World Health Organization Quality of Life Survey-Brief 1. WHO-QOL Pre Training For this survey, you will indicate your Code Number, your zip or mail code and today's date at the end of the survey. Please answer the 26 question of the WHO Quality of Life Survey completely, honestly and (if possible) without interruptions. Read the questions carefully. The scale is reversed for some questions. Thank you! Question Title * 1. How would you rate your quality of life? (Required.) Very Poor Poor Neither Poor nor Good Good Very Good Very Poor Poor Neither Poor nor Good Good Very Good Question Title * 2. How satisfied are you with your health? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 3. To what extent do you feel that physical pain prevents you from doing what you need to do? (Required.) Not at all A little A moderate amount Very much An extreme amount Not at all A little A moderate amount Very much An extreme amount Question Title * 4. How much do you need any medical treatment to function indoor daily life? (Required.) Not at all A little A Moderate Amount Very much An extreme amount Not at all A little A Moderate Amount Very much An extreme amount Question Title * 5. How much do you enjoy life? (Required.) Not at all A little A moderate amount Very much An extreme amount Not at all A little A moderate amount Very much An extreme amount Question Title * 6. To what extent do you feel your life to be meaningful? (Required.) Not at all A little A Moderate Amount Very much An extreme amount Not at all A little A Moderate Amount Very much An extreme amount Question Title * 7. How well are you able to concentrate? (Required.) Not at all Slightly A Moderate amount Very much An extreme amount Not at all Slightly A Moderate amount Very much An extreme amount Question Title * 8. How safe do you feel in your daily life? (Required.) Not at all Slightly A Moderate amount Very Much Extremely. Not at all Slightly A Moderate amount Very Much Extremely. Question Title * 9. How healthy is your physical environment? (Required.) Not at all Slightly A Moderate amount Very Much Extremely. Not at all Slightly A Moderate amount Very Much Extremely. Question Title * 10. Do you have enough energy for everyday life? (Required.) Not at all A little Moderately Mostly Completely Not at all A little Moderately Mostly Completely Question Title * 11. Are you able to accept your bodily appearance? (Required.) Not at all A little Moderately Mostly Completely Not at all A little Moderately Mostly Completely Question Title * 12. Have you enough money to meet your needs? (Required.) Not at all A little Moderately Mostly Completely Not at all A little Moderately Mostly Completely Question Title * 13. How available to you is the information that you need in your day-to-day life? (Required.) Not at all A little Moderately Mostly Completely Not at all A little Moderately Mostly Completely Question Title * 14. To what extent do you have the opportunity for leisure activities? (Required.) Not at all A little Moderately Mostly Completely Not at all A little Moderately Mostly Completely Question Title * 15. How well are you able to get around? (Required.) Very poor Poor Neither poor nor well Well Very well Very poor Poor Neither poor nor well Well Very well Question Title * 16. How satisfied are you with your sleep? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 17. How satisfied are you with your ability to perform your daily living activities? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 18. How satisfied are you with your capacity for work? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 19. How satisfied are you with your abilities? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 20. How satisfied are you with your personal relationships? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 21. How satisfied are you with your sex life? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 22. How satisfied are you with the support you get from your friends? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 23. How satisfied are you with the conditions of your living place? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 24. How satisfied are you with your access to health services? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 25. How satisfied are you with your mode of transportation? (Required.) Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Very dissatisfied Dissatisfied Neither satisfied nor dissatisfied Satisfied Very satisfied Question Title * 26. How often do you have negative feelings, such as blue mood, despair, anxiety and depression? (Required.) Never Seldom Quite often Very often Always Never Seldom Quite often Very often Always Question Title * 27. ID number and your zip or postal code. (Required.) Study ID Number (use initials if you are uncertain about your number) ZIP/Postal Code Question Title * 28. Please enter today's date: (Required.) SUBMIT