World Health Organization Disability Assessment Schedule 2.0

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* 1. Demographic Info:

This questionnaire asks about difficulties due to health/mental health conditions.  Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs. Think back over the past 30 days and answer these questions thinking about how much difficulty you had doing the following activities. For each question, please select only one response.

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* 2. In the last 30 days, how much difficulty did you have in:

Understanding & communicating

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D1.1 Concentrating on doing something for ten minutes?
D1.2 Remembering to do important things?
D1.3  Analyzing and finding solutions to problems in day to day life?
D1.4 Learning a new task, for example, learning how to get to a new place?
D1.5 Generally understanding what people say?
D1.6 Starting & maintaining a conversation?

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* 3. In the last 30 days, how much difficulty did you have in:

Getting around

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D2.1 Standing for long periods, such as 30 minutes?
D2.2 Standing up from sitting down
D2.3 Moving around inside your home?
D2.4 Getting out of your home?
D2.5 Walking a long distance, such as a mile (or equivalent)

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* 4. In the last 30 days, how much difficulty did you have in:

Self-care

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D3.1 Washing your whole body?
D3.2 Getting dressed?
D3.3 Eating?
D3.4 Staying by yourself for a few days?

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* 5. Because of their health condition, in the past 30 days, how much difficulty did you have in:

Getting along with people

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D4.1 Dealing with people you do not know?
D4.2 Maintaining a friendship?
D4.3 Getting along with people who are close to you?
D4.4 Making new friends?
D4.5 Sexual activities

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* 6. Because of their health condition, in the past 30 days, how much difficulty did you have in:

Life activities- Household

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D5.1 Taking care of your household responsibilities?
D5.2 Doing most important household tasks well?
D5.3 Getting all the household work done that that you needed to do?
D5.4 Getting your household work done as quickly as needed?

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* 7. Life activities- School/ Work

If you work (paid, non-paid, self employed) or go to school, complete questions D5.5-D5.8 below.
Otherwise, skip to D6.1.

Because of your health condition, in the past 30 days how much difficulty did you have in:

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D5.5 Your day-to-day work/ school?
D5.6 Doing your most important work/ school tasks well?
D5.7 Getting all of the work done that you needed to do?
D5.8 Getting your work done as quickly as needed?

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* 8. Participation in society

In the past 30 days:

  1- None 2- Mild 3- Moderate 4- Severe 5 Extreme or cannot do
D6.1 How much of a problem did you have in joining in community activities (for example festivities, religious, or other activities) in the same way as anyone else can?
D6.2 How much of a problem did you have because of barriers or hindrances around you?
D6.3 How much of a problem did you have living with dignity because of the attitudes and actions of others?
D6.4 How much time did you spend on your health condition or its consequences?
D6.5 How much has you been emotionally affected by your or health condition?
D6.6 How much has your health been a drain on his or her financial resources or the financial resources of you or your family?
D6.7 How much of a problem did your family have because of your health problems?
D6.8 How much of a problem did you have in doing things by yourself for relaxation or pleasure?

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