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Emotional Distress-Depression-Short Form 1 Trastorno emocional - Depresión – Cuestionario abreviado 1 FORM CODE: PRM VERSION: A ID NUMBER: Contact Occasion SEQ # Administrative Information / 0a. Completion Date: Month / 0b. Staff ID: Day Year Instructions: Please respond to each item by marking one box per row. (Responda a cada enunciado marcando una casilla por línea). Affix the participant ID label above. In the past 7 days…. En los últimos 7 días.... Never Nunca Rarely Rara vez Sometimes Algunas veces Often A menudo Always Siempre I felt worthless…………………………. Sentí que no valía nada....................................... 1 2 3 4 5 I felt that I had nothing to look forward to……………………………………….. Sentí que nada me ilusionaba ............................. 1 2 3 4 5 EDDEP06 I felt helpless…………………………… Me sentí indefenso/a (que no podía hacer nada para ayudarme) .......................................... 1 2 3 4 5 EDDEP17 I felt sad………………………………... Me sentí triste ...................................................... 1 2 3 4 5 EDDEP22 I felt like a failure………………………. Me sentí fracasado/a ........................................... 1 2 3 4 5 EDDEP29 I felt depressed…………………………. Me sentí deprimido/a ........................................... 1 2 3 4 5 EDDEP36 I felt unhappy………………………….. Me sentí descontento/a ....................................... 1 2 3 4 5 I felt Hopeless………………………….. Me sentí desesperanzado/a ................................ 1 2 3 4 5 EDDEP04 EDDEP05 EDDEP41 PROMIS (PRM) © 2008 PROMIS Health Organization and PROMIS Cooperative Group Page 1 of 1