Questionnaires

These questionnaires is not intended to replace a visit to a mental health professional. Only a professional can diagnose depression. The completed questionnaires can be shown to a healthcare professional to help open a dialogue about depression and its symptoms.

Questionnaire Packet

To monitor our patients’ progress, we advise patients to please fill out these forms at least once or twice a week

Burns Anxiety Inventory (BAI)

The Burns Anxiety Inventory (BAI) is an assessment tool used to measure anxiety. Developed by psychiatrist David Burns, the inventory, or checklist, can be self-administered or administered by a clinician. It can help people to monitor their own anxiety over time, and to become more aware of anxious symptoms. It also aids clinicians in diagnosing anxiety disorders.

Generalized Anxiety Disorder 7 (GAD-7)

It is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD). GAD-7 has seven items, which measure severity of various signs of generalized anxiety disorder according to reported response categories of “not at all,” “several days,” “more than half the days,” and “nearly every day.” Assessment is indicated by the total score, which made up by adding together the scores for the scale all seven items.

CAGE Questionnaire

The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism.

The Australian Scale for Aspergers Syndrome

The following questionnaire is designed to identify behaviours and abilities indicative of Asperger’s Syndrome in children during their primary school years. This is the age at which the unusual pattern of behaviour and abilities is most conspicuous. Each question or statement has a rating scale with 0 as the ordinary level expected of a child of that age.

Quick Inventory of Depressive Symptomatology (Self-Report) (QIDS-SR16)

QIDS assess all the criterion symptom domains designated by the American Psychiatry Association Diagnostic and Statistical Manual of Mental Disorders – 4th edition (DSM-IV) (APA 1994) to diagnose a major depressive episode. This assessment can be used to screen for depression, although they have been used predominantly as measures of symptom severity. The seven day period prior to assessment is the usual time frame for assessing symptom severity.

Geriatric Depression Scale Short Form (GDS-SF)

15-item screening tool used to identify depression in older adults. Used with healthy, medically ill and mild to moderately cognitively impaired adults. Extensively used in community, acute and long-term care settings.

Primary Care PTSD Screen (PC-PTSD)

The PC-PTSD is a 4-item screen that was designed for use in primary care and other medical settings and is currently used to screen for PTSD in veterans at the VA. Thescreen includes an introductory sentence to cue respondents to traumatic events.

Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire. The PHQ-9 is a powerful tool for assisting primary care clinicians in diagnosing depression as well as selecting and monitoring treatment.

Hamilton Rating Scale for Depression (HAM-D)

The questionnaire, which is designed for adult patients and is in the public domain, rates the severity of symptoms observed in depression such as low mood, insomnia, agitation, anxiety and weight loss. It is presently one of the most commonly used scales for rating depression in medical research.