Alexandre Mitellus

Tag: English

  • Burn Depression Checklist

    Burn's Depression Checklist

    Please answer all questions based on how you have been feeling over the past 30 days. Select one option per question. All answers are required.

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    GDPR consent is required.
    Mental health consent is required.

    Thoughts and Feelings

    1. Feeling sad or down in the dumps

    2. Feeling unhappy or blue

    3. Crying spells or tearfulness

    4. Feeling discouraged

    5. Feeling hopeless

    6. Low Self-Esteem

    7. Feeling worthless or inadequate

    8. Guilt or shame

    9. Criticising yourself or blaming others

    10. Difficulty in making decisions

    Activities and Personal Relationships

    11. Loss of interest in family, friends or colleagues

    12. Loneliness

    13. Spending less time with family or friends

    14. Loss of motivation

    15. Loss of interest in work or other activities

    16. Avoiding work or other activities

    17. Loss of pleasure or satisfaction in life

    Physical Symptoms

    18. Feeling tired

    19. Difficulty sleeping or sleeping too much

    20. Decrease or increases appetite

    21. Loss of interest in sex

    22. Worrying about your health

    Suicidal Urges

    23. Do you have any suicidal thoughts?

    24. Would you like to end your life?

    25. Do you have a plan for harming yourself?

    Please answer all questions.

  • K10 Test

    K10 Test

    These questions concern how you have been feeling over the past 30 days. Select an option for each question that best represents how you have been. Answer all questions.

    Rating Scale:
    1 = None of the time
    2 = A little of the time
    3 = Some of the time
    4 = Most of the time
    5 = All of the time


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    GDPR consent is required.
    Mental health consent is required.

    1. During the last 30 days, about how often did you feel tired out for no good reason?

    2. During the last 30 days, about how often did you feel nervous?

    3. During the last 30 days, about how often did you feel so nervous that nothing could calm you down?

    4. During the last 30 days, about how often did you feel hopeless?

    5. During the last 30 days, about how often did you feel restless or fidgety?

    6. During the last 30 days, about how often did you feel so restless you could not sit still?

    7. During the last 30 days, about how often did you feel depressed?

    8. During the last 30 days, about how often did you feel that everything was an effort?

    9. During the last 30 days, about how often did you feel so sad that nothing could cheer you up?

    10. During the last 30 days, about how often did you feel worthless?

    Please answer all questions.

    Data collection disclamer

    More info on the Kessler Psychological Distress Scale (K10) can be found here.

  • DASS – 21

    Please read each statement and select a number 0, 1, 2, or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

    Rating Scale:
    0 = Did not apply to me at all (NEVER)
    1 = Applied to me to some degree, or some of the time (SOME)
    2 = Applied to me to a considerable degree, or a good part of time (OFTEN)
    3 = Applied to me very much, or most of the time (MOSTLY)


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    GDPR consent is required.
    Health evaluation consent is required.

    1. I found it hard to wind down

    2. I was aware of dryness of my mouth

    3. I couldn't seem to experience any positive feeling at all

    4. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion)

    5. I found it difficult to work up the initiative to do things

    6. I tended to over-react to situations

    7. I experienced trembling (e.g., in the hands)

    8. I felt that I was using a lot of nervous energy

    9. I was worried about situations in which I might panic and make a fool of myself

    10. I felt that I had nothing to look forward to

    11. I found myself getting agitated

    12. I found it difficult to relax

    13. I felt down-hearted and blue

    14. I was intolerant of anything that kept me from getting on with what I was doing

    15. I felt I was close to panic

    16. I was unable to become enthusiastic about anything

    17. I felt I wasn't worth much as a person

    18. I felt that I was rather touchy

    19. I was aware of the action of my heart in the absence of physical exertion (e.g., sense of heart rate increase, heart missing a beat)

    20. I felt scared without any good reason

    21. I felt that life was meaningless

    Please answer all questions.

    More info on the test