I've been studying a few facts about depression. I would like to
ask you a few questions about depression. Don't feel like you have
to answer any question you don't want to answer.
1. What year were you
born? |
|
YEAR OF BIRTH |
DON'T KNOW |
REFUSE |
|
2. What is the
highest grade or year of school you have completed? [Read choices if
necessary.] |
|
Eighth grade or less |
Some high school |
High school graduate or GED
certificate |
Some post high school |
College graduate (Associate or
Bachelor's) |
Post graduate education or degree |
Other (Specify) |
DON'T KNOW |
REFUSE |
|
3. What is the
highest grade or year of school that anyone else in your
household has completed? [Read choices if
necessary.] |
|
Eighth grade or less |
Some high school |
High school graduate or GED
certificate |
Some post high school |
College graduate (Associate or
Bachelor's) |
Post graduate education or degree |
Other (Specify) |
DON'T KNOW |
REFUSE |
|
4. Are you currently:
[List the choices.] |
|
Employed or self-employed full-time |
Employed or self-employed part-time |
Homemaker or caregiver |
Out of work or unable to work |
Student |
Student and employed |
Retired |
Something else (Specify) |
REFUSE |
|
5. Are you currently:
[Pick
one from the list that you feel best describes your current status.”] |
|
Married |
Partnered |
Divorced |
Widowed |
Separated |
Never married |
Other (Specify) |
DON'T KNOW |
REFUSE |
|
6. Do you have a
history of depression in your family? |
|
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7. Do you ever feel
hopeless? If so, do you know why? |
|
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8. Have you
experienced a traumatic or emotional even recently? If so,
how have you felt since it happened? |
|
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9. Have you lost
someone close to you recently? If so, how have you felt
since it happened? |
|
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Most of the time, do people say you are a pessimist or an optimist? |
|
Optimist |
Pessimist |
Id you don't know, which do you think you are
more like? |
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10.What is your energy
level most of the time? |
|
Very high |
High |
Medium |
Low |
Very low |
|
11.Did you know that depression is
a very common illness in the United States? |
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12.When you feel down,
depressed, or blue, what help you feel good again? |
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13.What do you think
causes depression in people? |
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