Mood and Wellbeing Questionnaire (GDS-15)

This form is for your appointment with Dr Jha. It is not checked out of hours, so please don’t use it for anything urgent: call 999 in an emergency, or NHS 111 or your GP for other urgent problems.

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- Step 1 of 2

Mood and Emotional Wellbeing

This short questionnaire helps us understand how you have been feeling in yourself.

It includes 15 simple yes or no questions and usually takes only a few minutes to complete. Please answer based on how you have felt over the past week. There are no right or wrong answers.

It will take 3-5 min to complete.

Patient name *

Date of birth *

Next

There are 15 questions to answer.

It will take 3-5 min to complete.

1. Are you basically satisfied with your life? *

• Yes
• No

2. Have you dropped many of your activities and interests? *

• Yes
• No

3. Do you feel that your life is empty? *

• Yes
• No

4. Do you often get bored? *

• Yes
• No

5. Are you in good spirits most of the time? *

• Yes
• No

6. Are you afraid that something bad is going to happen to you? *

• Yes
• No

7. Do you feel happy most of the time? *

• Yes
• No

8. Do you often feel helpless? *

• Yes
• No

9. Do you prefer to stay at home rather than going out and doing new things? *

• Yes
• No

10. Do you feel you have more problems with memory than most? *

• Yes
• No

11. Do you think it is wonderful to be alive now? *

• Yes
• No

feel that Have

12. Do you feel pretty worthless the way you are now? *

• Yes
• No

13. Do you feel full of energy? *

• Yes
• No

14. Do you feel that your situation is hopeless? *

• Yes
• No

15. Do you think that most people are better off than you are? *

• Yes
• No

Consent *

• I confirm that the information provided is accurate to the best of my knowledge.
• I consent to this information being used for clinical assessment and stored securely in accordance with data protection regulations.

Submit

Your answers are stored securely on this website for Dr Jha. They are copied into your clinical record and deleted from the website within 90 days. Privacy notice

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