Please describe your mood over the past three days.
Please describe the degree in which you have worried about your life during the past three days. Consider how intense these feelings have been and if they have been consistently there.
How well have you slept in the past three days? Please do not take into consideration the use of medications. If you have slept longer than usual mark box 6.
Have you had difficulty concentrating during the past three days?
Have you had difficulty staying motivated during the past three days?
How do you rate your degree of empathy for other people and your degree of passion for activities and topics that make you happy?
Are you worried about the future? Do you worry more than usual about the household economy and your health?
Do you have an appetite for life? Have you contemplated suicide in the past three days?