| HAVE YOU RECENTLY | |
|---|---|
| 1. | Been feeling perfectly well and in good health? |
| 2. | Been feeling in need of a good tonic? |
| 3. | Been feeling run down and out of sorts? |
| 4. | Felt that you are ill? |
| 5. | Been getting any pains in your head? |
| 6. | Been getting a feeling of tightness or pressure in your head? |
| 7. | Been having hot or cold spells? |
| 8. | Lost much sleep over worry? |
| 9. | Had difficulty in staying asleep once you are off? |
| 10. | Felt constantly under strain? |
| 11. | Been getting edgy and bad-tempered? |
| 12. | Been getting scared or panicky for no good |
| 13. | Found everything getting on top of you? |
| 14. | Been feeling nervous and strung-up all the time? |
| 15. | Been managing to keep yourself busy and occupied? |
| 16. | Been taking longer over the things you do? |
| 17. | Felt on the whole you were doing things well? |
| 18. | Been satisfied with the way you’ve carried out your task? |
| 19. | Felt that you are playing a useful part in things? |
| 20. | Felt capable of making decisions about things? |
| 21. | Been able to enjoy your normal day-to-day activities? |
| 22. | Been thinking of yourself as a worthless person? |
| 23. | Felt that life is entirely hopeless? |
| 24. | Felt that life isn’t worth living? |
| 25. | Thought of the possibility that you might make away with yourself? |
| 26. | Found at times you couldn’t do anything because your nerves were too bad? |
| 27. | Found yourself wishing you were dead and away from it all? |
| 28. | Found that the idea of taking your own life kept coming into your mind? |