I. People Who Give Personal Support
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A. Family Members
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How supportive are these people now:
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There is No Such Person
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None
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Some
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A lot
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1. Your wife‚ husband‚ or significant other person
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2. Your children or grandchildren
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3. Your parents or grandparents
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4. Your brothers or sisters
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5. Your other blood relatives
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6. Your relatives by marriage (for example: in-laws‚ ex-wife‚ ex-husband)
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B. Non-Family Members
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7. Your neighbors
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8. Your co-workers
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9. Your church members
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10. Your other friends
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C. Special Supportive Person
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11. Do you have one particular person whom you trust and to whom you can go with personal difficulties?
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Yes
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No
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12. If you answered “yes”‚ which of the above types of person is he or she? (for example: child‚ parent‚ neighbor) ____________
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II. People Who Cause Personal Stress
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A. Family Members
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How stressed do you feel by these people now:
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There is No Such Person
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None
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Some
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A lot
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1. Your wife‚ husband‚ or significant other person
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-–––-
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-–––-
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-–––-
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-–––-
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2. Your children or grandchildren
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-–––-
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-–––-
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3. Your parents or grandparents
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-–––-
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-–––-
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-–––-
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4. Your brothers or sisters
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-–––-
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-–––-
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-–––-
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5. Your other blood relatives
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-–––-
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-–––-
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-–––-
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-–––-
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6. Your relatives by marriage (for example: in-laws‚ ex-wife‚ ex-husband)
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-–––-
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-–––-
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-–––-
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B. Non-Family Members
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7. Your neighbors
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8. Your co-workers
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9. Your church members
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10. Your other friends
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C. Most Stressful Person
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11. Is there one particular person who is causing you the most personal stress now?
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Yes
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No
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12. If you answered “yes”‚ which of the above types of person is he or she? (for example: child‚ parent‚ neighbor) ____________
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12. If you answered “yes”‚ which of the above types of person is he or she? (for example: child‚ parent‚ neighbor) _________
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Parkerson‚ GR‚ Jr.‚ Michener‚ JL.‚ Wu‚ LR. et al. (1989). Associations among family support‚ family stress‚ and personal functional health status. Journal of Clinical Epidemiology‚ 42(3):217–229.
Parkerson‚ GR‚ Jr.‚ Michener‚ JL.‚ Wu‚ LR.‚ et al. (1989). The effect of a telephone family assessment intervention on the functional health of patients with elevated family stress. Med Care‚ 27(7):680–693.
Parkerson‚ GR‚ Jr.‚ Broadhead‚ WE.‚ Tse‚ CKJ. (1991). Validation of the Duke Social Support and Stress Scale. Family Medicine‚ 23(5):357–360.
Parkerson‚ GR‚ Jr.‚ Broadhead‚ WE.‚ Tse‚ CKJ. (1992). Quality of life and functional health of primary care patients. Journal of Clinical Epidemiology‚ 45:1303–1313.
Parkerson‚ GR‚ Jr.‚ Broadhead‚ WE.‚ Tse‚ CKJ. (1995). Perceived family stress as a predictor of health-related outcomes. Arch Fam Med‚ 4:253–260.
Parkerson‚ GR‚ Jr. (2002). User’s guide for Duke health measures. Durham‚ NC: Duke University Department of Community and Family Medicine.
McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS