Please indicate whether any of your (blood) relatives have had any of these concerns:						other than the child in this study
	Grandparents	Parents	Aunts/Uncles	Brothers/Sisters	Children
Suicide	□	□	□	□	□
Alcohol/Drug Problems	□	□	□	□	□
Mental Hospital	□	□	□	□	□
Depression Problems	□	□	□	□	□
Manic or Bipolar	□	□	□	□	□
Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?						Yes	No