BHM-20 Mood Survey

Behavioral Health Measure-20® (BHM-20®) Click to Download the Celesthealth BHM-20 Scoring Guide Manual
Please answer these questions as they relate to the past two weeks.
1. How distressed have you been?
Extremely distressed (0)
Very distressed (1)
Moderately distressed (2)
A little bit distressed (3)
Not at all distressed (4)
2. How satisfied have you been with your life?
Not satisfied at all (0)
Mildly satisfied (1)
Somewhat satisfied (2)
Satisfied (3)
Very satisfied (4)
3. How energetic and motivated have you been feeling?
Not at all energetic and motivated (0)
A little bit energetic and motivated (1)
Somewhat energetic and motivated (2)
Energetic and motivated (3)
Very energetic and motivated (4)
Please use the following rating scale:
0 Almost Always
1 Often
2 Sometimes
3 A Little Bit
4 Never
In the past two weeks how much have you been distressed by:
4. Feeling fearful, scared. (0) (1) (2) (3) (4)
5. Alcohol/drug use interfering with your performance
at school or work. (0) (1) (2) (3) (4)
6. Wanting to harm someone. (0) (1) (2) (3) (4)
7. Not liking yourself. (0) (1) (2) (3) (4)
8. Difficulty concentrating. (0) (1) (2) (3) (4)
9. Eating problem interfering with relationships (family or friends). (0) (1) (2) (3) (4)
10. Thoughts of ending your life. (0) (1) (2) (3) (4)
11. Feeling sad most of the time. (0) (1) (2) (3) (4)
12. Feeling hopeless about the future. (0) (1) (2) (3) (4)
13. Powerful, intense mood swings (highs and lows). (0) (1) (2) (3) (4)
14. Alcohol/drug use interfering with your relationships
with family and/or friends. (0) (1) (2) (3) (4)
15. Feeling nervous. (0) (1) (2) (3) (4)
16. Heart pounding or racing. (0) (1) (2) (3) (4)
Please use the following rating scale:
0 Terrible, 1 Poorly, 2 Fair, 3 Well,4 Very well
How have you been getting along in the following areas of your life over the past two weeks? Leave
blank if the item does not apply.
17. Nonfamily Social Relationships/Friends (for
example, communication, closeness, level of activity). (0) (1) (2) (3) (4)
18. Life Enjoyment (for example, recreation,
life appreciation, leisure activities). (0) (1) (2) (3) (4)
19. Work/School (for example, performance, attendance). (0) (1) (2) (3) (4)
20. Intimate Relationships (for example, support,
communication, closeness). (0) (1) (2) (3) (4)
21. If you answered 0-3 on #10 above, please check below to indicate your overall risk of
suicide.
Extremely high risk ____ (0)
High risk ____ (1)
Moderate risk ____ (2)
Low risk ____ (3)
No risk ____ (4)

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