Welcome to this survey. Press Next to begin.

Please answer the following questions.

During the PAST TWO WEEKS, how often you feel the way described in each of the following statements.

… how often did you feel that you lacked companionship?

Hardly Ever Some of the time Often

… how often did you feel left out?

Hardly Ever Some of the time Often

… how often did you feel isolated from others?

Hardly Ever Some of the time Often

Read each of the following statements carefully, indicate how you felt during the PAST TWO WEEKS

There is a special person who is around when I am in need.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

There is a special person with whom I can share my joys and sorrows.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

My family really tries to help me.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

I get the emotional help and support I need from my family

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

I have a special person who is a real source of comfort to me.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

My friends really try to help me.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

Read each of the following statements carefully, indicate how you felt during the PAST TWO WEEKS

I can count on my friends when things go wrong.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

I can talk about my problems with my family.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

I have friends with whom I can share my joys and sorrows.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

There is a special person in my life who cares about my feelings.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

My family is willing to help me make decisions.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

I can talk about my problems with my friends.

Very strongly disagree Strongly disagree Mildly disagree Neutral Mildly agree Strongly agree Very Strongly agree

During the PAST TWO WEEKS:

… how often have you been upset because of something that happened unexpectedly?

Never Almost never Sometimes Fairly often Very often

… how often have you felt that you were unable to control important things in your life?

Never Almost never Sometimes Fairly often Very often

… how often have you felt nervous and stressed?

Never Almost never Sometimes Fairly often Very often

… how often have you dealt successfully with irritating life hassles?

Never Almost never Sometimes Fairly often Very often

… how often have you felt that you were effectively coping with important changes that were occurring in your life?

Never Almost never Sometimes Fairly often Very often

… how often have you felt confident about your ability to handle your personal problems?

Never Almost never Sometimes Fairly often Very often

… how often have you felt that things were going your way?

Never Almost never Sometimes Fairly often Very often

During the PAST TWO WEEKS:

… how often have you found that you could not cope with all the things that you had to do?

Never Almost never Sometimes Fairly often Very often

… how often have you been able to control irritations in your life?

Never Almost never Sometimes Fairly often Very often

… how often have you felt that you were on top of things?

Never Almost never Sometimes Fairly often Very often

… how often have you been angered because of things that happened that were outside your control?

Never Almost never Sometimes Fairly often Very often

… how often have you found yourself thinking about things that you have to accomplish ?

Never Almost never Sometimes Fairly often Very often

… how often have you been able to control the way you spend your time ?

Never Almost never Sometimes Fairly often Very often

… how often have you felt difficulties were piling up so high that you could not overcome them?

Never Almost never Sometimes Fairly often Very often

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