Kutcher Adolescent Depression Scale-Self Report

Assessment 1 of 14

Form Instructions & Things to Know

How to fill this form:
  • Read each question carefully before selecting an answer.
  • Select the most accurate option based on your observations.
  • Do not skip questions; every response helps in the assessment.
Things to know:
10-15 Mins

Estimated completion time.

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Note: This is a screening and assessment tool, not clinical (medical).

First, please provide your contact information.

Information about the individual being assessed.

1. Feelings of worthlessness, hopelessness, letting people down, not being a good person.
2. Trouble concentrating, can't keep your mind on schoolwork or work, daydreaming when you should be working, hard to focus when reading, getting "bored" with work or school.
3. Low mood, sadness, feeling blah or down, depressed, just can’t be bothered.
4. Irritable, loosing your temper easily, feeling pissed off, loosing it.
5. Feeling decreased interest in: hanging out with friends; being with your best friend; being with your boyfriend/girlfriend; going out of the house; doing school work or work; doing hobbies or sports or recreation.
6. Feeling that life is not very much fun, not feeling good when usually (before getting sick) would feel good, not getting as much pleasure from fun things as usual (before getting sick).
7. Feeling worried, nervous, panicky, tense, keyed up, anxious.
8. Sleep difficulties - different from your usual (over the years before you got sick): trouble falling asleep, lying awake in bed.
9. Feeling tired, feeling fatigued, low in energy, hard to get motivated, have to push to get things done, want to rest or lie down a lot.
10. Physical feelings of worry like: headaches, butterflies, nausea, tingling, restlessness, diarrhea, shakes or tremors.
11. Thoughts, plans or actions about suicide or self-harm.