During the past 30 days‚ for about how many days:
1. Has pain made it hard for you to do your usual activities such as self-care‚ work‚ or recreation?
2. Have you felt sad‚ blue‚ or depressed?
3. Have you felt worried‚ tense‚ or anxious?
4. Have you felt you did not get enough rest or sleep?
5. Have you felt very health and full of energy?
This instrument can be found on pages 132-133 of Latino Families and Youth: A Compendium of Assessment Tools‚ available online at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23171&Itemid=
For questions 1 to 4‚ healthy days are calculated by subtracting the number of unhealthy days indicated by thesurveyed person from 30 days. For question 5‚ healthy daysare the number of days indicated by the person surveyed.
Question 1: Pain = 30 − # of days
Question 2: Depression = 30 − # of days
Question 3: Anxiety = 30 − # of days
Question 4: Insomnia = 30 − # of days
Question 5: Vitality = # of days
Centers for Disease Control and Prevention. (November 2000). Measuring healthy days: Population assessment of health-related quality of life. Atlanta‚ Georgia: CDC‚ November 2000.