Mental Health Baseline
This is the second part of your application to the Mooditude Grant. You must complete the form in its entirety. We appreciate your feedback and we look forward to getting back to you on your request!

The Patient Health Questionnaire (PHQ-9) is a self administered version of the PRIME-MD diagnostic instrument for common mental disorders. It is a tool utilized to screen depression and monitor changes in signs/symptoms of depression. The Generalized Anxiety Disorder scale (GAD-7) is a self-administered diagnostic report that is used for screening, diagnosing, and assessing the severity of an anxiety disorder.

Your response to this form is confidential and will be simply used for research purposes. Your responses will remain between you and Mooditude. Please make sure to complete both this form and the Grant Award Request Form .
Your Name: *
Your Email: *
Over the last 2 weeks, how often have you been bothered by any of the following problems? *
Not at all
Several days
More than half the days
Nearly every day
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself--or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed. Or the opposite--being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead, or of hurting yourself
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? *
Over the last 2 weeks, how often have you been bothered by the following problems? *
Not at all sure
Several days
Over half the days
Nearly every day
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it's hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen
If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? *
Any additional comments you'd like to share?
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