Emotional Wellness Questonnaire

Over the last 2 weeks, how often have been bothered by the following:

Page 2 of 9

Little Interest or pleasure in doing things:

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite, overeating, binge eating, or disorder eating

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

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

Moving or speaking so slowly that other people could have noticed, or the opposite -- being so fidgety or restless that you've been moving around a lot more than usual

Thoughts that you would be better off dead, or hurting yourself in some way