Step 1 of 4 25% Please select all the items that apply.Depression 1 1. I feel sad, empty and/or hopeless most of the day, nearly every day. depression 2 2. Those around me tell me I appear sad, down or depressed. depression 3 3. I have a diminished interest or pleasure in all, or almost all, activities. depression 4 4. I have experienced significant weight loss when not dieting or weight gain. depression 5 5. I cannot sleep or sleep more than 12 hours nearly every day. depression 6 6. I feel agitated, restless or feel like I’m being slowed down. depression 7 7. I feel fatigue or loss of energy nearly every day. depression 8 8. I experience feelings of worthlessness or excessive or inappropriate guilt nearly every day. depression 9 9. I have a diminished ability to think or concentrate or feel indecisiveness nearly every day. depression 10 10. I have recurrent thoughts of death, suicidal thoughts or find myself planning to commit suicide. Select all that apply.Anxiety 1 1. I feel anxious for more days than not. Anxiety 2 2. I find it difficult to control the worry. Anxiety 3 3. I feel restless, keyed up or on edge. Anxiety 4 4. I am easily fatigued. Anxiety 5 5. I have difficulty concentrating or mind going blank. Anxiety 6 6. I am often irritable. Anxiety 8 7. I feel muscle tension. Anxiety 8 8. I have difficulty falling or staying asleep or have unsatisfying sleep. Select all that apply.RELIGIOUS OR SPIRITUAL PROBLEM 1 1. I feel distressed about the loss of my faith. RELIGIOUS OR SPIRITUAL PROBLEM 2 2. I am questioning the truth about my faith. RELIGIOUS OR SPIRITUAL PROBLEM 3 3. I’m angry at God. RELIGIOUS OR SPIRITUAL PROBLEM 4 4. I have problems associated with conversion to a new faith or my long-time faith. RELIGIOUS OR SPIRITUAL PROBLEM 5 5. I am questioning my spiritual values. RELIGIOUS OR SPIRITUAL PROBLEM 6 6. I don’t know: “Who am I?” This field is hidden when viewing the formDepression ScoreThis field is hidden when viewing the formAnxiety ScoreThis field is hidden when viewing the formReligious or Spiritual Problems ScoreName(Required) First Name Email(Required) Δ
