top of page

Burns Depression Checklist

Instructions: Choose the best answer for how you have felt over the past week, including today. Mark the answer that best describes how much that symptom or problem has bothered you.

0 = Not at all 1 = Somewhat 2 = Moderate 3 = A lot 4= Extreme

Category I: Thoughts and Feelings
Feeling sad or in the dumps
Feeling unhappy or blue
Crying spells or tearfulness
Feeling discouraged
Feeling hopeless
Low self-esteem
Feeling worthless or inadequate
Guilty or ashamed
Criticizing yourself or blaming others
Difficulties making decisions
Category II: Activities and Personal Relationships
Loss of interest in family, friends or colleagues
Loneliness
Spending less time with family or friends
Loss of motivation
Loss of interest in work or other activities
Avoiding work or other activities
Loss of pleasure or satisfaction in life
Category III: Physical Symptoms
Feeling tired
Difficulty sleeping or sleeping too much
Decreased or increased appetite
Loss of interest in physical intimacy / sex
Worrying about your health
Category IV: Suicidal Urges
Do you have any suicidal thoughts?
Would you like to end your life?
Do you have a plan for harming yourself?

0-5 No depression                     6-10  Normal but unhappy

11-25 Mild depression               26-50 Moderate depression

51-75 Severe depression           76-100 Extreme depression

Thanks for submitting!

bottom of page