Forms – Columbia Parent

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

Columbia DISC Depression Scale (Ages 11 and over)

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

Child & Adolescent Psychiatry at Columbia University & NYSPI
Client name*
First Last
Client 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 – to be completed by Parent
Please answer the following questions as honestly as possible.

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

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

Columbia DISC Depression Scale (Ages 11 and over)

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

Columbia – to be completed by Parent

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