This is a survey on Mental Health for a CUV psychology course. Please read each item and place a
mark in the box opposite the reply which comes closest to how you felt in the past week. The best
answers are what immediately comes to mind.
Individual's Gender:: Male: Female: Question No. I feel tense or 'wound up': Most of the time A
lot of the time Time to time, occasionally Not at all
2: I still enjoy the things I used to enjoy: Not at all. Only a little. Not quite as much.
Definitely as much.
3: I feel as if I am slowed down: Nearly all of the time. Very often. Sometimes Not at all
4: I get a sort of frightened feeling like 'butterflies' in the stomach': Very often. Quite often.
Occasionally. Not at all.
5: I get a sort of frighten- ing feeling like something awful is about to happen: Very definitely
and quite badly Yes, but not too badly. A little, but it doesn't worry me. Not at all.
6: I have lost interest in my appearance: Definitely I don't take as much care as I should. I may
not take quite as much care. I take just as much care as ever.
7: I can laugh and see the funny side of things: Not at all Definitely not quite so much now Not
quite so much now. As much as I always could.
8: I feel restless as if I have to be on the move: Very much indeed Quite a lot. Not very much.
Not at all.
9: Worrying thoughts go through my mind: A great deal of the time. A lot of the time. From time to
time but not too often. Only occasionally.
10: I look forward with enjoyment to things: Definitely less than I used to. Hardly at all.
Rather less than I used to. As much as I ever did.
11: I feel cheerful:. Not at all. Not often. Sometimes. Most of the time.
12: I get sudden feelings of panic: Very often indeed. Quite often. Not very often. Not at all.
13: I can sit at ease and relaxed: Not at all. Not often. Usually. Definitely.
14: I can enjoy a good book or radio or TV programme: Very seldom. Not very often.
Sometimes. Often.
Thank you for your help!