Inuka Self Assessment
Email
*
I have adequate help for my baby and family (baby sitting help, getting kids to their activities, help with house chores, ease of getting off from work when you need to)
*
1 (Never)
2
3
4
5 (Always)
My baby is feeding well
*
1 (Never)
2
3
4
5 (Always)
As a working mom, I would like to quit my job to take care of my baby but I cannot because of financial pressure (skip this question if you are not in a paying job)
*
1 (Not at all)
2
3
4
5 (Definitely)
As a stay at home mom I feel sad that I am not working a paying job (skip this question if you are not a stay at home mom)
*
1 (Never)
2
3
4
5 (Always)
I'm experiencing mood swings (Severe mood changes, feeling depressed or hopeless)
*
1 (Never)
2
3
4
5 (Always)
I often cry without a clear reason.
*
1 (Never)
2
3
4
5 (Always)
I am struggling to connect (bond) with my baby
*
1 (Not at all)
2
3
4
5 (Definitely)
I am pulling away from family and friends (not communicating frequently with family and friends, not interested in social interactions)
*
1 (Not at all)
2
3
4
5 (Definitely)
I am eating much more or much less than usual
*
1 (Not at all)
2
3
4
5 (Definitely)
Changes in sleep patterns: I am experiencing insomnia (inability to fall asleep) or sleeping less than usual.
*
1 (Never)
2
3
4
5 (Always)
I feel overwhelmingly tired and lack energy to do what I need to do
*
1 (Never)
2
3
4
5 (Always)
I don't find pleasure in activities I once enjoyed
*
1 (I find no pleasure )
2
3
4
5 (I still find pleasure)
I am experiencing intense irritability and anger
*
1 (Not at all)
2
3
4
5 (Definitely)
I am experiencing severe anxiety and or panic attacks.
*
1 (Not at all)
2
3
4
5 (Definitely)
I feel worthless, guilty, or like a bad mother
*
1 (Never)
2
3
4
5 (Always)
I have trouble concentrating or making decisions.
*
1 (Never)
2
3
4
5 (Always)
I have thoughts of harming myself or my baby
*
1 (Not at all)
2
3
4
5 (Definitely)