Have you been thinking about suicide lately?

Yes

No

Have you lost interest in activities that were once pleasurable, including sex?

Yes

No

Do you experience persistent sad, anxious or "empty" feelings?

Yes

No

Would you rather hide under the covers than get out into the sunlight?

Yes

No

Have you been suffering from chronic insomnia?

Yes

No

Have you noticed an excessive weight gain or loss lately?

Yes

No

Do you abuse drugs or alcohol?

Yes

No