Please check all that apply.
If none, click next.
I am currently taking antidepressants to treat my depression.
I have a lifetime history of bipolar disorder, schizophrenia, schizoaffective disorder, or Major Depressive Disorder with psychotic features.
I currently suffer from anorexia nervosa, bulimia nervosa, or obsessive compulsive disorder (OCD).
I am breastfeeding, pregnant, or trying to become pregnant within the next 6-9 months.
I have been diagnosed with epilepsy in the past.
I am in detox or inpatient hospital treatment for substance dependence.
I am currently taking mood stabilising medication (e.g. Lithium, anti-convulsants, or anti-psychotics).
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What is the HIGHEST level of education that you’ve completed?


Years should be a number (0-30).
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What best describes your current employment status?
Unemployed, not looking for employment
Unemployed, looking for employment
Full-time employed for pay
Part-time employed for pay
Self-employed for pay
Retired, not working
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What is your race?
Please choose one race with which you primarily identify.
Asian
Black / African-American
White
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
Hispanic
Unknown
Other
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Did any of the following make you feel fearful, anxious, or nervous because you were afraid you’d have an anxiety attack in the situation?
Select all that apply, or press next if none apply.
Standing in long lines
Driving or riding in a car
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Previous Traumatic Events
Select all that apply to you, or press next if none apply.
Reminders of a traumatic event made me shake, break out into a sweat, or have a racing heart.
I have witnessed a traumatic event such as rape, assault, someone dying in an accident, or any other extremely upsetting event.
I have tried to avoid activities, places, or people that reminded me of a traumatic event.
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Select all that apply to you, or skip if none apply.
I have been bothered by aches and pains in many different parts of my body.
I experience a depressed mood most of the day, nearly every day.
I worry a lot about doing or saying something to embarrass myself when asking a question in a group of people.
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How many other times in your life have you been clinically depressed?

Please enter a number (0-30).
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Falling Asleep
Please choose one. During the past seven days...
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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Sleep During the Night
Please choose one. During the past seven days...
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 easily.
I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.
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Waking Up Too Early
Please choose one. During the past seven days...
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 can't go back to sleep.
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Sleeping Too Much
Please choose one. During the past seven days...
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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Feeling Sad
Please choose one. During the past seven days...
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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Concentration and Decision Making
Please choose one. During the past seven days...
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 to make decisions.
I cannot concentrate well enough to read or cannot make even minor decisions.
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View of Myself
Please choose one. During the past seven days...
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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Thoughts About Suicide or Death
Please choose one. During the past seven days...
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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General Interest
Please choose one. During the past seven days...
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 interest in only one or two of my formerly pursued activities.
I have virtually no interest in formerly pursued activities.
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Energy Levels
Please choose one. During the past seven days...
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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Feeling Slow
Please choose one. During the past seven days...
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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Restlessness
Please choose one. During the past seven days...
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.
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Waking Up Too Early (after 4:00 am)
Please choose one. During the past seven days...
Absent (No difficulty)
Mild (e.g. I wake up earlier than usual but can go back to sleep)
Moderate to severe (e.g. I wake up 1-3 hours before usual, and I am unable to sleep again)
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Feeling Ill
Please choose one. During the past seven days...
I feel that I'm depressed and ill.
I feel that I'm ill, but I don't think it's due to depression. I think it's due to other factors.
I don't feel that I'm ill.
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I experience symptoms of anxiety such as fainting, headache, tremor, sweating, hyperventilation, indigestion, or needing the bathroom a lot.
Please choose one.
Not at all
Mildly
Moderately
Moderately severely
Severely
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Thoughts About Suicide or Death
Please choose one.
I feel that life is empty and not worth living
I experience recurrent thoughts or wishes about dying.
I have active suicidal thoughts, threats, and gestures.
I have had a serious suicide attempt.
I feel none of the above. I do not think at all about suicide.
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Fatigue and Aching
Please choose one. During the past seven days...
I experience occasional, mild fatigue, easy tiring, and aching.
I experience moderate to severe fatigue (obviously low in energy, tired all the time, frequent backaches, headaches, heavy feelings in limbs)
I experience none of the above.
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Delays (or slowing) in thinking, speaking or moving
Absent (No difficulty).
Mild (slightly flattened affect).
Moderate (monotonous voice, delayed answering, sitting motionless).
Moderately severe (conversations are difficult and prolonged).
Extremely severe (conversations are impossible).
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Choose question A or B.

A. Select one answer that describes you in the past seven days.

There is no change from 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.

B. Select one answer that describes you in the past seven days.

There is no change from my usual appetite.
I feel a 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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Choose question A or B

A. Select one answer that describes you in the past seven days.

I have not had a change in my weight.
I feel as if I have had a slight weight loss.
I have lost 2 pounds or more.
I have lost 5 pounds or more.

B. Select one answer that describes you in the past seven days.

I have not had a change in my weight.
I feel as if I have had a slight weight gain.
I have gained 2 pounds or more.
I have gained 5 pounds or more.
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Have you received a prescription for an antidepressant from a doctor in the past two weeks?

Yes
No
Which one?