Summary

This document is a questionnaire to assess the well-being of the respondent. The questionnaire asks questions about feelings, emotions, control of behavior, nervousness and more. It includes multiple-choice and rating scale questions.

Full Transcript

01 Fahey6/e 6/11/04 10:51 AM Page 1 Name _________________________ Section _______________ Date ______________________________ Lab A1-1 The General Well-Being Scale For each question, choose the answer that b...

01 Fahey6/e 6/11/04 10:51 AM Page 1 Name _________________________ Section _______________ Date ______________________________ Lab A1-1 The General Well-Being Scale For each question, choose the answer that best describes how you have felt and how things have been going for you during the past month. 1. How have you been feeling in general? 5 _____ In excellent spirits 4 _____ In very good spirits 3 _____ In good spirits mostly 2 _____ I’ve been up and down in spirits a lot 1 _____ In low spirits mostly 0 _____ In very low spirits 2. Have you been bothered by nervousness or your “nerves”? 0 _____ Extremely so—to the point where I could not work or take care of things 1 _____ Very much so 2 _____ Quite a bit 3 _____ Some—enough to bother me 4 _____ A little 5 _____ Not at all 3. Have you been in firm control of your behavior, thoughts, emotions, or feelings? 5 _____ Yes, definitely so 4 _____ Yes, for the most part 3 _____ Generally so 2 _____ Not too well 1 _____ No, and I am somewhat disturbed 0 _____ No, and I am very disturbed 4. Have you felt so sad, discouraged, hopeless, or had so many problems that you wondered if anything was worthwhile? 0 _____ Extremely so—to the point I have just about given up 1 _____ Very much so 2 _____ Quite a bit 3 _____ Some—enough to bother me 4 _____ A little bit 5 _____ Not at all (over) Fahey/Insel/Roth, Fit and Well, Sixth Edition. © 2005 The McGraw-Hill Companies. 01 Fahey6/e 6/11/04 10:51 AM Page 2 LAB A1-1 (continued) 5. Have you been under or felt you were under any strain, stress, or pressure? 0 _____ Yes—almost more than I could bear 1 _____ Yes—quite a bit of pressure 2 _____ Yes—some, more than usual 3 _____ Yes—some, but about usual 4 _____ Yes—a little 5 _____ Not at all 6. How happy, satisfied, or pleased have you been with your personal life? 5 _____ Extremely happy—couldn’t have been more satisfied or pleased 4 _____ Very happy 3 _____ Fairly happy 2 _____ Satisfied—pleased 1 _____ Somewhat dissatisfied 0 _____ Very dissatisfied 7. Have you had reason to wonder if you were losing your mind, or losing control over the way you act, talk, think, feel, or of your memory? 5 _____ Not at all 4 _____ Only a little 3 _____ Some, but not enough to be concerned 2 _____ Some, and I’ve been a little concerned 1 _____ Some, and I am quite concerned 0 _____ Much, and I’m very concerned 8. Have you been anxious, worried, or upset? 0 _____ Extremely so—to the point of being sick, or almost sick 1 _____ Very much so 2 _____ Quite a bit 3 _____ Some—enough to bother me 4 _____ A little bit 5 _____ Not at all 9. Have you been waking up fresh and rested? 5 _____ Every day 4 _____ Most every day 3 _____ Fairly often 2 _____ Less than half the time 1 _____ Rarely 0 _____ None of the time (over) 01 Fahey6/e 6/11/04 10:51 AM Page 3 LAB A1-1 (continued) 10. Have you been bothered by any illness, bodily disorder, pain, or fears about your health? 0 _____ All the time 1 _____ Most of the time 2 _____ A good bit of the time 3 _____ Some of the time 4 _____ A little of the time 5 _____ None of the time 11. Has your daily life been full of things that are interesting to you? 5 _____ All the time 4 _____ Most of the time 3 _____ A good bit of the time 2 _____ Some of the time 1 _____ A little of the time 0 _____ None of the time 12. Have you felt downhearted and blue? 0 _____ All of the time 1 _____ Most of the time 2 _____ A good bit of the time 3 _____ Some of the time 4 _____ A little of the time 5 _____ None of the time 13. Have you been feeling emotionally stable and sure of yourself? 5 _____ All of the time 4 _____ Most of the time 3 _____ A good bit of the time 2 _____ Some of the time 1 _____ A little of the time 0 _____ None of the time 14. Have you felt tired, worn out, used up, or exhausted? 0 _____ All of the time 1 _____ Most of the time 2 _____ A good bit of the time 3 _____ Some of the time 4 _____ A little of the time 5 _____ None of the time (over) 01 Fahey6/e 6/11/04 10:51 AM Page 4 LAB A1-1 (continued) Circle the number that seems closest to how you have felt generally during the past month. 15. How concerned or worried about your health have you been? Not 10 8 6 4 2 0 Very concerned concerned at all 16. How relaxed or tense have you been? Very 10 8 6 4 2 0 Very relaxed tense 17. How much energy, pep, and vitality have you felt? No energy 0 2 4 6 8 10 Very at all, energetic, listless dynamic 18. How depressed or cheerful have you been? Very 0 2 4 6 8 10 Very depressed cheerful Scoring Add up all the points for the answers you have chosen, and find your score in the table below. 81–110 Positive well-being 76–80 Low positive 71–75 Marginal 56–70 Stress problem 41–55 Distress 26–40 Serious 0–25 Severe Source: National Center for Health Statistics. General Well-Being Scale (GWBS).

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