Brain Health Survey

Q1: Have you recently been feeling down, depressed or hopeless?

No, not at all

No, but occasionally I feel this way

Yes, I do sometimes feel this way

Yes, I feel this way all the time

Q2: Have you recently had trouble sleeping?

No, I always sleep fine

No, but sometimes I struggle to fall asleep

Yes, I often have trouble falling and staying asleep

Yes, I very rarely get a good nights rest

Q3: Have you recently been feeling tired or lacking energy?

No, not at all

No, but sometimes I do lack energy

Yes, I often feel tired and usually sometimes lack energy

Yes, I always feel tired and have no energy

Q4: Have you recently suffered from a low appetite or found yourself binge eating?

No, I've never had that problem

No, but occasionally I won't be that hungry and I have had cravings before

Yes, I often have a loss of appetite and usually binge on junk food when I'm feeling low

Yes, I have had a constant battle with low appetite and binge eating on junk foods

Q5: Have you recently felt bad about yourself or that you are a failure?

No, I generally feel good about myself

No, but occasionally I wonder whether I am good enough

Yes, I sometimes feel that I am just not good enough

Yes, I hate myself and feel like I am a complete failure

Q6: Have you recently had trouble concentrating on things, such as reading something or watching television?

No, my concentration is usually really good

No, but sometimes I daydream

Yes, I will often have trouble focussing on what I am doing

Yes, I am unable to concentrate on one thing, my mind just runs all over the place

Q7: Have you recently had trouble with remembering things?

No, my memory is perfect

No, but occasionally I forget where I placed my keys

Yes, at times I find it difficult to remember key details and I often misplace things

Yes, I am always forgetting things and find it difficult to remember even the most basic things

Q8: Have you recently been so fidgety or restless that you find yourself moving around a lot more than normal?

No, I am always calm and relaxed

No, but sometimes I will feel a bit anxious on the inside

Yes, I do tend to get restless and I fidget when I am stressed

Yes, I constantly fidget and can never sit still

Q9: Have you ever had thoughts that you would be better off dead, or ever contemplated hurting yourself?

No, absolutely not

No, but I've contemplated suicide once or twice in my life

Yes, I sometimes think about suicide and have self harmed in the past

Yes, I often think about taking my own life and feel the world would be better off without me in it

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