Dr Leigh Martens

Self-Assessments

Please answer each question.

Over the past two weeks or more, how often have you noticed or been concerned about any of the following in your child?

Question	Almost Never	Sometimes	Often	Very Often
1: Found your child appearing down in the dumps, troubled or sad?
2: Displayed a diminished interest or pleasure when performing daily activities?
3: Had a reduced appetite or ate far more than usual?
4: Experienced trouble falling or staying asleep, or slept too much in general?
5: Demonstrated a slowness in his/her movements or thought processes, or the opposite, appeared agitated, irritable and restless?
6: Complained about or appeared to be lethargic, tired or unusually listless?
7: Expressed thoughts of guilt, worthlessness or low self-esteem?
8: Displayed a diminished ability to mentally engage, make decisions or focus?
9: Spoke about morbid topics such as death or that life is not worth living?