TNC - Quick Inventory of Depressive Symptomatology (Self-Report) (QIPS-SR1)

Quick Inventory of Depressive Symptomatology Self-Report QIDS-SR16

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Name(Required)

First Last

Date(Required)

MM slash DD slash YYYY

INSTRUCTIONS: Please click the one response to each item that best describes you for the past seven days.

SLEEP ITEMS

1. Falling Asleep:(Required)

0 I never take longer than 30 minutes to fall asleep.

1 I take at least 30 minutes to fall asleep, less than half the time.

2 I take at least 30 minutes to fall asleep, more than half the time.

3 I take more than 60 minutes to fall asleep, more than half the time.

2.Sleep During the Night:(Required)

0 I do not wake up at night.

1 I have a restless, light sleep with a few brief awakenings each night.

2 I wake up at least once a night, but I go back to sleep easily.

3 I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.

3.Waking Up Too Early:(Required)

0 Most of the time, I awaken no more than 30 minutes before I need to get up.

1 More than half the time, I awaken more than 30 minutes before I need to get up.

2 I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.

3 I awaken at least one hour before I need to and can’t go back to sleep.

4.Sleeping Too Much:(Required)

0 I sleep no longer than 7-8 hours/night, without napping during the day.

1 I sleep no longer than 1 O hours in a 24-hour period including naps.

2 I sleep no longer than 12 hours in a 24-hour period including naps.

3 I sleep longer than 12 hours in a 24-hour period including naps.

Enter the highest score on any 1-4 above:

Please enter a number from 0 to 3.

APPETITE/WEIGHT CHANGES

5.Feeling Sad:(Required)

0 I do not feel sad

1 I feel sad less than half the time.

2 I feel sad more than half the time.

3 I feel sad nearly all of the time.

6.Decreased Appetite:(Required)

0 There is no change in my usual appetite.

1 I eat somewhat less often or lesser amounts of food than usual.

2 I eat much less than usual and only with personal effort.

3 I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat.

7.Increased Appetite:(Required)

0 There is no change from my usual appetite.

1 I feel a need to eat more frequently than usual.

2 I regularly eat more often and/or greater amounts of food than usual.

3 I feel driven to overeat both at mealtime and between meals.

8.Decreased Weight (Within the Last Two Weeks):(Required)

0 I have not had a change in my weight.

1 I feel as if I’ve had a slight weight loss.

2 I have lost 2 pounds or more.

3 I have lost 5 pounds or more.

9.Increased Weight (Within the Last Two Weeks):(Required)

0 I have not had a change in my weight.

1 I feel as if I’ve had a slight weight gain.

2 I have gained 2 pounds or more.

4 I have gained 5 pounds or more.

Enter the highest score on anv 6-9 above:

Please enter a number from 0 to 4.

10.Concentration/Decision Making:(Required)

0 There is no change in my usual capacity to concentrate or make decisions.

1 I occasionally feel indecisive or find that my attention wanders.

2 Most of the time, I struggle to focus my attention or to make decisions.

3 I cannot concentrate well enough to read or cannot make even minor decisions.

11.View of Myself:(Required)

0 I see myself as equally worthwhile and deserving as other people.

1 I am more self blaming than usual.

2 I largely believe that I cause problems for others.

3 I think almost constantly about maior and minor defects in myself.

12.Thoughts of Death or Suicide:(Required)

0 I do not think of suicide or death.

1 I feel that life is empty of wonder if it’s worth living.

2 I think of suicide or death several times a week for several minutes.

3 I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my life.

13.General Interest:(Required)

0 There is no change from usual in how interested I am in other people or activities.

1 I notice that I am less interested in people or activities.

2 I find I have interest in only one or two of my formerly pursued activities.

3 I have virtually no interest in formerly pursued activities.

14.Energy Level:(Required)

0 There is no change in my usual level of energy.

1 I get tired more easily than usual.

2 I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking or going to work).

3 I really cannot carry out most of my usual daily activities because I just don’t have the energy.

PSYCHOMOTOR

15.Feeling Slowed Down:(Required)

0 I think, speak, and move at my usual rate of speed.

1 I find that my thinking is slowed down, or my voice sounds dull or flat

2 It takes me several seconds to respond to most questions and I’m sure my thinking is slowed.

3 I am often unable to respond to questions without extreme effort.

16.Feeling Restless:(Required)

0 I do not feel restless.

1 I’m often fidgety, wringing my hands, or need to shift how I am sitting.

2 I have impulses to move about and am quite restless.

3 At times, I am unable to stay seated and need to pace around.

Enter the highest score on either of the 2 psychomotor items, 15 or 16 above:

Please enter a number from 0 to 3.

TOTAL SCORE: ______ (Range 0-27)(Required)

Quick Inventory of Depressive Symptomatology (QIDS SR-16) Scoring Instructions

This scale is a self-report measure of depression. Items: 16 Reliability: Internal consistency for the QIDS-SR16 = (Cronbach’s a=0.86) QIDS-SR1s scores correlated highly with /DS-SR3o (.96} and HAM-D24 (.86} scores. Validity: The QIDS-SR16, IDS-SR3o, and HAM-D24, had very similar sensitivity in detecting change in symptoms. This suoaests these three scales have high concurrent validity. Scoring: Questions in the QIDS – SR-116 correlate with the nine DSM-IV symptom criterion domains, Including: Sleep disturbance (initial, middle, and late insomnia or hypersomnia) (Q1 – 4), Sad mood (Q5), Decrease/increase in appetite/weight (Q6 – 9), Concentration (Q10), Self-criticism (Q11 ), Suicidal ideation (Q12), Interest (Q13), Energy/fatigue (Q14), Psychomotor agitation/retardation (Q15 – 16).

Scoring Instructions:

1. Enter the highest score on any 1 of the 4 sleep items (1-4)

2. Enter score on item 5

3. Enter the highest score on any 1 of the appetite/weight items (6-9)

4. Enter score on item 10

5. Enter score on item 11

6. Enter score on item 12

7. Enter score on item 13

8. Enter score on item 14

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TNC – Quick Inventory of Depressive Symptomatology (Self-Report) (QIPS-SR1)