Edinburgh | Driscoll Health Plan

Your Name:*

First Last

Your date of birth:*

Your Member ID:*

Your phone number:*

Your address:*

Street Address Address Line 2 City ZIP Code

State*

Your baby’s date of birth:*

Since you are pregnant or have recently had a baby, we would like to know how you are doing now. Please select the answer that is closest to how you have felt during THE PAST 7 DAYS and not just how you are feeling today.

In the past 7 days:

I have been able to laugh and see the funny side of things*

As much as I always could
Not quite so much now
Definitely not so much now
Not at all

I have looked forward with enjoyment to things*

As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all

I have blamed myself unnecessarily when things went wrong*

Yes, most of the time
Yes, some of the time
Not very often
No, never

I have been anxious or worried for no good reason*

No, not at all
Hardly ever
Yes, sometimes
Yes, very often

I have felt scared or panicky for no good reason*

Yes, quite a lot
Yes, sometimes
No, not much
No, not at all

Things have been getting on top of me*

Yes, most of the time I haven’t been able to cope at all
Yes, sometimes I haven’t been coping as well as usual
No, most of the time I have coped quite well
No, I have been coping as well as ever

I have been so unhappy that I have had difficulty sleeping*

Yes, most of the time
Yes, sometimes
Not very often
No, not at all

I have felt sad or miserable*

Yes, most of the time
Yes, quite often
Not very often
No, not at all

I have been so unhappy that I have been crying*

Yes, most of the time
Yes, quite often
Only occasionally
No, never

The thought of harming myself has occurred to me*

Yes, quite often
Sometimes
Hardly ever
Never

Edinburgh Score

Hidden

Escalate

Hidden

Spanish

Hidden

English

Hidden

Harming Often

Hidden

Harming sometimes

Depression Screening