Clinical Trauma & Mental Health Assessment

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🏥 Clinical Mental Health Self-Assessment

PTSD (PCL-5), Depression (PHQ-9), Anxiety (GAD-7), Dissociation, Sleep, ACEs, and Grief (BGQ-5)

For reflection and next steps — not a diagnosis.

Safety note: If you’re in immediate danger, call 999 (UK) / 112 (EU) / 911 (US/CA). In the UK you can call 116 123 (Samaritans) or text SHOUT to 85258.

📋 Basic information

Optional — helps tailor suggestions.

Age range

Have you received mental health treatment before?

🔍 Trauma history (optional)

Select anything that fits. You can skip this section if you prefer.

Life experiences

When did your most significant experience happen?

🧠 PTSD symptoms (PCL-5, past month)

How much have you been bothered by the following?

1. Repeated, disturbing, unwanted memories of the event

2. Repeated, disturbing dreams of the event

3. Suddenly feeling or acting as if it were happening again (reliving)

As if you were reliving it

4. Feeling very upset when reminded of the event

5. Strong physical reactions when reminded (heart pounding, trouble breathing, sweating)

E.g., heart pounding, trouble breathing, sweating

6. Avoiding memories, thoughts, or feelings about it

7. Avoiding external reminders (people, places, conversations, activities)

8. Trouble remembering important parts of the event

9. Strong negative beliefs about yourself, others, or the world

10. Blaming yourself or others for the event or what happened after

11. Strong negative feelings (fear, horror, anger, guilt, shame)

12. Loss of interest in activities you used to enjoy

13. Feeling distant or cut off from other people

14. Trouble experiencing positive feelings (e.g., inability to feel happiness or love)

15. Irritable behaviour, angry outbursts, or acting aggressively

16. Taking too many risks or doing harmful things

17. Being super alert, watchful, or on guard

18. Feeling jumpy or easily startled

19. Difficulty concentrating

20. Trouble falling or staying asleep

😔 Depression (PHQ-9, last 2 weeks)

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling or staying asleep, or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading or watching TV

8. Moving or speaking so slowly that other people could have noticed — or the opposite: being so fidgety or restless

9. Thoughts that you would be better off dead, or of hurting yourself

😰 Anxiety (GAD-7, last 2 weeks)

1. Feeling nervous, anxious, or on edge

2. Not being able to stop or control worrying

3. Worrying too much about different things

4. Trouble relaxing

5. Being so restless that it’s hard to sit still

6. Becoming easily annoyed or irritable

7. Feeling afraid as if something awful might happen

🌀 Dissociation & disconnection

1. Feeling disconnected from yourself, like watching from outside (depersonalisation)

2. Things around you feel unreal or foggy (derealisation)

3. Finding yourself somewhere with no memory of getting there

4. Feeling emotionally numb or cut off from feelings

5. ‘Spacing out’ and not aware of surroundings

😴 Sleep & nights (past month)

Overall sleep quality

Trouble falling asleep

Wake during night & can’t get back to sleep

Nightmares or disturbing dreams wake you up

Do you avoid sleep due to fear of dreams/thoughts?

🤝 Support & safety

Support system

Are you currently in physical danger or unsafe?

In the past month, any thoughts of ending your life or harming yourself?

💼 Daily life impact

How difficult have these problems made life/work/relationships?

Are you using alcohol or drugs to cope?

🏫 Adverse Childhood Experiences (before 18) — optional

This is a simple count (0–10). It isn’t a diagnosis.

🖤 Grief screening (BGQ-5, past month) — optional

May help if you’re bereaved. Not a diagnosis.

1. In the past month, how often have you felt that your life is empty or meaningless because of your loss?

2. In the past month, how often has it been hard to accept the death?

3. In the past month, how often have you felt stunned, dazed, or shocked by the loss?

4. In the past month, how often do memories of your loved one interfere with everyday life?

5. In the past month, how often have you felt bitter, angry, or that moving on is impossible?

🚨 Emergency resources

🇬🇧 United Kingdom
Samaritans: 116 123
NHS 111 (urgent, non-emergency)
🇺🇸 United States
988 Suicide & Crisis Lifeline
Crisis Text Line: Text HOME to 741741
🇨🇦 Canada
Talk Suicide: 1-833-456-4566
Kids Help Phone: 1-800-668-6868
🇦🇺 Australia
Lifeline: 13 11 14
Beyond Blue: 1300 224 636