1. How happy‚ satisfied‚ or pleased have you been with your personal life during the past month?
1=Extremely Happy‚ 2= Very happy most the time‚ 3= Generally satisfied‚ 4= Sometimes Fairly Dissatisfied‚ 5= Generally Dissatisfied‚ 6=Very Dissatisfied
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1=All the time‚ 2= Most of the time‚ 3= A good bit of the time‚ 4= Some of the time‚ 5= A little of the time‚ 6= None of the time
2. How much of the time have you felt lonely during the past month?
4. How much of the time have you felt that the future looks hopeful and promising?
5. How much of the time has your daily life been full of things that were interesting?
6. How much of the time did you feel relaxed and free from tension?
7. How much of the time have you generally enjoyed the things you do?
10. How much of the time have you felt loved or wanted?
11. How much of the time have you been a very nervous person?
13. How much of the time have you felt tense‚ or “high-strung”?
17. How much of the time have you felt calm and peaceful?
18. How much of the time have you felt emotionally stable?
19. How much of the time have you felt downhearted and blue?
22. How much of the time were you able to relax without difficulty?
23. How much of the time did you feel that your love relationships‚ loving and being loved were full and complete?
26. How much of the time has living been a wonderful adventure for you?
29. How much of the time have you felt restless‚ fidgety or impatient?
30. How much of the time have you been moody or brooded about things?
31. How much of the time have you felt cheerful or light hearted?
34. How much of the time were you a happy person?
36. How much of the time have you been in low or very low spirits?
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1= Always‚ 2= Very Often‚ 3= Fairly Often‚ 4= Sometimes‚ 5= Almost Never‚ 6= Never
3. How often did you become nervous or jumpy when faced with excitement or unexpected situations?
12. When you have got up in the morning‚ about how often did you expect to have an interesting day?
15. How often did your hands shake when you tried to do something?
16. How often did you feel that you had nothing to look forward to?
20. How often have you felt like crying?
21. How often have you felt that other would be better off if you were dead?
24. How often did you feel that nothing turned out for you the way you wanted it to?
27. How often have you felt so down in the dumps that nothing could cheer you up?
32. How often did you get rattled‚ upset of flustered?
35. How often did you find yourself trying to calm down?
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8. During the past month‚ have you had any reason to wonder if you were losing your mind‚ or losing control over the way you act‚ talk‚ think‚ feel or of your memory?
1= Not at All‚ 2= Maybe a little‚ 3= Yes‚ but not enough to be concerned‚ 4= Yes‚ been a little concerned‚ 5= Yes‚ quite concerned‚ 6= Yes‚ very concerned
9. Did you feel depressed during the past month?
1= Yes‚ to the did not care about anything for days‚ 2= Yes‚ very depressed almost every day‚ 3= Yes‚ quite depressed several times‚ 4= Yes‚ a little depressed now & then‚ 5= No‚ Never
14. During the past month‚ have you been in firm control of your behaviour‚ thoughts‚ emotions or feelings?
1= Yes‚ definitely‚ 2= Most of the time‚ 3= A good bit of the time‚ 4= Some of the time‚ 5= A little of the time‚ 6= None of the time
25. How much have you been bothered by nervousness‚ or your nerves‚ during the past month?
1= Extremely‚ 2= Very Much‚ 3= Bothered quite a bit‚ 4= Bothered some‚ 5= Bothered a little‚ 6= Not bothered
28. During the past month‚ did you think about taking your own life?
1= Yes‚ Very often; 2= Yes‚ fairly often; 3= Yes‚ a few times; 4= Yes at one time; 5= Never
33. During the past month‚ have you been anxious or worried?
1= Extremely‚ 2= Very Much‚ 3= Quite a bit‚ 4= Some‚ 5= A little‚ 6= Not at all
37.How often during the past month have you been waking up feeling fresh and rested?
1= Always Every day; 2= Almost Every day; 3 Most days; 4= Some days not‚ usually; 5= Hardly; 6= Never
38. During the past month‚ have you been under or felt you were under any strain‚ stress or pressure?
1=More than I can bear; 2=Quite a bit; 3= Some more than usual; 4=Some‚ but about normal; 5=Yes‚ a little bit; 6=Not at all
Anxiety: Items 3‚ 11‚ 13‚ 15‚ 25‚ 29‚ 32‚ 33 and 35
Loss of Behavioural / Emotional Control: Items 9‚ 19‚ 30 and 36
General Positive Affect: Items 4‚ 5‚ 6‚ 7‚ 12‚ 17‚ 26‚ 31‚ 34 and 37
Emotional Ties: Items 10 and 23
Life Satisfaction: Item 1
Of the 38 items‚ 35 are used to score the six mental health subscales (items 2‚ 22 and 38 are omitted from the subscales).
This instrument can be found at: http://www.rand.org/pubs/reports/R1987z1.html
Ware‚ J. E.‚ Brook‚ R. H.‚ Davies‚ A. R.‚ Williams‚ K. N.‚ Stewart‚ A.‚ Rogers‚ W. H.‚ & Johnston‚ S. A. (1980). Conceptualization and measurement of health for adults in the Health Insurance Study.
Ware‚ John E.‚ Robert H. Brook‚ Allyson Ross Davies‚ Kathleen N. Williams‚ Anita Stewart‚ William H. Rogers‚ Cathy A. Donald and Shawn A. Johnston‚ Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol. I‚ Model of Health and Methodology‚ Santa Monica‚ Calif.: RAND Corporation‚ R-1987/1-HEW‚ 1980. As of April 17‚ 2015: http://www.rand.org/pubs/reports/R1987z1