Self assessment questionnaire :: Keeping Well Bedfordshire, Luton and Milton Keynes

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Sometimes it can be challenging to recognise or acknowledge that we are not feeling our best. The below self-assessment questionnaires can help you to understand how you’ve been feeling over the last two weeks.

Questionnaire one looks at the common symptoms that are associated with low mood.
Questionnaire two looks at the common symptoms that are associated with anxiety.

Low mood questionnaire

Over the last 2 weeks, how often have you been bothered by the following problems?	Several days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things	1	2	3
2. Feeling down, depressed, or hopeless	1	2	3
3. Trouble falling or staying asleep, or sleeping too much	1	2	3
4. Feeling tired of having little energy	1	2	3
5. Poor appetite or overeating	1	2	3
6. Feeling bad about yourself - or that you are a failure or have let yourself or family down	1	2	3
7. Trouble concentrating on things, such as reading the newspaper or watching television	1	2	3
8. Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual	1	2	3
9. Thoughts that you would be better off dead or of hurting yourself in some way	1	2	3

Anxiety questionnaire

Over the last 2 weeks, how often have you been bothered by the following problems?	Several days	More than half the days	Nearly every day
1. Feeling nervous, anxious or on edge	1	2	3
2. Not being able to stop or control worrying	1	2	3
3. Worrying too much about different things	1	2	3
4. Trouble relaxing	1	2	3
5. Being so restless that it is hard to sit still	1	2	3
6. Becoming easily annoyed or irritable	1	2	3
7. Feeling afraid as if something awful might happen	1	2	3

You will get a different score for each questionnaire but need to complete both. These scores are anonymous and will not be saved or sent to us at Keeping Well BLMK.

These questionnaires do not provide a clinical diagnosis but can help you to understand how you have been feeling. If you would like to discuss your scores, you can write them down and get in touch with us.

The questionnaires are not intended to replace a consultation with a GP.

Accessibility tools

Self assessment questionnaire

Low mood questionnaire

Anxiety questionnaire