Anne M. Dennis, MA, LMFT
 Specializing in the Diagnosis and Treatment of Prenatal & Postpartum Depression and Anxiety Disorders.

ph: 626.204.4098
email: annedennis@mac.com

1055 East Colorado Blvd.
5th Floor
Pasadena, CA 91106

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If you are pregnant or have recently given birth, this assessment will help determine your level of depression.

Name:   Email:  
Phone: (optional)        
           
Please answer the following questions as best as possible with respect to the last 7 days:
1. I have been able to laugh and see the funny side of things  
As much as I always could        
Not quite so much now        
Definitely not so much now        
Not at all        
           
2. I have looked forward with enjoyment to things  
As much as I ever did        
Rather less than I used to        
Definitely less than I used to        
Hardly at all        
           
3. I have blamed myself unnecessarily when things went wrong  
Yes, most of the time        
Yes, some of the time        
Not very often        
No, never        
           
4. I have been anxious or worried for no good reason  
No, not at all        
Hardly ever        
Yes, sometimes        
Yes, very often        
           
5. I have felt scared or panicky for no very good reason  
Yes, quite a lot        
Yes, sometimes        
No, not much        
No, not at all        
           
   
6. Things have been getting on top of me        
Yes, most of the time I haven’t been able to cope at all    
Yes, sometimes I haven’t been coping as well as usual    
No, most of the time I have coped quite well      
No, I have been coping as well as ever      
           
7. I have been so unhappy that I have had difficulty sleeping  
Yes, most of the time      
Yes, sometimes      
Not very often      
No, not at all      
           
8. I have felt sad or miserable  
Yes, most of the time    
Yes, quite often    
Not very often    
No, not at all    
           
9. I have been so unhappy that I have been crying  
Yes, most of the time    
Yes, quite often    
Only occasionally    
No, never    
           
10. The thought of harming myself has occurred to me  
Yes, quite often    
Sometimes    
Hardly ever    
Never    
     
Special Comments: Please use the space below to list comments/questions you may have.
           

 

You are not alone. It’s not your fault. Help is near.

© Copyright 2009, Anne M. Dennis. LMFT