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The following questions ask about how you have been feeling during the PAST TWO WEEKS. For each question, please select the option that best describes how often you had this feeling.

Q1: During PAST TWO WEEKS, about how often did you feel …

… nervous?

… hopeless?

… restless or fidgety?

… so depressed that nothing could cheer you up?

… that everything was an effort?

… worthless?

Q2: The last six questions asked about feelings that might have occurred during PAST TWO WEEKS. Taking them altogether, did these feelings occur more often in PAST TWO WEEKS than is usual for you, about the same as usual, or less often than usual? (If you never have any of these feelings, select “about the same as usual”)

The next few questions are about how these feelings may have affected you in PAST TWO WEEKS. You need not answer these questions if you answered “None of the time” to all of the six questions about your feelings.

Q3: During PAST TWO WEEKS, how many days out of 14 were you totally unable to work or carry out your normal activities because of these feelings?

(Number of Days)

Input is not a number!

Q4: Not counting the days you reported in response to Q3, how many days in the PAST TWO WEEKS were you able to do only half or less of what you would normally have been able to do, because of these feelings?

(Number of Days)

Input is not a number!

Q5: During the PAST TWO WEEKS, how many times did you see a doctor or other health professional about these feelings?

(Number of Times)

Input is not a number!

Q6: During the PAST TWO WEEKS, how often have physical health problems been the main cause of these feelings?

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