Depression Assessment Questionnaire

This easy to use patient questionnaire has been validated for use in Primary Care. It is used by your Doctor to monitor the severity of depression and response to treatment. It can also be used to make a tentative diagnosis of depression.

Last Updated: 19/10/2023

Your Details

Surname *

First Names *

Address and Postcode *

Date of Birth *

Phone Number - Mobile and/or home *

Email Address

Patient Health Review

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Rate by Scale

Please answer the following questions using the following scale: 0 - never avoid it, 2- slightly avoid it, 4 - definitely avoid it, 6 - markedly avoid it, 8 - always avoid it

Social situations due to a fear of being embarrassed or making a fool of myself

Certain Situations Because of a Fear of Having a Panic Attack or Other Distressing Symptoms (Such as Loss of Bladder Control, Vomiting or Dizziness)

Certain Situations Because of a Fear of Particular Objects or Activities (Such as Animals, Heights, Seeing Blood, Being in Confined Spaces, Driving or Flying)

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Depression Assessment Questionnaire

Further Information