Group Work

Mood Score (PHQ/GAD)

In order for us to get a better idea of how you are feeling at the moment and to help us understand how we can best support you please complete this quick mood score self assessment below and click on the submit button.

All fields highlighted in red are mandatory.

First name:

Last name:

Over the last 2 weeks, how often have you been bothered by the following problems?

How's your mood?	Not at all	Less than half the days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things:	0	1	2	3
2. Feeling down, depressed or hopeless:	0	1	2	3
3. Trouble falling or staying asleep, or sleeping too much:	0	1	2	3
4. Feeling tired or having little energy:	0	1	2	3
5. Poor appetite or over eating:	0	1	2	3
6. Feeling bad about yourself - or that you have let yourself of your family down:	0	1	2	3
7. Trouble concentrating on things, such as reading the newspaper or watching television:	0	1	2	3
8. 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:	0	1	2	3
9. Thoughts that you would be better off dead or of hurting yourself in any way:	0	1	2	3
*(if you circle 1 or higher for Q9 please answer the following questions 9a, 9b and 9c)*

9a) Do you have any current plans to end your life?

Yes No

9b) What stops you from acting on these thoughts?

9c) Have you ever acted on these thoughts in the past?

Yes No

If yes, please tell us more about this including when this was:

How anxious are you?	Less than half the days	More than half the days	Nearly every day
1. Feeling nervous, anxious or on edge:	1	2	3
2. Not being able to stop or control worrying:	1	2	3
3. Worrying too much about different things:	1	2	3
4. Trouble relaxing:	1	2	3
5. Being so restless that it's hard to sit still:	1	2	3
6. Becoming easily annoyed or irritable:	1	2	3
7. Feeling afraid as if something awful might happen:	1	2	3

SUBMIT >

If you live in Birmingham and need help?

If you need help or support or have any questions please call.
0121 301 5990
or click here to email us

If you live outside of Birmingham and need help?

If you need help or support please visit the Hearts and Minds website.

Acacia Family Support
Phone: 0121 301 5990

5a Coleshill Street
Sutton Coldfield
West Midlands
B72 1SD

Phone line operates:
Monday to Friday
9:15am - 3:00pm

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Group Work

Mood Score (PHQ/GAD)

If you live in Birmingham and need help?

If you live outside of Birmingham and need help?