738 Assessment MeasuresDSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult
Name:__________________________________________ ______________ Age: __________ Sex: [ ] Male [ ] Female Date:_____________
If the measure is being completed by an informant , what is your relationship with the individual?: __________________________ ____
In a typical week, approximately how much time do you spend with th e individual? _________________________ hours/week
Instructions:  The questions below ask about things that might have bothered you. For each question, circle the nu mber that best describes ho w much (or how 
often) you have been bothered  by each problem during the past TWO (2) WEEKS.
During the past TWO (2) WEEKS,  how much (or how often) 
have you been bothered by the following problems?None
Not at 
allSlight
Rare, less than 
a day or twoMild
Several 
daysModerate
More than
half the daysSevere
Nearly 
every dayHighest 
Domain Score
(clinician)
I. 1.Little interest or pleasure in doing things? 0 1 2 3 4
2.Feeling down, depressed, or hopeless? 0 1 2 3 4
II. 3. Feeling more irritated, gr ouchy, angry than usual? 0 1 2 3 4
III. 4.Sleeping less than usual, but still have a lot of energy? 0 1 2 3 4
5.Starting lots more projects than usual or doing more risky things 
than usual?0 1 2 3 4
IV. 6.Feeling nervous, anxious, frig htened, worried, or on edge? 0 1 2 3 4