Depressed Anxious Stressed Survey

Thank you for taking this opportunity to complete the Depression, Anxiety and Stress Survey.

This survey will provide an indication of the severity of your symptoms and does not take the place of a full psychological assessment for diagnosing mood disorders such as depression or anxiety. 

Other factors that need to be assessed also come into play, such as how long you have experienced the symptoms for, whether you have been ill, whether you are malnourished, whether you have an alcohol or substance abuse problem and so on.

If you would like to receive more information on depression, please complete the Live It Up Newsletter sign up form to the right.

Your results will either be emailed to you, or you will be phoned, as per your preference which you will indicate in responding to the survey below.

Instructions:

1. There are no right or wrong answers.
2. Do not spend too much time on any statement.
3. Each answer has been pre-set to “3″, so please change your selection by clicking on the button.  

Please read each statement and select a number: 0 zero, 1, 2, or 3 to indicate how much the statement applied to you over the past week, i.e. the past 7 days.

The rating scale is as follows:
0 zero – Did not apply to me at all
1 - Applied to me to some degree, or some of the time
2 - Applied to me to a considerable degree, or a good part of the time
3 - Applied to me very much, or most of the time

And, thank you for visiting today. 

*(denotes required field)

Name: *

E-Mail Address: *

1. I found myself getting upset by quite trivial things: *

0 zero
1
2
3

2. I was aware of dryness of my mouth: *

Zero 0
1
2
3

3. I couldn't seem to experience any positive feeling at all: *

Zero 0
1
2
3

4. I experienced breathing difficulty (eg. excessively rapid breathing/breathlessness in the absence of physical exertion): *

Zero 0
1
2
3

5. I just couldn't seem to get going: *

Zero 0
1
2
3

6. I tended to over-react to situations: *

Zero 0
1
2
3

7. I had a feeling of shakiness: *

Zero 0
1
2
3

8. I found it difficult to relax: *

Zero 0
1
2
3

9. I found myself in situations that made me so anxious I was most relieved when they ended: *

Zero 0
1
2
3

10. I felt that I had nothing to look forward to: *

Zero 0
1
2
3

11. I found myself getting upset rather easily: *

Zero 0
1
2
3

12. I felt that I was using a lot of nervous energy: *

Zero 0
1
2
3

13. I felt sad and depressed: *

Zero 0
1
2
3

14. I found myself getting impatient when I was delayed in any way (eg. lifts/traffic lights/being kept waiting): *

Zero 0
1
2
3

15. I had a feeling of faintness: *

Zero 0
1
2
3

16. I felt that I had lost interest in just about everything: *

Zero 0
1
2
3

17. I felt I wasn't worth much as a person: *

Zero 0
1
2
3

18. I felt that I was rather touchy: *

Zero 0
1
2
3

19. I perspired noticeably (eg. hands sweaty) in the absence of high temperatures or physical exertion: *

Zero 0
1
2
3

20. I felt scared without any good reason: *

Zero 0
1
2
3

21. I felt that life wasn't worthwhile: *

Zero 0
1
2
3

22. I found it hard to wind down: *

Zero 0 1 2 3

23. I had difficulty in swallowing: *

Zero 0
1
2
3

24. I couldn’t seem to get any enjoyment out of the things I did: *

Zero 0
1
2
3

25. I was aware of the action of my heart in the absence of physical exertion for example sense of heart rate increase or heart missing a beat: *

Zero 0
1
2
3

26. I felt down-hearted and blue: *

Zero 0
1
2
3

27. I found that I was very irritable: *

Zero 0
1
2
3

28. I felt I was close to panic: *

Zero 0
1
2
3

29. I found it hard to calm down after something upset me: *

Zero 0
1
2
3

30. I feared that I would be thrown by some trivial but unfamiliar task: *

Zero 0
1
2
3

31. I was unable to become enthusiastic about anything: *

Zero 0
1
2
3

32. I found it difficult to tolerate interruptions to what I was doing: *

Zero 0
1
2
3

33. I was in a state of nervous tension: *

Zero 0
1
2
3

34. I felt I was pretty worthless: *

Zero 0
1
2
3

35. I was intolerant of anything that kept me from getting on with what I was doing: *

Zero 0
1
2
3

36. I felt terrified: *

Zero 0
1
2
3

37. I could see nothing in the future to be hopeful about: *

Zero 0
1
2
3

38.I felt that life was meaningless: *

Zero 0
1
2
3

39. I found myself getting agitated: *

Zero 0
1
2
3

40. I was worried about situations in which I might panic and make a fool of myself: *

Zero 0
1
2
3

41. I experienced trembling for example in the hands: *

Zero 0
1
2
3

42. I found it difficult to work up the initiative to do things: *

Zero 0
1
2
3

I would like my results:

with a phone call
emailed to me

Include any instructions for phone notification here.

My phone number is:

I am: *

Female
Male

My age is: *

How did you find or hear about this survey? *

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