Year 1 Thoughts and Feelings Questionnaire - Part II

Participant ID #  

46. Overall, how would you rate your quality of life: (1 = Low Quality of life; 10 = Best Quality of life)

As bad or worse than being dead Best quality of life

Worst Halfway Best
0 1 2 3 4 5 6 7 8 9 10
 
47. How satisfied are you with your current quality of life? (1 = Very Dissatisfied; 10 = Very Satisfied)

Not at all happy with quality of life now Very happy with quality of life now

Dissatisfied Satisfied
0 1 2 3 4 5 6 7 8 9 10
 
48. In general, would you say your health is:
 
Excellent Very good Good Fair Poor
 
49. Compared to one year ago, how would you rate your health in general now?
Much better now than 1 year ago
Somewhat better now than 1 year now
About the same
Somewhat worse now than 1 year ago
Much worse than 1 year ago
Not answered
 
The following are questions about a typical (or usual) day's activities. Does your health now limit you in these activities and, if so, how much?
 
Not limited Limited a little Limited a lot Not answered
50. Vigorous activities, such as running, lifting heavy objects, or strenuous sports
51. Moderate activities, such as moving a table, vacuuming, bowling, or golfing
52. Lifting or carrying groceries
53. Climbing several flights of stairs
54. Climbing one flight of stairs
55. Bending, kneeling, stooping
56. Walking more than a mile
57. Walking several blocks
58. Walking one block
59. Bathing or dressing yourself
 
60. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, neighbors, friends, or groups?
Not at all Slightly Moderately (Medium) Quite a bit Extremely
 
61. During the past 4 weeks how much bodily pain have you had?
None Very Mild Mild Moderate (Medium) Severe
 
62. During the past 4 weeks how much did pain interfere with you normal work (both outside your home and at home)?
Not at all A little bit Moderately (Medium) Quite a bit Extremely
 
The next questions are about your regular daily activities like work, child care, or community activities. As a result of your physical health, have any of the following problems occurred during the past 4 weeks?
 
No Yes Not answered
63. You cut down on the amount of time you spent on work or other activities
64. You accomplished less than you would have liked
65. You were limited in the kind of work or other activities you did
66. You had difficulty performing work or other activities (it took extra effort)
 
In the past 4 weeks as a result of any emotional problem (feeling depressed or anxious), have any of the following occurred?
 
No Yes Not answered
67. You cut down on the amount of time spent on work or other activities
68. You accomplished less than you would have liked
69. You did work or other things less carefully than usual
 
Of these statements, how true or false is each for you?
 
Definitely True Mostly True Not Sure Mostly False Definitely False
70. I seem to get sick a little easier than other people
71. I am as healthy as anybody I know
72. I expect my health to get worse
73. My health is excellent
 
All of the time Most of the time Some of the time A little of the time None of the time
74. During the past 4 weeks, how much of the time have your physical health or emotional problems interfered with you social activities (like visiting with friends and relatives)?
 
These questions are about how you feel and how things have been during the past 4 weeks. Give the one answer that comes closest to the way you have been feeling.
 
How much of the time during the past 4 weeks . . .
 
All of the time Most of the time A good bit of the time Some of the time A little of the time None of the time Not answered
75. Did you feel full of pep?
76. Have you been a very nervous person?
77. Have you felt so down in the dumps that nothing could cheer you up?
78. Have you felt calm and peaceful?
79. Did you have a lot of energy?
80. Have you felt downhearted and blue?
81. Did you feel worn out?
82. Have you been happy?
83. Did you feel tired?
 
84. Can you eat:
Without help (able to feed yourself completely)
With some help (need help with cutting, etc.)
Or are you completely unable to feed yourself?
Not answered
 
85. Can you dress and undress yourself:
Without help (able to pick out clothes, dress and undress yourself)
With some help
Or are you completely unable to dress and undress yourself?
Not answered
 
86. Can you get in and out of bed:
Without any help or aids
With some help (either from a person or with the aid of some device)
Or are you totally dependent on someone else to lift you?
Not answered
 
87. Can you take a bath or shower:
Without help
With some help (need help getting in and out of the tub, or need special attachments on the tub)
Or are you completely unable to bathe yourself?
Not answered