Over the last 2 weeks, how often have you been bothered by the following problems? (Use “✔” to indicate your answer in the box corresponding to your best response. Only tick one of the options on each item)

SN

Not at all

Several Days

More Than Half the Days

Nearly Every Day

1.

Feeling nervous, anxious or on edge

2.

Not being able to stop or control worrying

3.

Little interest or pleasure in doing things

4.

Feeling down, depressed, or hopeless

(For official coding: Total Score T____ = ____ + ____ + ____ )