Identification number
Age (years)
Sex
Race
...feel sad
...feel pessimistic about the future
...feel like a failure
...feel dissatisfied
...feel guilty or unworthy
...feel that I am being punished
...feel disappointed in myself
...feel am very critical of myself
...feel like harming myself
...feel like crying more than usual
...become annoyed or irritated easily
...have lost interest in other people
...have trouble making decisions
...feel unattractive
...feel like not working
...have trouble sleeping
...feel tired or fatigued
...makes my appetite lower than usual
...concerned about my health
...experience decreased libido
Sum of questions 1-20