Family Psychology Offices

2210 Line Avenue

Shreveport, Louisiana

Pregnancy and Postnatal Checklist

 

This CHECKLIST is not an established diagnostic instrument.  Rather, it is intended to help you indicate and articulate common symptoms and feelings of Depression & Anxiety in pregnancy and during the first year after a baby and to assist you in talking to your healthcare professional.

To complete the Checklist, please circle the appropriate number�that is the one that comes closest to the way you have been feeling and thinking during the past two weeks. 

                                                                                   Back to Checklists                                             Back to Home Page

0 = NOT AT ALL

1 = FROM TIME TO TIME

2 = QUITE OFTEN

3 = MOST OF THE TIME

                                                                      

Symptoms and Feelings 

Appetite change

 0  1  2  3

Being forgetful

 0  1  2  3

Being indecisive

 0  1  2  3

Confused thinking

 0  1  2  3

Crying spells

 0  1  2  3

Fears or fantasies of harming yourself or others

 0  1  2  3

Fears or fantasies of harming baby

 0  1  2  3

Feeling afraid

 0  1  2  3

Feeling angry

 0  1  2  3

Feeling anxious

 0  1  2  3

Feeling depressed

 0  1  2  3

Feeling fatigued

 0  1  2  3

Feeling frustrated

 0  1  2  3

Feeling guilty

 0  1  2  3

Feeling hopeless

 0  1  2  3

Feeling irritable

 0  1  2  3

Feeling like a bad mother

 0  1  2  3

Feeling lonely

 0  1  2  3

Feeling no love for the baby

 0  1  2  3

Feeling numb

 0  1  2  3

Feeling out of control

 0  1  2  3

Feeling panicky

 0  1  2  3

Feeling that your baby would be better off without you

 0  1  2  3

Feeling trapped

 0  1  2  3

Feeling unsupported � that no-one cares about you

 0  1  2  3

Having scary thoughts

 0  1  2  3

Insomnia/changes in your sleep patterns

 0  1  2  3

Loss of concentration

 0  1  2  3

Loss of interest in your appearance

 0  1  2  3

Loss of libido � no interest in sex

 0  1  2  3

Loss of motivation

 0  1  2  3

Loss of self-esteem

 0  1  2  3

Mood swings

 0  1  2  3

Obsessive thinking � weird thoughts keep going round in your head

 0  1  2  3

Panic attacks

 0  1  2  3

Pre-occupation with death �often thinking about death and dying

 0  1  2  3

Suicidal thinking � thinking of killing yourself

 0  1  2  3

Unusual conflict and fights with people close to you

 0  1  2  3

Unusual physical symptoms- headaches, irregular heartbeat, nausea, �knot in your stomach� etc.

 0  1  2  3

Unusual weight gain or loss

 0  1  2  3

Other

 0  1  2  3

SCORE (write total score)

 

 

CONTACT A HEALTH PROFESSIONAL IMMEDIATELY IF YOU HAVE ANY OF THE ABOVE SYMPTOMS THAT ARE HIGHLIGHTED IN RED.

 

GUIDELINES TO THE INTERPRETATION OF YOUR TOTAL SCORE

 

Less than 40 

=MILD adjustment difficulties;

41-69

=MODERATE-SEVERE Depression and Anxiety

70+                  

=SEVERE     DEPRESSION AND ANXIETY

 

 

If you score above 40, we recommend that you print this form and take it to your health professional

 

immediately.