Page 1

Phase 2: Perinatal Mood Assessment Scale

University of Nevada, Las Vegas

Demographics Page

1. What is your age?

2. What is your highest education level?

	High school
	Some college
	BA/BS
	MA/MS
	Ph.D./MD/DO/JD

3. Marital Status

	Single
	Divorced
	Married
	Cohabitating w/ partner

4. What is your ethnicity?

	1 - African American
	2 - American Indian
	3 - Asian/Pacific Islander
	4 - Caucasian
	5 - Hispanic

5. What is your family's annual income?

	1 - 0-$15,000
	2 - $15,001 - $30,000
	3 - $30,001 - $40,000
	4 - $40,001 - $50,000
	5 - $50,001 - $100,000
	6 - Greater than $100,000

6. How long since delivery?

	0-30 days
	31 days - 4 months
	4 months - 8 months
	8 months - 1 year

7. How many previous pregnancies have you had?

8. If you have had more than one child, did you have postpartum symptoms with previous children?

	Yes
	No

9. When did mood symptoms first appear?

	Pregnancy
	0-30 days postpartum
	31 days - 4 months postpartum
	4 months- 8 months postpartum
	8 months - 1 year postpartum

Maternal Health Lab Homepage