| HISTORY OF DEPRESSION QUESTIONNAIRE A1–A4 MAJOR DEPRESSION | |||
| (means: go to the diagnostic boxes, circle NO in all diagnostic boxes, and move to the next module) | |||
| A1 | Have you ever been consistently depressed or down, most of the day, nearly every day, for at least 2 weeks? | NO | YES |
| A2 | During your lifetime, have you experienced a period of 2 weeks or more when you have been less interested in most things or less able to enjoy the things you used to enjoy most of the time? | NO | YES* |
| is A1 or A2 coded YES? | NO | YES | |
| A3 | Over the two weeks, when you felt depressed or uninterested: | ||
| a | Was your appetite decreased or increased nearly every day? Did your weight decrease or increase without trying intentionally (i.e. by ± 5% of body weight or ± 8 lb or ± 3.5 kg, for a 160 lb/70 kg person in a month)? | NO | YES* |
| if YES to either, code YES. | |||
| b | Did you have trouble sleeping nearly every night (difficulty falling asleep, waking up in the middle of the night, early morning wakening or sleeping excessively)? | NO | YES |
| c | Did you talk or move more slowly than normal or were you fidgety, restless or having trouble sitting still almost every day? | NO | YES* |
| d | Did you feel tired or without energy almost every day? | NO | YES |
| e | Did you feel worthless or guilty almost every day? | NO | YES |
| f | Did you have difficulty concentrating or making decisions almost every day? | NO | YES |
| g | Did you repeatedly consider hurting yourself, feel suicidal, or wish that you were dead? | NO | YES |
| h | Loss of confidence or self-esteem | NO | YES* |
| are 5 or more answers (A1–A3) coded YES? |
MAJOR DEPRESSIVE EPISODE |
||
| if patient has current major depressive episode continue to A4, otherwise move to module b: | |||
| A4 | |||
| a | During your lifetime, did you have other periods of two weeks or more when you felt depressed or uninterested in most things, and had most of the problems we just talked about? | NO | YES |
| b | Did you ever have an interval of at least 2 months without any depression and any loss of interest between 2 episodes of depression? | NO | YES |
|
RECURRENT DEPRESSIVE DISORDER | |||
*
If patient has major depressive episode, current, code YES in corresponding questions on page 5.