Part 2: Mental health assessmet In the past 4 weeks, how frequently have you suffered from the following

1

Do you often have headaches

1/Yes

2/No

2

Is your apetite poor

1/Yes

2/No

3

Do you sleep badly

1/Yes

2/No

4

Are you easily frigtened

1/Yes

2/No

5

Do your hands shake

1/Yes

2/No

6

Do you feel nervous, tense or worried

1/Yes

2/No

7

Is your digestion poor

1/Yes

2/No

8

Do you have trouble thinking clearly

1/Yes

2/No

9

Do you feel unhappy

1/Yes

2/No

10

Do you cry more than usual

1/Yes

2/No

11

Do you find it difficult to enjoy yor daily activities

1/Yes

2/No

12

Do you find it difficult to make descisions

1/Yes

2/No

13

Is your daily work suffering

1/Yes

2/No

14

Are you unable to play a usefull rule in life

1/Yes

2/No