Your Results Suggestions

The following is the section of the survey that seeks to understand what results people are getting. We want to gather enough information for the researchers but make it simple enough for people to easily complete the survey. We also want the questions to feel relevant for everyone, including those who are against psychiatry or are otherwise ambivalent about the labels associated with our conditions.

Please chose 'Other" when clicking through the survey so you can see that it causes a new text box where people can put their own words in.

Please use the comments section at the bottom of the page for your feedback. Any feedback is welcome including, but not limited to, better wording, new topics and questions, more or less choices, etc.

- Step 1 of 4

Section 3: Results

This part of the study focuses on the results from using the solutions identified in Step 2.

Which Describes You? *

Depression Only
Bipolar

This needs to move to the top of all questions once we build the whole study into one form. Then we can skip the mania things for those who are only depressed.

Specific Results

This section asks if you have achieved some of the specific results that other people have mentioned. It also includes the chance to share your specific results that are not included on the list. If we get enough of them we will add them to the list for future participants.

What Results Have You Achieved For Depression? *

Less frequent episodes
Less Intense Episodes
Better able to function during lower intensity episodes
Better able to function during high intensity episodes
Less fear of states
States have become interesting instead of just painful
States have become beautiful experiences
Functionality is enhanced by the states
Less need to remove states or turn them down
Can handle states for longer periods
Less hospitalizations during states
Less missed work days during states
Less problems with relationships during states
Family and friends trust me more during states
More comfortable being in states
Others are more comfortable with me being in states
I value the states
I find tremendous insights that can only be found in the states
States no longer need to be lowered or turned down
I am a better person because of the states
I am more empathetic during the states
Less dependance on others during states
Less dependance on medicine to keep states under control
Less dependance on any tools to keep states under control
It is OK to be depressed
The pain is still there, it bothers me so little now I feel my soul is served by it

What Other Results Have You Achieved For Depression?

What Results Have You Achieved For Mania? *

Less frequent episodes
Less Intense Episodes
Better able to function during lower intensity episodes
Better able to function during high intensity episodes
Less fear of states
States have become interesting instead of just painful
States have become beautiful experiences
Functionality is enhanced by the states
Less need to remove states or turn them down
Can handle states for longer periods
Less hospitalizations during states
Less missed work days during states
Less problems with relationships during states
Family and friends trust me more during states
More comfortable being in states
Others are more comfortable with me being in states
I value the states
I find tremendous insights that can only be found in the states
States no longer need to be lowered or turned down
I am a better person because of the states
I am more empathetic during the states
Less dependance on others during states
Less dependance on medicine to keep states under control
Less dependance on any tools to keep states under control
It is OK to be manic
The pain is still there, it bothers me so little now I feel my soul is served by it

What Other Results Have You Achieved For Mania?

How Do You Feel About The Results?

This section is for finding out how people feel about the results they have gotten.

How have things changed for you? *

Got Unbelievably worse
Got a lot worse
Got a little worse
Better Than Expected
Stayed the same
Got a little better
Got a lot better
Got Unbelievably better

Are you happy with your results? *

Extremely Unhappy
Wish there was something better
Ambivalent
Better Than Expected
Never imagined that it could be this good

Please Note:

You are not required to fill in the blanks on questions that ask for a text answer, but all other questions must have a choice to be able to move to the next page. If you click the next button and see the same page again it is because one or more items were not answered.

Functionality Measurements

This section uses scales to measure what people have learned from their solutions and how that has changed the functionality.

You Picked Depression Only

This page tests mania functionality so you get to skip it. Please click on 'Next' to get to the next set of questions.

Remember that time…

Think of a time you might call a bit elevated, or maybe hypo-manic, and you were a little more elevated than you had full control of. It was becoming difficult to be able to function without causing some problems in your life. Please answer the following questions about that particular state.

intensity-m *

80 - unlimited energy, no need for sleep, mind racing 1,000 mi/hr, paranoia, delusional thoughts, rage, hallucinations, more difficult to function mentally, too much energy and information, out of control spending, disorganized, attention shifts rapidly, uncontrollable, pain is gone, delusions of grandeur, oneness with everything, euphoria, connectedness to everything
60 - "Houston we have a problem" ‘Super Powers’ energy bursting out, mind in every direction, racing thoughts, very difficult to sleep, aggravated, impatient, irrational, confused, intense, sense of grandeur, superiority, arrogance, tripping, elated, risk taking
40 - "I like this state" most productive, multi-task, creative, problem solving, engaged, pressured, fidgety, need to release energy, need to exercise, race, speed, focus is dissipating, rapid thoughts, focus on more than one thing at a time, elevated, high, anxious, exuberant, irritation, more interested in own point of view, love to experience more, more connected, full of ideas, drugs and alcohol more enticing, feels good to thinking and reacting so clearly
20 - alert, aware, awake, able, focused, clear thoughts, motivated, happy, positive, calm, sociable, engaged with life, unaware that anything is different, posture improves, joy in exercise, appetite returns, connected, purpose, confidence

How much time did you have?

How long does it usually last before it gets even stronger and harder to stay in full control? Please choose the description that bests matches your experience at the time.

time-m *

90 - You can stay in the state indefinitely without it changing intensity and without losing control of yourself.
80 - You can handle the state for several months, but less than a year before losing control of your behavior.
70 - You can handle the state for a month before losing control of your behavior.
60 - You can handle the state for more than a week, but less than a month before losing control of your behavior.
50 - You can handle the state for a week before losing control of your behavior.
40 - You can handle the state for days, but less than a week before losing control of your behavior.
30 - You can handle the state for hours, but less than a day before losing control of your behavior.
20 - You can handle the state for less than an hour before losing control.
10 - You can handle the state for seconds before losing control of your behavior.
0 - By the time you are even aware that the state is happening it is already too late. You are already overwhelmed by it and have zero time before it needs to change.

Were you aware...

Please choose from the descriptions below the one that best matches your experience at the time.

awareness-m *

90 - Your awareness is at the highest level during this state. You know exactly how your body feels. You can tell if heart rate is up or down, if energy levels are up or down. You are fully aware of your feelings and emotions. You are fully aware of your values and what they mean to you. You are fully aware of your choices for how to respond to any and all situations and have a full awareness of other's perceptions.
80 - Awareness is clearly enhanced by the state. You can see things more clearly and use this awareness to help you function better.
70 - You are much more aware than in a ‘normal’ state. Some awareness is enhanced greatly, but awareness appears as if happening faster than you can keep up with.
60 - You can see how awareness is enhanced by the state.
50 - Awareness is the same as when not having the state.
40 - The awareness is slightly decreasing. It is harder to notice some of the body signs that one experiences while in the state. Not really aware of any strong feelings that may be occurring.
30 - It is difficult to be aware. Some thoughts and feelings are surfacing up but for the most part, not really aware.
20 - There are clear indications that your awareness has decreased. You cannot feel emotions as usual, you can’t notice how your body feels, not really aware of the spiritual aspect.
10 - Awareness is minimal, you are barely aware of anything. Can't really feel your body, no thoughts , no feelings, no spiritual awareness etc...
0 - Not aware at all. You cannot feel your body, your thoughts, feelings at all.

Did you know…

Did you understand what you needed to do to function at your best during the state? Please choose the description that best matches your understanding about how to function during the state.

Try to see it as whether you understood how to function in the state and not whether you understand what triggers it, the brain chemistry, biology, genetics, drug interactions, etc.

understanding-m *

90 - A very thorough understanding of the state. Understand the state so well that you can summon any element of it at will and use it to your advantage and to the advantage of those around you.
80 - Understanding is substantial. Can find very little reason to not be comfortable with your ability to function in the state.
70 - Understanding is pretty good. There are a few things that get in the way of your overall understanding, but you are mostly comfortable with the current level of understanding.
60 - Understanding the state is a bit enhanced.
50 - Understanding of how to function is as good as when not in the state.
40 - Don’t understand this state as well as other states.
30 - Very little understanding of the state. Would be clearly more comfortable if state was not happening.
20 - Understanding is low. Many aspects of the state are impacting ability to function.
10 - Understanding of the state is very low. Really need to get out of the state.
0 - No understanding whatsoever, state must stop immediately.

How did you do?

Were you able to function? Or was the state getting in the way and making it harder in some ways? Please choose the description that best matches your experience at the time.

Try to remember a time when you were in the state, not how you think you can function during the next one.

functionality-m *

90 - You function at the highest level during this state.
80 - Functionality is clearly enhanced by the state. You get more done and do a better job of it. Can accomplish anything requested.
70 - You get much more accomplished than during a ‘normal’ state. Some functionality is enhanced greatly, but other things are harder than normal to accomplish.
60 - You can see how some of the things you want to accomplish are enhanced and would be much more so if you understood how to better minimize the down sides.
50 - Functionality is the same as when not having the state.
40 - The state is slightly impacting functionality. It is harder to accomplish some of the things you need to do.
30 - There are clear indications that the state is slowing down your ability to get the same things done as when not having the state.
20 - It is difficult to get the things done that are needed. Some tasks you cannot do when asked.
10 - Functionality is minimal, but you can at least eat and take minimal care or yourself.
0 - Cannot function at all. You need to be on a machine just to stay alive and that has nothing to do with a physical ailment.

Were you comfortable?

When the dentist pauses while drilling your teeth and asks if you are comfortable, he is not asking if you like it. He is asking if you can hold still and let him finish. He is asking about your confidence in your ability to function in the task you need to do. We do not define comfort as whether you like it or not, but as being confident in your ability to function. Please choose from the following options what best describes your comfort at the time of being in the state.

comfort-m *

90 - Most comfortable ever in any state.
80 - Very comfortable during state. Can find very little reason to not be comfortable.
70 - Pretty comfortable during state. There are a few things that detract from total comfort, but mostly a pretty comfortable state.
60 - Slightly more comfortable than normal.
50 - Equally comfortable as when not in the state.
40 - A little less comfortable than normal. There are a few reasons that the state is taking away comfort.
30 - Pretty uncomfortable. Would be clearly more comfortable if state was not happening.
20 - Comfort pretty low. Many aspects of the state are causing discomfort.
10 - Seriously uncomfortable. Really need to get out of the state.
0 - So uncomfortable it has to stop immediately.

What about the people around you?

You might have to ask, but how were the people around you at the time? Were they comfortable with you being in the state? Or were they worried that you were going to blow up or somehow become a problem?

comfort-others-m *

90 - Most comfortable ever in any state.
80 - Very comfortable during state. Can find very little reason to not be comfortable.
70 - Pretty comfortable during state. There are a few things that detract from total comfort, but mostly a pretty comfortable state.
60 - Slightly more comfortable than normal.
50 - Equally comfortable as when not in the state.
40 - A little less comfortable than normal. There are a few reasons that the state is taking away comfort.
30 - Pretty uncomfortable. Would be clearly more comfortable if state was not happening.
20 - Comfort pretty low. Many aspects of the state are causing discomfort.
10 - Seriously uncomfortable. Really need to get out of the state.
0 - So uncomfortable it has to stop immediately.

How did you feel about it?

Think about what it was like during the state and chose from the options below what best describes the value you saw at the time it was happening. Please do not assume that the next time you are in the state you will see tremendous value in it and function well. You need to answer it from an actual time you were in the state, perhaps the last time you can remember.

value-during-m *

90 - Most valuable state ever.
80 - Very valuable to experience the state. Can find very little reason to not value the state.
70 - State is pretty valuable. There are a few reasons that detract from total value, but mostly a pretty valuable state.
60 - Slightly more valuable than a normal state.
50 - State is equally valuable as when in any other state.
40 - A little less valuable than other states. There are a few reasons that the state feels less valuable.
30 - Value is low and causes one to feel concern and discomfort when experiencing the state.
20 - Value is so low you would rather for the state to not be happening at all.
10 - Barely any value at all. Really need to get out of the state.
0 - No value at all. The state has to stop immediately or I am at risk.

Is it valuable to have been through the state?

Looking back on the state, we can value things differently than when we were in them. Please look back to a time when you were in the state and think about how you see it now. You may have thought at the time you were going through a terrible thing, but when you look at it now you can see how it helped enhance your life in some way once you got through it and learned from the experience. All things considered, was it an asset for you to be in the state? Or does it cause more problems than benefits? Please choose from the options below what best describes the value you see when looking back at the state.

value-after-m *

90 - Most valuable state ever.
80 - Very valuable to experience the state. Can find very little reason to not value the state.
70 - State is pretty valuable. There are a few reasons that detract from total value, but mostly a pretty valuable state.
60 - Slightly more valuable than a normal state.
50 - State is equally valuable as when in any other state.
40 - A little less valuable than other states. There are a few reasons that the state feels less valuable.
30 - Value is low and causes one to feel concern and discomfort when experiencing the state.
20 - Value is so low you would rather for the state to not be happening at all.
10 - Barely any value at all. Really need to get out of the state.
0 - No value at all. The state has to stop immediately or I am at risk.

Please Note:

Remember that time…

Think of a time you might call a bit down, or maybe hypo-depressed, and you were a little more down than you had full control of. It was becoming difficult to be able to function without causing some problems in your life. Please answer the following questions about that particular state.

intensity-d *

80 - exhaustion, run over by truck, extreme sadness, thought and visions of suicide, obsessive thoughts, hyper-focused, spiritual despair, feel trapped, can't escape, coming apart, sleeping 12 hrs day, crying a lot, don't want to be living
60 - physical pain, no more empathy for others, have to work to find meaning, very run down, overwhelmed, sadness, cannot remember any good times, thoughts beginning to obsess, turning toward negative view of everything, spiritual emptiness, life loses meaning, cannot make decisions, distraught
40 - increasing sense that something bad is going to happen, difficulty following routine or schedule, watch more TV/read news, fear, heading into a pit, melancholy, lethargic, general body aches & pains, sadness, obsessive thinking/ruminating, mind slowing down, perceptions numb, unmotivated, tired, uninterested, extremely bored, headaches, negative, need sleep, more emotional, cry a lot, need to express creatively
20 - slight loss of energy, a little slower, more focused, starting to focus on detail, uncomfortable, inward, interiorized thoughts, watch more TV

How much time did you have?

How long does it usually last before it gets even stronger and harder to stay in full control? Please choose the description that bests matches your experience at the time.

time-d *

90 - You can stay in the state indefinitely without it changing intensity and without losing control of yourself.
80 - You can handle the state for several months, but less than a year before losing control of your behavior.
70 - You can handle the state for a month before losing control of your behavior.
60 - You can handle the state for more than a week, but less than a month before losing control of your behavior.
50 - You can handle the state for a week before losing control of your behavior.
40 - You can handle the state for days, but less than a week before losing control of your behavior.
30 - You can handle the state for hours, but less than a day before losing control of your behavior.
20 - You can handle the state for less than an hour before losing control.
10 - You can handle the state for seconds before losing control of your behavior.
0 - By the time you are even aware that the state is happening it is already too late. You are already overwhelmed by it and have zero time before it needs to change.

Were you aware?

Please choose from the descriptions below the one that best matches your experience at the time.

awareness-d *

90 - Your awareness is at the highest level during this state. You know exactly how your body feels. You can tell if heart rate is up or down, if energy levels are up or down. You are fully aware of your feelings and emotions. You are fully aware of your values and what they mean to you. You are fully aware of your choices for how to respond to any and all situations and have a full awareness of other's perceptions.
80 - Awareness is clearly enhanced by the state. You can see things more clearly and use this awareness to help you function better.
70 - You are much more aware than in a ‘normal’ state. Some awareness is enhanced greatly, but awareness appears as if happening faster than you can keep up with.
60 - You can see how awareness is enhanced by the state.
50 - Awareness is the same as when not having the state.
40 - The awareness is slightly decreasing. It is harder to notice some of the body signs that one experiences while in the state. Not really aware of any strong feelings that may be occurring.
30 - It is difficult to be aware. Some thoughts and feelings are surfacing up but for the most part, not really aware.
20 - There are clear indications that your awareness has decreased. You cannot feel emotions as usual, you can’t notice how your body feels, not really aware of the spiritual aspect.
10 - Awareness is minimal, you are barely aware of anything. Can't really feel your body, no thoughts , no feelings, no spiritual awareness etc...
0 - Not aware at all. You cannot feel your body, your thoughts, feelings at all.

Did you know…?

Did you understand what you needed to do to function at your best during the state? Please choose the description that best matches your understanding about how to function during the state.

Try to see it as whether you understand how to function in the state and not whether you understand what triggers it, the brain chemistry, biology, genetics, drug interactions, etc.

understanding-d *

90 - A very thorough understanding of the state. Understand the state so well that you can summon any element of it at will and use it to your advantage and to the advantage of those around you.
80 - Understanding is substantial. Can find very little reason to not be comfortable with your ability to function in the state.
70 - Understanding is pretty good. There are a few things that get in the way of your overall understanding, but you are mostly comfortable with the current level of understanding.
60 - Understanding the state is a bit enhanced.
50 - Understanding of how to function is as good as when not in the state.
40 - Don’t understand this state as well as other states.
30 - Very little understanding of the state. Would be clearly more comfortable if state was not happening.
20 - Understanding is low. Many aspects of the state are impacting ability to function.
10 - Understanding of the state is very low. Really need to get out of the state.
0 - No understanding whatsoever, state must stop immediately.

How did you do?

Were you able to function? Or was the state getting in the way and making it harder in some ways? Please choose the description that best matches your experience at the time.

Try to remember a time when you were in the state, not how you think you can function during the next one.

functionality-d *

90 - You function at the highest level during this state.
80 - Functionality is clearly enhanced by the state. You get more done and do a better job of it. Can accomplish anything requested.
70 - You get much more accomplished than during a ‘normal’ state. Some functionality is enhanced greatly, but other things are harder than normal to accomplish.
60 - You can see how some of the things you want to accomplish are enhanced and would be much more so if you understood how to better minimize the down sides.
50 - Functionality is the same as when not having the state.
40 - The state is slightly impacting functionality. It is harder to accomplish some of the things you need to do.
30 - There are clear indications that the state is slowing down your ability to get the same things done as when not having the state.
20 - It is difficult to get the things done that are needed. Some tasks you cannot do when asked.
10 - Functionality is minimal, but you can at least eat and take minimal care or yourself.
0 - Cannot function at all. You need to be on a machine just to stay alive and that has nothing to do with a physical ailment.

Were you comfortable?

comfort-d *

90 - Most comfortable ever in any state.
80 - Very comfortable during state. Can find very little reason to not be comfortable.
70 - Pretty comfortable during state. There are a few things that detract from total comfort, but mostly a pretty comfortable state.
60 - Slightly more comfortable than normal.
50 - Equally comfortable as when not in the state.
40 - A little less comfortable than normal. There are a few reasons that the state is taking away comfort.
30 - Pretty uncomfortable. Would be clearly more comfortable if state was not happening.
20 - Comfort pretty low. Many aspects of the state are causing discomfort.
10 - Seriously uncomfortable. Really need to get out of the state.
0 - So uncomfortable it has to stop immediately.

What about the people around you?

comfort-others-d *

90 - Most comfortable ever in any state.
80 - Very comfortable during state. Can find very little reason to not be comfortable.
70 - Pretty comfortable during state. There are a few things that detract from total comfort, but mostly a pretty comfortable state.
60 - Slightly more comfortable than normal.
50 - Equally comfortable as when not in the state.
40 - A little less comfortable than normal. There are a few reasons that the state is taking away comfort.
30 - Pretty uncomfortable. Would be clearly more comfortable if state was not happening.
20 - Comfort pretty low. Many aspects of the state are causing discomfort.
10 - Seriously uncomfortable. Really need to get out of the state.
0 - So uncomfortable it has to stop immediately.

How did you feel about it?

value-during-d *

90 - Most valuable state ever.
80 - Very valuable to experience the state. Can find very little reason to not value the state.
70 - State is pretty valuable. There are a few reasons that detract from total value, but mostly a pretty valuable state.
60 - Slightly more valuable than a normal state.
50 - State is equally valuable as when in any other state.
40 - A little less valuable than other states. There are a few reasons that the state feels less valuable.
30 - Value is low and causes one to feel concern and discomfort when experiencing the state.
20 - Value is so low you would rather for the state to not be happening at all.
10 - Barely any value at all. Really need to get out of the state.
0 - No value at all. The state has to stop immediately or I am at risk.

Is it valuable to have been through the state?

value-after-d *

90 - Most valuable state ever.
80 - Very valuable to experience the state. Can find very little reason to not value the state.
70 - State is pretty valuable. There are a few reasons that detract from total value, but mostly a pretty valuable state.
60 - Slightly more valuable than a normal state.
50 - State is equally valuable as when in any other state.
40 - A little less valuable than other states. There are a few reasons that the state feels less valuable.
30 - Value is low and causes one to feel concern and discomfort when experiencing the state.
20 - Value is so low you would rather for the state to not be happening at all.
10 - Barely any value at all. Really need to get out of the state.
0 - No value at all. The state has to stop immediately or I am at risk.

Please Note:

World Health Organization Quality Of Life Survey (WHOQOL-BREF)

This page is a standard World Health Organization Quality Of Life Survey (WHOQOL-BREF) survey. We cannot change any of the questions and have to ask them exactly as they are to use them with their permission. It is an important survey so that our studies can be standardized and accepted by researchers. Thank you for understanding and participating. This is the final page of questions in the whole study.

What Is Your Gender? *

Male
Female

We recognize that many people are against forcing gender with only two choices, but to use the WHOQOL-BREF we must ask questions exactly as they require. Sorry.

What is your date of birth? *

What is the highest education you received? *

None at all
Elementary School
High School
College

What is your marital status? *

Single
Married
Living as Married
Separated
Divorced
Widowed

Are you currently ill? *

If something is wrong with your health, what do you think it is? *

Instructions

This questionnaire asks how you feel about your quality of life, health, or other areas of your life. Please answer all the questions. If you are unsure about which response to give to a question, please choose the one that appears most appropriate. This can often be your first response. Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about your life in the last two weeks.

Please read each question, assess your feelings, and choose the option that gives the best answer for you.

How would you rate your quality of life? *

Very poor	Poor	Neither poor nor good	Good	Very Good
How would you rate your quality of life? Very poor	How would you rate your quality of life? Poor	How would you rate your quality of life? Neither poor nor good	How would you rate your quality of life? Good	How would you rate your quality of life? Very Good

How satisfied are you with your health? *

Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
How satisfied are you with your health? Very dissatisfied	How satisfied are you with your health? Dissatisfied	How satisfied are you with your health? Neither satisfied nor dissatisfied	How satisfied are you with your health? Satisfied	How satisfied are you with your health? Very satisfied

The following questions ask about how much you have experienced certain things in the last two weeks. *

	Not at all	A little	A moderate amount	Very much	An extreme amount
To what extent do you feel that physical pain prevents you from doing what you need to do?	To what extent do you feel that physical pain prevents you from doing what you need to do? Not at all	To what extent do you feel that physical pain prevents you from doing what you need to do? A little	To what extent do you feel that physical pain prevents you from doing what you need to do? A moderate amount	To what extent do you feel that physical pain prevents you from doing what you need to do? Very much	To what extent do you feel that physical pain prevents you from doing what you need to do? An extreme amount
How much do you need any medical treatment to function in your daily life?	How much do you need any medical treatment to function in your daily life? Not at all	How much do you need any medical treatment to function in your daily life? A little	How much do you need any medical treatment to function in your daily life? A moderate amount	How much do you need any medical treatment to function in your daily life? Very much	How much do you need any medical treatment to function in your daily life? An extreme amount
How much do you enjoy life?	How much do you enjoy life? Not at all	How much do you enjoy life? A little	How much do you enjoy life? A moderate amount	How much do you enjoy life? Very much	How much do you enjoy life? An extreme amount
To what extent do you feel your life to be meaningful?	To what extent do you feel your life to be meaningful? Not at all	To what extent do you feel your life to be meaningful? A little	To what extent do you feel your life to be meaningful? A moderate amount	To what extent do you feel your life to be meaningful? Very much	To what extent do you feel your life to be meaningful? An extreme amount

The following questions ask about how completely you experience or were able to do certain things in the last two weeks. *

	Not at all	A little	Moderately	Mostly	Completely
Do you have enough energy for everyday life?	Do you have enough energy for everyday life? Not at all	Do you have enough energy for everyday life? A little	Do you have enough energy for everyday life? Moderately	Do you have enough energy for everyday life? Mostly	Do you have enough energy for everyday life? Completely
Are you able to accept your bodily appearance?	Are you able to accept your bodily appearance? Not at all	Are you able to accept your bodily appearance? A little	Are you able to accept your bodily appearance? Moderately	Are you able to accept your bodily appearance? Mostly	Are you able to accept your bodily appearance? Completely
Have you enough money to meet your needs?	Have you enough money to meet your needs? Not at all	Have you enough money to meet your needs? A little	Have you enough money to meet your needs? Moderately	Have you enough money to meet your needs? Mostly	Have you enough money to meet your needs? Completely
How available to you is the information that you need in your day-to-day life?	How available to you is the information that you need in your day-to-day life? Not at all	How available to you is the information that you need in your day-to-day life? A little	How available to you is the information that you need in your day-to-day life? Moderately	How available to you is the information that you need in your day-to-day life? Mostly	How available to you is the information that you need in your day-to-day life? Completely
Towhatextentdo you have the opportunity for leisure activities?	Towhatextentdo you have the opportunity for leisure activities? Not at all	Towhatextentdo you have the opportunity for leisure activities? A little	Towhatextentdo you have the opportunity for leisure activities? Moderately	Towhatextentdo you have the opportunity for leisure activities? Mostly	Towhatextentdo you have the opportunity for leisure activities? Completely

How well are you able to get around in the last two weeks? *

Very poor	Poor	Neither poor nor well	Well	Very well
How well are you able to get around? Very poor	How well are you able to get around? Poor	How well are you able to get around? Neither poor nor well	How well are you able to get around? Well	How well are you able to get around? Very well

The following questions ask you to say how good or satisfied you have felt about various aspects of your life over the last two weeks. *

	Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
How satisfied are you with your sleep?	How satisfied are you with your sleep? Very dissatisfied	How satisfied are you with your sleep? Dissatisfied	How satisfied are you with your sleep? Neither satisfied nor dissatisfied	How satisfied are you with your sleep? Satisfied	How satisfied are you with your sleep? Very satisfied
How satisfied are you with your ability to perform your daily living activities?	How satisfied are you with your ability to perform your daily living activities? Very dissatisfied	How satisfied are you with your ability to perform your daily living activities? Dissatisfied	How satisfied are you with your ability to perform your daily living activities? Neither satisfied nor dissatisfied	How satisfied are you with your ability to perform your daily living activities? Satisfied	How satisfied are you with your ability to perform your daily living activities? Very satisfied
How satisfied are you with your capacity for work?	How satisfied are you with your capacity for work? Very dissatisfied	How satisfied are you with your capacity for work? Dissatisfied	How satisfied are you with your capacity for work? Neither satisfied nor dissatisfied	How satisfied are you with your capacity for work? Satisfied	How satisfied are you with your capacity for work? Very satisfied
How satisfied are you with yourself?	How satisfied are you with yourself? Very dissatisfied	How satisfied are you with yourself? Dissatisfied	How satisfied are you with yourself? Neither satisfied nor dissatisfied	How satisfied are you with yourself? Satisfied	How satisfied are you with yourself? Very satisfied
How satisfied are you with your personal relationships?	How satisfied are you with your personal relationships? Very dissatisfied	How satisfied are you with your personal relationships? Dissatisfied	How satisfied are you with your personal relationships? Neither satisfied nor dissatisfied	How satisfied are you with your personal relationships? Satisfied	How satisfied are you with your personal relationships? Very satisfied
How satisfied are you with your sex life?	How satisfied are you with your sex life? Very dissatisfied	How satisfied are you with your sex life? Dissatisfied	How satisfied are you with your sex life? Neither satisfied nor dissatisfied	How satisfied are you with your sex life? Satisfied	How satisfied are you with your sex life? Very satisfied
How satisfied are you with the support you get from your friends?	How satisfied are you with the support you get from your friends? Very dissatisfied	How satisfied are you with the support you get from your friends? Dissatisfied	How satisfied are you with the support you get from your friends? Neither satisfied nor dissatisfied	How satisfied are you with the support you get from your friends? Satisfied	How satisfied are you with the support you get from your friends? Very satisfied
How satisfied are you with the conditions of your living place?	How satisfied are you with the conditions of your living place? Very dissatisfied	How satisfied are you with the conditions of your living place? Dissatisfied	How satisfied are you with the conditions of your living place? Neither satisfied nor dissatisfied	How satisfied are you with the conditions of your living place? Satisfied	How satisfied are you with the conditions of your living place? Very satisfied
How satisfied are you with your access to health services?	How satisfied are you with your access to health services? Very dissatisfied	How satisfied are you with your access to health services? Dissatisfied	How satisfied are you with your access to health services? Neither satisfied nor dissatisfied	How satisfied are you with your access to health services? Satisfied	How satisfied are you with your access to health services? Very satisfied
How satisfied are you with your mode of transportation?	How satisfied are you with your mode of transportation? Very dissatisfied	How satisfied are you with your mode of transportation? Dissatisfied	How satisfied are you with your mode of transportation? Neither satisfied nor dissatisfied	How satisfied are you with your mode of transportation? Satisfied	How satisfied are you with your mode of transportation? Very satisfied

The follow question refers to how often you have felt or experienced certain things in the last two weeks. *

	Never	Seldom	Quite often	Very often	Always
How often do you have negative feelings, such as blue mood, despair, anxiety, depression?	How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Never	How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Seldom	How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Quite often	How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Very often	How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Always

Did someone help you to fill out this form? *

How long did it take to fill out this particular page? *

This page is a standard World Health Organization Quality Of Life Survey (WHOQOL-BREF) survey. We cannot change any of the questions and have to ask them exactly like they are to use them. Thank you for participating.

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