Name:

Age:

Date:

1. Are you basically satisfied with your life?

Yes No

2. Have you dropped many of your activities and interests?

Yes No

3. Do you feel that your life is empty?

Yes No

4. Do you often get bored?

Yes No

5. Are you in good spirits most of the time?

Yes No

6. Are you afraid that something bad is going to happen to you?

Yes No

7. Do you feel happy most of the time?

Yes No

8. Do you often feel helpless?

Yes No

9. Do you prefer to stay at home, rather than going out and doing new things?

Yes No

10. Do you feel you have more problems with memory than most people?

Yes No

11. Do you think it is wonderful to be alive now?

Yes No

12. Do you feel pretty worthless the way you are now?

Yes No

13. Do you feel full of energy?

Yes No

14. Do you feel that your situation is hopeless?

Yes No

15. Do you think that most people are better off than you are?

Yes No

Comments:

Geriatric Depression Assessment Form