Download:
pdf |
pdf The following questions ask you about how you felt or behaved in the past week. Please read each
question and shade in the best answer in the appropriate circle. Remember, there are no right or
wrong answers.
The response categories are:
Rarely or none of the time (less than once per week)
Some or a little of the time (1 - 2 days per week)
Occasionally or a moderate amount of the time (3 - 4 days per week)
Most or all of the time (5 - 7 days per week)
1. I was bothered by things that usually don’t bother me……......
2. I did not feel like eating: my appetite was poor……..….............
{
{
{
Rarely
Some
Occasionally
{
{
{
Rarely
Some
Occasionally
3. I felt that I could not shake off the blues even with the help of
family and friends……..…..…..…..…..…..…..….......................
{
{
{
Rarely
Some
Occasionally
4. I felt that I was just as good as other people……..…..…..........
{
{
{
Rarely
Some
Occasionally
5. I had trouble keeping my mind on what I was doing……..….....
6. I felt depressed……..…..…..…..…..…..…..…..…..…..….........
7. I felt that everything I did was an effort……..…..…..…............
8. I felt hopeful about the future……..….…..…..…..…...…..........
9. I thought my life had been a failure……..…..…..…..….............
10. I felt fearful……..…..…..…..…..…..…..…..…..…..…..….........
SEARCH 3 Cohort Study – CES-D 11-01-10
{
{
{
Rarely
Some
Occasionally
{
{
{
Rarely
Some
Occasionally
{
{
{
Rarely
Some
Occasionally
{
{
{
Rarely
Some
Occasionally
{
{
{
Rarely
Some
Occasionally
{
{
{
Rarely
Some
Occasionally
{
Most
{
Most
{
Most
{
Most
{
Most
{
Most
{
Most
{
Most
{
Most
{
Most
Page 1 of 3
The response categories are:
Rarely or none of the time (less than once per week)
Some or a little of the time (1 - 2 days per week)
Occasionally or a moderate amount of the time (3 - 4 days per week)
Most or all of the time (5 - 7 days per week)
11. My sleep was restless……..…..…..………..…..…..….................
12. I was happy……..…..…..…..…..…..…..…..…..…..…..............
13. I talked less than usual……..…..…..…..…..…..…..…..….........
{
{
{
{
Rarely
Some
Occasionally
Most
{
{
{
{
Rarely
Some
Occasionally
Most
{
{
{
{
Rarely
Some
Occasionally
Most
14. I felt lonely……..…..…..…..…..…..…..…..…..….…...…..........
{
{
{
{
Rarely
Some
Occasionally
Most
15. People were unfriendly……..…..…..….…..…..…..…...….........
{
{
{
{
Rarely
Some
Occasionally
Most
{
{
{
{
Rarely
Some
Occasionally
Most
{
{
{
{
Rarely
Some
Occasionally
Most
{
{
{
{
Rarely
Some
Occasionally
Most
16. I enjoyed life……..…..…..…..…..…..…..…..…..…..….............
17. I had crying spells……..…..…..…..….…..…..…..…...…...........
18. I felt sad……..…..…..…..…..…..…..….…..…..…..…...............
19. I felt that people disliked me……..…..…..…..…..…..…............
20. I could not get going……..…..…..…..….…..…...…..…............
{
{
{
{
Rarely
Some
Occasionally
Most
{
{
{
{
Rarely
Some
Occasionally
Most
This is the end of the questionnaire. Thank you for answering these questions.
SEARCH 3 Cohort Study – CES-D – 11-01-10
Page 2 of 3
FOR STUDY USE ONLY
Date Completed
Month
Day
Year
Date Reviewed
Reviewer Code
Month
Day
Year
Date Entered
Month
Day
SEARCH 3 Cohort Study – CES-D – 11-01-10
Year
Data Entry
Code
Page 3 of 3
| File Type | application/pdf |
| File Title | Microsoft Word - CESD 9-13-10 Cohort from 5-01-02 11-01-10 FINAL FINAL |
| Author | stmoxley |
| File Modified | 2011-05-10 |
| File Created | 2010-10-30 |