleep |
| | I take at least 30 minutes to fall asleep, less than half the time |
| | I take at least 30 minutes to fall asleep, more than half the time |
| | I take more than 60 minutes to fall asleep, more than half the time |
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| 2. Sleep during the night: |
| | I do not wake up at night |
| | I have a restless, light sleep with a few brief awakenings each night |
| | I wake up at least once a night, but I go back to sleep eventually |
| | I awaken more than once a night and stay awake for 20 minutes or more, more than half the time |
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| 3. Waking up too early: |
| | Most of the time, I awaken no more than 30 minutes before I need to get up |
| | More than half the time, I awaken more than 30 minutes before I need to get up |
| | I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually |
| | I awaken at least one hour before I need to, and I can't go back to sleep. |
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| 4. Sleeping too much: |
| | I sleep no longer than 7-8 hours/night without napping during the day |
| | I sleep no longer than 10 hours in a 24-hour period, including naps |
| | I sleep no longer than 12 hours in a 24-hour period, including naps |
| | I sleep longer than 12 hours in a 24-hour period, including naps |
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| 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 |
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| 6. Decreased appetite: |
| | There is no change in my usual appetite |
| | I eat somewhat less often or lesser amounts of food than usual |
| | I eat much less than usual and only with personal effort |
| | I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat |
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| 7. Increased appetite: |
| | There is no change in my usual appetite |
| | I feel the need to eat more frequently than usual |
| | I regularly eat more often and/or greater amounts of food than usual |
| | I feel driven to overeat both at mealtime and between meals |
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| 8. Decreased weight: (within the last TWO WEEKS) |
| | I have not had a change in my weight |
| | I feel as if I've had a slight weight loss |
| | I have lost 2 pounds or more |
| | I have lost 5 pounds or more |
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| 9. Increased weight: (within the last TWO WEEKS) |
| | I have not had a change in my weight |
| | I feel as if I've had a slight weight gain |
| | I have gained 2 pounds or more |
| | I have gained 5 pounds or more |
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| 10. Concentration / decision making: |
| | There is no change in my usual capacity to concentrate or make decisions |
| | I occasionally feel indecisive or find that my attention wanders |
| | Most of the time, I struggle to focus my attention or make decisions |
| | I cannot concentrate well enough to read or cannot make even minor decisions |
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| 11. View of myself: |
| | I see myself as equally worthwhile and deserving as other people |
| | I am more self-blaming than usual |
| | I largely believe that I cause problems for others |
| | I think almost constantly about major and minor defects in myself |
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| 12. Thoughts of death or suicide: |
| | I do not think of suicide or death |
| | I feel that life is empty or wonder if it's worth living |
| | I think of suicide or death several times a week for several minutes |
| | 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 |
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| 13. General interest: |
| | There is no change from usual in how interested I am in other people or activities |
| | I notice that I am less interested in people or activities |
| | I find I have interests in only one or two of my formerly pursued activities |
| | I have virtually no interest in formerly pursued activities |
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| 14. Energy level: |
| | There is no change in my usual level of energy |
| | I get tired more easily than usual |
| | 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 really cannot carry out most of my usual daily activities because I just don't have the energy |
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| 15. Feeling slowed down: |
| | I think, speak, and move at my usual rate of speed |
| | I find that my thinking is slowed down or my voice sounds dull or flat |
| | It takes me several seconds to respond to most questions, and I'm sure my thinking is slowed |
| | I am often unable to respond to questions without extreme effort |
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| 16. Feeling restless: |
| | I do not feel restless |
| | I'm often fidgety, wringing my hands, or need to shift how I am sitting |
| | I have impulses to move about and am quite restless |
| | At times, I am unable to stay seated and need to pace around |
