Depression Checklist
The following checklist will help you start a conversation with your provider. Check the boxes that best describe your experience over the past 2 weeks, and take the checklist with you to give to your provider at your next visit.
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| In the past 2 weeks (14 days), how often have you: | A Few Days | Over Half the Days | Every Day |
|---|---|---|---|
| Felt sad or low? | |||
| Felt more tired than usual, or have less energy during the day? | |||
| Felt upset or annoyed at little things? | |||
| Had trouble thinking, concentrating, or making decisions? | |||
| Had no appetite or been eating too much? | |||
| Worried that you might hurt yourself or felt like you wanted to die? | |||
| Had trouble enjoying things that used to be fun? | |||
| Felt like you have no one to talk to? | |||
| Felt that you just can’t make it through the day? | |||
| Felt worthless or hopeless? | |||
| Had headaches, backaches, or stomachaches? |
| In the past 2 weeks (14 days), how often have you: | A Few Days | Over Half the Days | Every Day |
|---|---|---|---|
| Had problems sleeping when your baby sleeps, or sleeping too much? | |||
| Felt numb or disconnected from your baby? | |||
| Had scary or negative thoughts about your baby? | |||
| Worried that you might hurt your baby? | |||
| Felt worried or scared that something bad might happen? | |||
| Felt guilty or ashamed about your job as a mom? |
Page last reviewed: May 5, 2021