Select the statements that best describe your actual feelings over the last few months.
Please be honest with your answers. This inventory is confidential and secure; any information collected will be used for the express purpose of contacting you regarding the submission of this form only.
☐ 1. I no longer have any interest in the things that used to interest me.
☐ 2. I feel hopeless about the future.
☐ 3. I can’t make decisions because I have a difficult time concentrating.
☐ 4. I feel sluggish or restless.
☐ 5. I am gaining or losing weight without trying to.
☐ 6. I get tired for no reason.
☐ 7. I am sleeping too much, or too little.
☐ 8. I feel unhappy.
☐ 9. I become irritable or anxious easily.
☐ 10. I have spontaneous urges to cry.
☐ 11. I think about dying or killing myself.
– If you checked statement 11, please seek help immediately.
Caring people are standing by to help. Contact Lifeways at our Malheur location, (800) 995-9169, or at our Umatilla location at (866) 343-4473.
– If you checked five or more of these statements and have felt this way every day for several months, you should schedule a free behavioral health screening at Lifeways.
– If you checked less than five statements but still feel your ability to function in life is impaired, you should schedule a free behavioral health screening at Lifeways.
We are here to help. Please contact Lifeways at our Malheur location at (800) 995-9169 or at our Umatilla location at (866) 343-4473.
This assessment was developed to help you become more familiar with what you or someone you care about may be experiencing. If it can help explain your feelings, share this inventory with someone who cares about you or with a behavioral health professional.
It’s important to note that only a health care professional can diagnose a behavioral health disorder.