LEIPAD Questionnaire

How would you rate your overall physical health?

Are you able to get up and down the stairs without help?

Are you able to dress all by yourself?

Are you able to eat by yourself?

Are you able to bathe or take a shower by yourself?

Do you have sleep problems?

Do you feel tired, without energy?

Do you have difficulties concentrating?

Are you able to accomplish your usual tasks either at home, at work, or elsewhere?

Can you shop all by yourself?

Can you travel by public transportation?

How much do your physical health problems (if any) stand in the way of doing the things you want to do?

How often, would you say, does it happen that you are not able to think clearly or that you are confused?

How much do your problems with thinking (if any) stand in the way of doing the things you want to do?

How good is your memory?

How much do your memory problems (if any) stand in the way of doing the things you want to do?

Taking everything in consideration, how anxious do you feel?

How much do your feelings of anxiety (if any) stand in the way of doing the things you want to do?

Taking everything in consideration, how depressed (blue) do you feel at present?

How much do your depressed feelings (if any) stand in the way of doing the things you want to do?

How satisfied are you with your social ties or relationships?

Do you feel emotionally satisfied in your relationships with other people?

Is there someone to talk to about personal affairs when you want to?

Are you interested in sex?

How often do you have sexual contact?

How satisfied are you with your ability to manage your hobbies or recreational activities?

How satisfied are you with your financial situation?

Do you feel that you cannot afford the standard of living you would need?

How satisfied are you with your life at present when compared to the past?

Taking everything in consideration, how would you expect things will go in the future?

How much do your expectations of the future stand in the way of doing or initiating the things you want to do?

I feel easily annoyed or irritated.

I have temper outbursts that I cannot control.

I get into arguments with others.

I tend to be resentful.

Taking everything in consideration, do you feel inferior to other people?

How often do you avoid things (refrain from doing things) because you feel inferior?

I tend to have a negative opinion of myself.

How often do you feel that most people cannot be trusted?

Do you trust in God or some superior being?

Do you find comfort or support in such a belief?

I am always ready to go out of my way to help someone else.

I like to gossip at times.

There have been times when I was quite jealous of the good fortune of others.

Over the past several years, I am often troubled by the difficulties I have dealing with others.

Over the past several years, I am bothered by the kind of person I am.

Over the past several years, the way I behave often gets me into trouble, either on the job, at home, or elsewhere.

Over the past several years, other people often seem to be bothered by the things I do or say.

I haven't got as far in life as I'd like to because of the kind of person I am.