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01. MOOD
Mood and emotional stability. Record whether you feel sad, happy, irritated, or any other emotional state.
- How do you rate your mood in the last few week?
- How often have you recently felt a sense of hopelessness or hopelessness?
- What percentage of the day do you feel you have enough energy?
- How quickly do you fall asleep at night and how good is your sleep?
- How much time do you spend on activities that you used to enjoy?
- How often do you feel guilty or worthless?
- To what extent do you think about death or thoughts of harming yourself?
- What changes have you noticed in your appetite?
- How much time do you spend with other people and how do you feel about social interaction?
- How do you perceive the stressors in your life and how significantly do they affect your mood?
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02. SLEEP
Sleep and its duration. Describe if you have trouble falling asleep, wake up during the night, or feel rested in the morning.
- How do you rate the quality of your sleep in recent weeks?
- How often do you suffer from insomnia or difficulty falling asleep lately?
- How many hours do you sleep on average per night?
- How often do you wake up during the night, and how do you feel when you wake up?
- Do you have problems maintaining continuous sleep, or do you often have nightmares?
- How do you feel after waking up in the morning?
- How much time do you spend preparing for sleep, such as relaxation activities before bed?
- Do you have a fixed sleep pattern or is your sleep irregular?
- How often do you find yourself unable to fall asleep due to stress or anxiety?
- Do you have any specific habits or remedies you use to help you fall asleep?
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03. ENERGY
Energy level and vitality throughout the day. Note if you feel tired or have trouble concentrating.
- How would you rate your overall energy level in the last few weeks?
- How long does it take you to wake up full of energy after waking up in the morning?
- How often have you recently felt tired or exhausted during the day?
- What is your ability to concentrate and pay attention?
- What percentage of the day do you feel active and full of energy?
- Do you have specific times of the day when you have more or less energy?
- How does your energy level differ during the day and at night?
- Do you have any specific activities that drain you or energize you?
- How does your mental state affect your physical energy?
- How often do you feel unable to carry out daily tasks due to lack of energy?
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04. LOSS OF INTEREST
Difficulty maintaining interest in regular activities or hobbies that you usually enjoy.
- How often have you recently experienced a loss of interest in activities you used to enjoy?
- How has your interest in social interactions with family and friends changed?
- Do you tend to avoid or refuse to participate in events or activities?
- What is your willingness to do new things or try new activities?
- What percentage of your free time do you spend actively and happily?
- Do you feel like you can't find meaning or joy in the things you used to think were important?
- How has your interest in work or school responsibilities changed compared to pre-depression?
- Do you have any activities that you still find enjoyable or inspiring?
- How does losing interest affect your interpersonal relationships?
- Do you tend to withdraw into yourself or withdraw from activities and contact with others?
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05. WEIGHT AND DIET
Relationship with food and weight. Record if you have changes in appetite and how this affects your weight status.
- How has your weight changed in recent weeks/months?
- What is your appetite?
- How often do you skip food or lose interest in food?
- Do you tend to overeat or undereat in response to stress or sadness?
- How do your eating habits change in stressful situations?
- How does your emotional state affect your food choices?
- What are your opinions about your body weight or appearance?
- Have you recently had problems with digestion or absorption of food?
- How often do you try to avoid food because of low mood or feelings of guilt?
- Do you change your diet in response to external pressures or expectations?
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06. SENSE OF GUILT OR WORTHLESSNESS
Guilty or worthless. Note what may be causing these feelings.
- How often do you feel guilty or worthless?
- Do you tend to blame yourself for things that are out of your control?
- How much do feelings of guilt affect you in your daily activities?
- Do you tend to overestimate your mistakes or shortcomings?
- How often do you feel like you are unable to meet the expectations or standards you set for yourself?
- How does feeling worthless affect your interpersonal relationships?
- Do you ever feel like you are a burden to others?
- Do you tend to overlook your successes and focus only on your mistakes?
- How much do feelings of guilt affect your decision-making and self-expression?
- Do you feel unable to accept praise or recognition from others?
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07. THOUGHTS OF DEATH OR SUICIDE
Thoughts of death or suicide. Be honest and record if these thoughts occur to you.
- How often do you think about death or ending your life?
- Do you feel that thoughts of death or suicide are affecting your daily life?
- Do you have specific plans to commit suicide?
- How open do you feel to sharing these ideas with others?
- How much do you see thoughts of death as an escape or a solution to problems?
- Do you tend to talk about death or suicide with other people?
- How much do you feel your life has meaning or value?
- Do you feel that thoughts of death are a reaction to stress or specific life situations?
- How connected are these thoughts to the emotional state you are experiencing?
- Do you have someone you can talk to about these thoughts?
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08. PHYSICAL SYMPTOMS
Physical symptoms you might associate with depression, such as body aches, migraines, or changes in energy levels.
- How often have you been dealing with pain or discomfort in your body lately?
- Are you having trouble falling asleep or staying asleep because of the physical discomfort?
- How do you rate your energy performance level throughout the day?
- Do you often feel general physical exhaustion or weakness?
- Do you have problems with digestion or digesting food?
- How do you rate your ability to be physically active or exercise?
- Do you often have headaches or migraines?
- How often do you notice tension or sore muscles in your body?
- Do you have trouble breathing or often feel short of breath?
- How do you rate your overall feeling of well-being in your body?
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09. SOCIAL ISOLATION
Level of social interaction and whether you feel isolated from family, friends or colleagues.
- How often do you avoid social activities or meeting other people?
- How do you rate your ability to establish or maintain new relationships?
- Do you often feel lonely or isolated from others?
- Do you tend to avoid communication or meeting your family?
- How often do you spend time with friends or family?
- How do you rate your comfort when participating in social events or in public spaces?
- Do you tend to decline invitations to social events or meetings?
- Do you feel that you have someone with whom you can talk openly about your feelings?
- How do you rate your ability to share happy or sad events with others?
- Do you have any concerns or fears related to interpersonal relationships?
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10. STRESSORS
The current stressors in your life. Record what may be contributing to your emotional difficulties and persistent feelings of depression.
- How do you rate the amount of stress in your daily life?
- How often do you feel overwhelmed by work or school?
- How do you rate your ability to handle stressful situations?
- Do you tend to worry about the future or often think about possible negative events?
- Do you feel that a specific situation or event has caused you significant stress recently?
- How do you rate your ability to relax or unwind from stress?
- How much does your stress translate into physical symptoms like headaches or tension?
- Do you feel that social situations or interpersonal relationships stress you out?
- Do you feel that you are not coping well with stress?
- How do you rate your overall level of life satisfaction in relation to stress?