Modified seasonal pattern assessment questionnaire

Name:				Age:
Date of birth: (dd/mm/yyyy)				Sex: Male Female
Date form completed: (dd/mm/yyyy)

1. To what degree do each of the following change with the seasons? (Mark one square only per question.)
	0 No change	1 Slight change	2 Moderate change	3 Marked change	4 Extremely marked change
A. Sleep length
B. Social activity (including family, friends, and coworkers)
C. Mood (overall feeling of well being)
D. Weight
E. Appetite
F. Energy level
	Total score:__________
2. If you experience changes with the seasons, do you feel that these are a problem for you?
No Yes
If yes, is the problem...	Mild	Moderate	Marked	Severe	Disabling
3. Do you typically feel worst in Winter?
No Yes

A positive screen requires each of the following:

Global seasonality score ≥11
Seasonal changes are a problem to at least a moderate degree in mood and behavior (eg, sleep, social activity, and weight)
Patient feels worst in winter

Patients who screen positive for seasonal affective disorder should be interviewed to establish the diagnosis.

Modified from: Rosenthal NE, Bradt GH, Wehr TA. Seasonal pattern assessment questionnaire. Bethesda, MD, National Institute of Mental Health, 1984.

Graphic 102614 Version 2.0