QIDS – SR
Name: ______________________________________ Sex: ____
Birthdate: _______________________ Date of Testing: _______________
Instructions:
Please encircle the one response to each item that best describes you for the past seven (7) days.
Item 1
A I never take longer than 30 minutes to fall asleep
B I take at least 30 minutes to fall asleep, less than half the time.
C I take at least 30 minutes to fall asleep, more than half the time.
D I take more than 60 minutes to TX, The asleep, more than half the time.
Item 2
A I do not wake up at night.
B I have a restless, light sleep with a few brief awakenings each night.
C I wake up at least once a night, but I go back to sleep easily
D I awaken more than once a night and stay awake for 20 minutes or more, state than half the ti
me.
Item 3
A Most of the time, I awaken no more than 30 minutes before I need to get up
B More than half the time, I awaken more than 30 minutes before I need to get up.
C I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually
.
D I awaken at least one hour before I need to, and can’t go back to sleep
Item 4
A I sleep no longer than 7–8 hours/night, without napping during the day
B I sleep no longer than 10 hours in a 24 hour period including naps.
C I sleep no longer than 12 hours in a 24hour period including naps.
D I sleep longer than 12 hours in a 24hour period including naps.
Item 5
A I do not feel sad
B I feel sad less than half the time.
C I feel sad more than half the time.
D I feel sad nearly all the time.
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Item 6
A There is no change in my usual appetite
B I eat somewhat lesser amounts of food than usual
C I eat much less than usual and only with personal effort
D I rarely eat within 24hour period, and only with extreme personal effort
or when others persuade me to eat.
Item 7
A There is no change from my usual appetite.
B I feel a need to eat more frequently than usual.
C I regularly eat more often and/or greater amounts of food than usual.
D I feel driven to overeat both at mealtime and between meals.
Item 8
A I have not had a change in my weight.
B I feel as if I’ve had a slight weight loss.
C I have lost 2 pounds or more.
D I have lost 5 pounds or more.
Item 9
A I have not had a change in my weight.
B I feel as if I’ve had a slight weight gain.
C I have gained 2 pounds or more
D I have gained 5 pounds or more
Item 10
A There is no change in my usual capacity to concentrate or make decisions.
B I occasionally feel indecisive that my attention wanders.
C Most of the time, I struggle to focus my attention or to make decisions.
D I cannot concentrate well enough to read or cannot make even minor decisions.
Item 11
A I see myself as equally worthwhile and deserving as other people.
B I am more self-blaming than usual.
C I largely believe that I cause problems for others.
D I think almost constantly about major and minor defects in myself.
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Item 12
A I do not think of suicide or death.
B I feel that life is empty or wonder if it’s worth living
C I think of suicide or death several times a week for several minutes
D 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.
Item 13
A There is no change from usual in how interested I am in people or activities
B I notice that I am less interested in people or activities.
C I find I have interest in only one or two of my formerly pursued activities.
D I have virtually no interest in formerly pursued activities.
Item 14
A There is no change in my usual level of energy.
B I get tired more easily than usual.
C I have to make a big effort to start or finish my usual daily activities
(for example, shopping, homework, cooking or going to work).
D I really cannot carry out most of my usual daily activities because I just don’t have the energy.
Item 15
A I think, speak, and move at my usual rate of speed.
B I find that my thinking is slowed down or my voice sounds dull or flat.
C It takes me several seconds to respond to most questions and I’m sure my thinking is slowed.
D I am often unable to respond to questions without extreme effort.
Item 16
A I do not feel restless.
B I’m often fidgety, wringing my hands, or need to shift how I am sitting.
C I have impulses to move about and am quite restless.
D At times, I am unable to stay seated and need to pace around.
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Quick Inventory of Depressive Symptomatology – Self Report
QIDS-SR
It is a scale that assess all 9 symptom domains needed to diagnose a DSMIV major depressive episode to
assess for symptom remission and include items to assess melancholic, and atypical symptom features
as well as commonly associated symptoms such as anxiety or pain. The instruments are scaled to allow
the detection of milder levels of depression, exclude uncommonly encountered items (e.g.
depersonalization) and do not rate psychotic symptoms.
It is used for adolescents, adults, and older adults. Typically, clients can finish this in less than 10
minutes. Its main purpose is to assess severity of, and change in, depressive symptoms.
Scoring Instructions
A = 0; B = 1; C = 2; D=3. It has score range of 0 to 27.
1. Enter the highest score on any of the Items 1 – 4 ____________
2. Item 5 ____________
3. Enter the highest score on any of the Items 6 – 9 ____________
4. Item 10 ____________
5. Item 11 ____________
6. Item 12 ____________
7. Item 13 ____________
8. Item 14 ____________
9. Enter the highest score on any of the Items 15 – 16 ____________
TOTAL SCORE ____________
Interpretation
Score Interpretation
0-5 Normal
6 - 10 Mild Depressive Symptoms
11 - 15 Moderate Depressive Symptoms
16 - 20 Severe Depressive Symptoms
21 and above Very Severe Depressive Symptoms
