Geriatric Depression Scale - Short Form - Geronet

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STEP 1 ASSESSMENT: GERIATRIC DEPRESSION SCALE
Resident Name:_______________________
Staff Interviewer:___________________________
Date of Interview:____/____/____
mm
dd
yy
Check Response
DK=Don’t Know NR=No Response or Nonsense Response REF=Refusal to answer question
IF RESPONSE OF “SOMETIMES”, RESTATE THE QUESTION: “How do you feel MOST of the time?”
1. Are you basically satisfied with your life?
___YES
___NO
___DK/NR/REF
2. Have you dropped most of your activities and interests?
___YES
___NO
___DK/NR/REF
3. Do you feel that your life is empty?
___YES
___NO
___DK/NR/REF
4. Do you often get bored?
___YES
___NO
___DK/NR/REF
5. Are you in good spirits most of the time?
___YES
___NO
___DK/NR/REF
6. Are you afraid that something bad is going to happen to you?
___YES
___NO
___DK/NR/REF
7. Do you feel happy most of the time?
___YES
___NO
___DK/NR/REF
8. Do you often feel helpless?
___YES
___NO
___DK/NR/REF
9. Do you think it is wonderful to be alive?
___YES
___NO
___DK/NR/REF
10. Do you feel worthless the way you are now?
___YES
___NO
___DK/NR/REF
11. Do you feel full of energy?
___YES
___NO
___DK/NR/REF
12. Do you feel that your situation is hopeless?
___YES
___NO
___DK/NR/REF
SCORE > 4 = PROBABLE DEPRESSION
TOTAL SCORE:_________
Scoring System: Each BOLD-FACED answer counts one (1) point.
Do not calculate total score if more than 4 of the 12 questions have DK/NR/REF answers.
Interview outcome (check one):
Complete ___
Refused ___
I:Doc/DMC/Project/Schnelle/Forms/Assessment G_GDS (1/17/03)

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