Forms – Columbia Teen

Columbia DISC Depression Scale (Ages 11 and over) – Teen (rev 20220822)

Columbia DISC Depression Scale (Ages 11 and over)

Present State (last 4 weeks)
TO BE COMPLETED BY TEEN

Child & Adolescent Psychiatry at Columbia University & NYSPI
Client name*
First Last
Date of birth*
MM slash DD slash YYYY
Program*
- Psychiatry only
- CGC
- School-based Health Center
- FFT
- MDFT
- IICAPS
Is the client 11 years old, or older?*
- Yes
- No
Columbia Form
Please answer the following questions as honestly as possible.

In the last four weeks …
1. Have you often felt sad or depressed?*
- No
- Yes
2. Have you felt like nothing is fun for you and you just aren't interested in anything?*
- No
- Yes
3. Have you often felt grouchy or irritable and often in a bad mood, when even little things would make you mad?*
- No
- Yes
4. Have you lost weight, more than just a few pounds?*
- No
- Yes
5. Have you lost your appetite or often felt less like eating?*
- No
- Yes
6. Have you gained a lot of weight, more than just a few pounds?*
- No
- Yes
7. Have you felt much hungrier than usual or eaten a lot more than usual?*
- No
- Yes
8. Have you had trouble sleeping – that is, trouble falling asleep, staying asleep, or waking up too early?*
- No
- Yes
9. Have you slept more during the day than you usually do?*
- No
- Yes
10. Have you often felt slowed down … like you walked or talked much slower than you usually do?*
- No
- Yes
11. Have you often felt restless … like you just had to keep walking around?*
- No
- Yes
12. Have you had less energy than you usually do?*
- No
- Yes
13. Has doing even little things made you feel really tired?*
- No
- Yes
14. Have you often blamed yourself for bad things that happened?*
- No
- Yes
15. Have you felt you couldn't do anything well or that you weren't as good looking or as smart as other people?*
- No
- Yes
16. Has it seemed like you couldn't think as clearly or as fast as usual?*
- No
- Yes
17. Have you often had trouble keeping your mind on your [schoolwork/work] or other things?*
- No
- Yes
18. Has it often been hard for you to make up your mind or to make decisions?*
- No
- Yes
19. Have you often thought about death or about people who had died or about being dead yourself?*
- No
- Yes
20. Have you thought seriously about killing yourself?*
- No
- Yes
21. Have you tried to kill yourself in the last four weeks?*
- No
- Yes
22. Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt?*
- No
- Yes
Columbia Teen Score
Automatically calculated – do not edit

Score	Chance of Depression	How often is this seen?
0-6	Very unlikely	in 2/3 of teens
7-11	Moderately likely	in 1/4 of teens
12-15	Likely	in 1/10 of teens
16 and above	Highly likely	in 1/50 of teens

Forms – Columbia Teen

Columbia DISC Depression Scale (Ages 11 and over) – Teen (rev 20220822)

Columbia DISC Depression Scale (Ages 11 and over)

Present State (last 4 weeks) TO BE COMPLETED BY TEEN

Columbia Form

Present State (last 4 weeks)
TO BE COMPLETED BY TEEN