Place check mark (√) in correct column.

A little of the time

Some of the time

Good part of the time

Most of the time

I feel down-hearted and blue.

Morning is when I feel the best.

I have crying spells or feel like it.

I have trouble sleeping at night.

I eat as much as I used to.

I still enjoy sex.

I notice that I am losing weight.

I have trouble with constipation.

My heart beats faster than usual.

I get tired for no reason.

My mind is as clear as it used to be.

I find it easy to do the things I used to.

I am restless and can’t keep still.

I feel hopeful about the future.

I am more irritable than usual.

I find it easy to make decisions.

I feel that I am useful and needed.

My life is pretty full.

I feel that others would be better off if I were dead.

I still enjoy the things I used to do.