Postpartum Depression Assessment Form

Name

Date of Birth

Assessment Date

Weeks Postpartum

Assessment Questions

1. I have been able to laugh and see the funny side of things:

2. I have looked forward with enjoyment to things:

3. I have blamed myself unnecessarily when things went wrong:

4. I have been anxious or worried for no good reason:

5. I have felt scared or panicky for no good reason:

6. Things have been getting on top of me:

7. I have been so unhappy that I have had difficulty sleeping:

8. I have felt sad or miserable:

9. I have been so unhappy that I have been crying:

10. The thought of harming myself has occurred to me:

Additional Comments