Mental Health Self-Assessment

This 10-question survey helps gauge potential suitability for FDA-Approved Nasal treatment for depression. Rate how often each statement applies to you over the past two weeks.

Answer each on a 1-5 scale: 1=Never, 2=Rarely, 3=Sometimes, 4=Often, 5=Always.

Start the Self-Assessment

I feel sad, down, or depressed.

1 - Never

2

3

4

5 - Always

I feel hopeless about the future.

1 - Never

2

3

4

5 - Always

I have lost interest in activities I used to enjoy.

1 - Never

2

3

4

5 - Always

I have trouble sleeping or staying asleep.

1 - Never

2

3

4

5 - Always

I feel fatigued or have low energy most days.

1 - Never

2

3

4

5 - Always

I feel worthless or excessively guilty.

1 - Never

2

3

4

5 - Always

I have trouble concentrating or making decisions.

1 - Never

2

3

4

5 - Always

I feel anxious or restless.

1 - Never

2

3

4

5 - Always

Antidepressants have not helped my depression.

1 - Never

2

3

4

5 - Always

My depression interferes with work or daily activities.

1 - Never

2

3

4

5 - Always

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