| 1. Been able to concentrate on what you’re doing? | Better than usual | Same as usual | Less than usual | Much less than usual |
| 2. Lost much sleep over worry? | Not at all | No more than usual | Rather more than usual | Much more than usual |
| 3. Felt you were playing a useful part in things? | More so than usual | Same as usual | Less useful than usual | Much less useful |
| 4. Felt capable of making decisions about things? | More so than usual | Same as usual | Less so than usual | Much less capable |
| 5. Felt constantly under strain? | Not at all | No more than usual | Rather more than usual | Much more than usual |
| 6. Felt you couldn’t overcome your difficulties? | Not at all | No more than usual | Rather more than usual | Much more than usual |
| 7. Been able to enjoy your normal day-to-day activities? | More so than usual | Same as usual | Less so than usual | Much less than usual |
| 8. Been able to face up to your problems? | More so than usual | Same as usual | Less so than usual | Much less able |
| 9. Been feeling unhappy and depressed? | Not at all | No more than usual | Rather more than usual | Much more than usual
|
| 10. Been losing confidence in yourself? | Not at all | No more than usual | Rather more than usual | Much more than usual |
| 11. Been thinking of yourself as a worthless person? | Not at all | No more than usual | Rather more than usual | Much more than usual |
| 12. Been feeling reasonably happy, all things considered | More so than usual | About same as usual | Less so than usual | Much less than usual; |