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Monthly Well Being Check-in 9

This is a brief survey that helps helps people see if they may be experiencing symptoms of depression and notice any changes over time. We use it to better understand the mental health needs of the people we work with and connect them to the right help or resources. Looking at the results also helps us see how our program is working, how to make improvements and show our impact to people who may want to support our work.

 

All responses are kept strictly confidential and will not be shared outside of our organization.

Little interest or pleasure in doing things?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Feeling down, depressed, or hopeless?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Trouble falling or staying asleep, or sleeping too much?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Feeling tired or having little energy?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Poor appetite or overeating?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Feeling bad about yourself — or that you are a failure or have let yourself or your family down?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Trouble concentrating on things, such as reading the newspaper or watching television?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month
Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?
Not at all
Several days this month
More than half of the days this month
Nearly ever day this month

Mosaic Advocacy is an equal opportunity organization and does not discriminate based upon ethnicity, race,

gender, religion, disability, age, sexual orientation, national origin, socioeconomic background or any other status.

Mosaic Advocacy is a registered 501(c)3 nonprofit.

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