Section A # Yes No 1 Have you been consistently depressed or down, most of the day, nearly every day, for the past 2 weeks? 2 In the past 2 weeks, have you been less interested in most things of less able to enjoy the things you used to enjoy most of the time? 3 Have you felt sad, low or depressed most of the time for the last two years? 4 In the past month, did you think that you would be better off dead or wish you were dead? 5 Have you ever had a period of time when you were feeling up, hyper or full of energy or full of yourself that you got into trouble or that other people thought you were not your usual self? (Do not consider times when you were intoxicated on drugs or alcohol) 6 Have you ever been so irritable, grouchy or annoyed for several days, that you have arguments, verbal or physical fights, or shouted at people outside your family? Have you or others noticed that you have been more irritable or overreacted, compared to other people, even when you thought you were right to act this way?
Section B # Yes No 7a Have you had one or more occasions when you felt intensely anxious, frightened, uncomfortable or uneasy even when most people would not feel this way? 7b If yes, did these intense feelings get to be their worst within 10 minutes? 8 Do you feel anxious or uneasy in places or situations where you might have the panic-like symptoms we just spoke about? Or do you feel anxious or uneasy in situation where help might not be available or escape might be difficult? Examples include:
Being in a crowd
Standing in a line
Being alone away from home or alone at home
Crossing a bridge
Traveling in a bus, train or car. 9 Have you worried excessively or been anxious about several things over the past months? If no, skip question #10. 10 Are these worries present most days? 11 In the past month, were you afraid or embarrassed when others were others were watching or when you were the focus of attention? Were you afraid of being humiliated? Examples include:
Speaking in public
Eating in public or with others
Writing while someone watches
Being in a social situation. 12 In the past month, have you been bothered by thoughts, impulses, or images that you couldn't get rid of that were unwanted, distasteful, inappropriate, intrusive or distressing? Examples include:
Were you afraid that you would act on some impulse that would be really shocking?
Did you worry a lot about being dirty, contaminated or having germs? Did you worry a lot about contaminating others, or that you would harm someone even though you didn't want to?
Did you have fears or superstitions that you would be responsible for things going wrong?
Were you obsessed with sexual thoughts, images or impulses?
Did you hoard or collect lots of things?
Did you have religious obsessions? 13 In the past month, did you do something repeatedly without being able to resist doing it? Examples include:
Washing or cleaning excessively
Counting or checking things over and over
Repeating, collecting, or arranging things
Other superstitious rituals 14 Have you ever experienced or witnessed or had to deal with an extremely traumatic event that included actual or threatened death or serious injury to you or someone else? Examples include:
Sexual or physical assault
Being held hostage
Discovering a body
Sudden death of someone close to you
Natural disaster 15 Have you re-experienced the awful event in a distressing way in the past month? Examples include: