SYMPTOMS AND FEELINGS 0 1 2 3
Feeling no love for the baby
Feeling numb
Feeling out of control
Feeling panicky
Feeling that your baby would be better off without you
Feeling trapped
Feeling unsupported - that no one cares about you
having scary thoughts
Insomnia / change in sleep patterns
Loss of concentration
Loss of interest in your appearance
Loss of libido
Loss of motivation
Loss of self-esteem
Mood swings
obsessive thinking
Panic attacks
Pre-occupation with death
Suicidal thinking
Unusual conflict and fights with people close to you
unusual physical symptoms - headaches, irregular
heartbeat, nausea etc.
unusual weight gain or loss
other
SCORE (write total score here)
Guidelines to the interpretation of your total score
Less than 40 = Mild adjustment difficulties
41 - 69 = Moderate to severe depression and anxiety
70+ = Severe depression and anxiety
If you scored above 40, we recommend that you print this form and take it to your health
professional immediately.
CHAPTER 6: APPENDIX
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