SOS Brief Screen for Adolescent Depression

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please answer the following questions as honestly as possible.

Email *

Answer the questions below based on your feelings from the past four weeks...

1. Have you felt like nothing is fun for you and you just aren't interested in anything? *

Yes

2. Have you had less energy than you usually do? *

Yes

3. Have you felt you couldn't do anything well or that you weren't as good-looking or as smart as most other people? *

Yes

4. Have you thought seriously about killing yourself? *

Yes

5. Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt? *

Yes

6. Has doing even little things made you feel really tired? *

Yes

7. Has it seemed like you couldn't think as clearly or as fast as usual? *

Yes

Are you currently being treated for depression? *

Yes

Please add up the number of "Yes" answers to questions 1-7 above. How many "Yes" answers did you have? *

0-2

4-7

Clear form

Never submit passwords through Google Forms.

This form was created inside of Inland Leaders Charter School. Report Abuse