Question 1 of 22.
Have you ever sought or received professional help (therapy, counselling, self-help, group support, or medication)?
1. I'd rather not answer at this time
2. This is my first time seeking support
3. I've dabbled a little bit before
4. I've sought help multiple times or a lot
Question 2 of 22.
Negative emotion interferes with my work, school, or relationships
How often or likely is it to be, to experience negative emotion to the point it impacts your performance or network?
Question 3 of 22.
Over the last 2 weeks, how often have you been bothered by feeling tired or having little energy?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 4 of 22.
Over the last 2 weeks, how often have you been bothered by trouble falling, or staying asleep, or sleeping too much?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 5 of 22.
Over the last 2 weeks, how often have you been bothered by little interest or pleasure in doing things?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 6 of 22.
Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 7 of 22.
Over the last 2 weeks, how often have you been bothered by poor appetite or overeating?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 8 of 22.
Over the last 2 weeks, how often have you been bothered by feeling bad about yourself — or that you are a failure or have let yourself or your family down?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 9 of 22.
Over the last 2 weeks, how often have you been bothered by trouble concentrating on things, such as reading the newspaper or watching television?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 10 of 22.
Over the last 2 weeks, how often have you been bothered by moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 11 of 22.
Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?
2. Sometimes; several days
3. Everyday or near everyday
Question 12 of 22.
Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 13 of 22.
Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 14 of 22.
Over the last 2 weeks, how often have you been bothered by worrying too much about different things?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 15 of 22.
Over the last 2 weeks, how often have you been bothered by trouble relaxing?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 16 of 22.
Over the last 2 weeks, how often have you been bothered by being so restless that it's hard to sit still?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 17 of 22.
Over the last 2 weeks, how often have you been bothered by becoming easily annoyed or irritable?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 18 of 22.
Over the last 2 weeks, how often have you been bothered by feeling afraid as if something awful might happen?
2. Sometimes; several days
3. More than half of the days
4. Everyday or near everyday
Question 19 of 22.
If you have experienced any of the mentioned issues, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Question 20 of 22.
Are you satisfied with the amount of support you receive from family and friends?
2. Sometimes or occasionally satisfied
Question 21 of 22.
Learning how to manage my emotions is...
Question 22 of 22.
How ready are you to make a change in your life?
1. I'm not ready to change in the next 3 months
2. I'm considering change in the next 3 months
3. I'm thinking about kick-starting change this month
4. I'm ready to make change today
5. I'm already making progress