Quad: Emotional Well-Being Check (2021)

Mental Health Self-Assessment

This quiz is just for you, so don't worry - your results are completely private. No-one but you has access to your results, so be honest and don’t hold back.

PART A: Over the past two weeks, how often have you been bothered by any of the following problems? Circle the number that applies.*

	Never	Sometimes	Frequently	Always
1. I have little interest or pleasure in doing things.
2. I am feeling down or depressed or hopeless.
3. I have trouble falling or staying asleep or sleeping too much.
4. I am feeling tired or have little energy.
5. I have a poor appetite or am overeating.
6. I feel bad about myself — or that I am a failure or have let myself or my family down.
7. I have trouble concentrating on things such as reading the newspaper or watching television.
8. I move or speak so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that I have been moving around a lot more than usual.
9. I have thoughts that I would be better off dead or of hurting myself in some way.

INTERPRETING YOUR SCORE: 0-4 minimal depression; 5-9 mild depression; 10-14 moderate depression; 15-19 moderately severe; 20+ severe depression.

PART B: Over the past two weeks, how often have you been bothered by any of the following problems? Circle the number that applies.*

	Never	Sometimes	Frequently	Always
1. I am feeling nervous, anxious or on edge.
2. I am not able to stop or control worrying.
3. I worry too much about different things.
4. I have trouble relaxing.
5. I am so restless that it is hard to sit still.
6. I become easily annoyed or irritable.
7. I feel afraid as if something awful might happen.

INTERPRETING YOUR SCORE: 0-4 minimal anxiety; 5-9 mild anxiety; 10-14 moderate anxiety; 15+ severe anxiety
TOTAL SCORE: 0-4 minimal anxiety; 5-14 mild to moderate anxiety; 15+ severe anxiety
IMPORTANT! You do not need to carry a Quad Health plan to utilize EAP.

Call the Emotional Support Connection at 414.566.6080 to learn what services are available for you.
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Mental Health Self-Assessment