Burns' Depression Checklist*

INSTRUCTIONS: Select the appropriate option to indicate how much each of the symptoms has been bothering you in the past week including today. Please be honest and be sure to answer all 15 questions.

Sadness: Have you been feeling sad or down in the dumps?
Discouragement: Does the future look bleak or hopeless?
Low Self-Esteem: Do you feel worthless or think of yourself as a loser?
Inferiority: Do you feel inadequate or inferior to others?
Guilt: Do you get self-critical and blame yourself?
Indecisiveness: Is it hard to make decisions?
Irritability and Frustration: Have you been feeling angry or resentful?
Loss of Motivation: Do you feel overwhelmed and have to push yourself hard to do things?
Poor Self-Image: Do you think you're looking old or unattractive
Appetite Changes: Have you lost your appetite? Or, do you over eat compulsively?
Sleep Changes: Is it hard to get a good night's sleep? Or, are you tired and sleeping too much?
Loss of Libido: Have you lost your interest in sex?
Hypochondriasis: Do you worry a lot about your health?
Suicidal Impulses: Do you think life is not worth living or think you'd be better off dead?

Contact

1581 N 4325 W

Plain City, UT 84404

Phone (801) 698-4006

Fax (801) 730-7171

micheleashdown@gmail.com

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