Instructions : For every item below, circle the number of the statement that best describes how you have been feeling DURING THE PAST WEEK. Make sure to mark each item...

No more than usual

A little more than usual

Quite a bit more than usual

A great deal more than usual

I feel restless and on edge

1

2

3

4

I am irritable

1

2

3

4

I worry a lot

1

2

3

4

I have difficulty falling asleep

1

2

3

4

I feel tense all over

1

2

3

4

I fear something bad will happen

1

2

3

4

I can't relax

1

2

3

4

I have difficulty concentrating

1

2

3

4

I sweat a lot

1

2

3

4

I have difficulty breathing

1

2

3

4

I startle easily

1

2

3

4

I feel my heart beating

1

2

3

4

I feel light headed

1

2

3

4

I am apprehensive

1

2

3

4

I have indigestion

1

2

3

4

Scoring :

Add up your total score (that is, all the numbers that you have circled). Compare you score with the guidelines below.

your score:

Score

Depression Rating

Recommended Action

15 to 21

No anxiety evident

None

22 to 28

Mild to moderate anxiety

Monitor symptoms closely and seek professional evaluation if condition worsens

29 to 35

Moderately severe anxiety

If symptoms persist for more than one week, should obtain a professional evaluation

36 to 60

Severe anxiety

Should obtain a professional help and treatment without delay