These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. (Circle One Number on Each Line) 9. How much of the time during the past 4 weeks . . . A Good All of Most Some A Little None Bit of the of the of the of the of the the Time Time Time Time Time Time a. Did you feel full of pep? 1 2 3 4 5 6 b. Have you been a very nervous person? 1 2 3 4 5 6 c. Have you felt so down in the dumps that nothing 1 2 3 4 5 6 could cheer you up? d. Have you felt calm and peaceful? 1 2 3 4 5 6 e. Did you have a lot of energy? 1 2 3 4 5 6 f. Have you felt downhearted and blue? 1 2 3 4 5 6 g. Did you feel worn out? 1 2 3 4 5 6 h. Have you been a happy person? 1 2 3 4 5 6 i. Did you feel tired? 1 2 3 4 5 6 10. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? (Circle One Number) All of the time 1 Most of the time 2 Some of the time 3 A little of the time 4 None of the time 5 8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? Not at all 1 A little bit 2 Moderately 3 Quite a bit 4 Extremely 5 39
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