Over the last 2 weeks, how often have you been bothered by the following problems?

• Feeling nervous, anxious or on edge

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Not being able to stop or control worrying

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Worrying too much about different things

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Trouble relaxing

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Being so restless that it is hard to sit still

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Becoming easily annoyed or irritable

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Feeling afraid as if something awful might happen

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Little interest or pleasure in doing things

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Feeling down, depressed, or hopeless

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Trouble falling or staying asleep, or sleeping too much

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Feeling tired or having little energy

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Poor appetite or overeating

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Feeling bad about yourself, or that you are a failure, or have let yourself or your family down

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Trouble concentrating on things, such as reading the newspaper or watching television

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

• Thoughts that you would be better off dead, or of hurting yourself.

  • Not at all
  • Several days
  • More than half the days
  • Nearly every day