Questions Yes No

1. Have you ever experienced 18 4

depression?
2. Are you still experiencing depression? 12 10
3. Have you often been bothered by 12 10
feeling down, depressed or hopeless?
4. Do you know someone who is 18 4
experiencing depression?
Always Often Sometim Never
es
5. How often did you feel anxious? 0 5 17 0
Yes No
6. Is there a time that you tried to self- 9 13
harm?
Self Family Friends School Other
Activities s
7. What are the things that cause your 7 9 5 10 4
depression?
Yes No
8. If youre depressed are you having 13 9
trouble falling asleep, staying asleep
or sleeping too much?
9. If youre depressed, have you had a 8 14
poor appetite or been over eating?
10.Do you think that depression can be 20 2
treated?