Questionnaire

AQoL-8D (Researcher’s Copy)

(Mental Health)

NAME:
EMAIL:
TODAYS DATE:
DATE OF BIRTH:
COMMENTS:

1. INDEPENDENT LIVING
Q1 - How much help do you need with jobs around the house (eg preparing food, cleaning the house or gardening):

I can do all these tasks very quickly and efficiently without any helpI can do these tasks relatively easily without helpI can do these tasks only very slowly without helpI cannot do most of these tasks unless I have helpI can do none of these tasks by myself.

Q2 - Thinking about how easy or difficult it is for you to get around by yourself outside your house (eg shopping, visiting):

Getting around is enjoyable and easyI have no difficulty getting around outside my houseA little difficultyModerate difficultyA lot of difficultyI cannot get around unless somebody is there to help me.

Q3 - Thinking about how well you can walk:

I find walking or running very easyI have no real difficulty with walking or runningI find walking or running slightly difficult. I cannot run to catch a tram or train, I find walking uphill difficultWalking is difficult for me. I walk short distances only, I have difficulty walking up stairsI have great difficulty walking. I cannot walk without a walking stick or frame, or someone to help meI am bedridden.

Q4 - Thinking about washing yourself, toileting, dressing, eating or looking after your appearance:

These tasks are very easy for meI have no real difficulty in carrying out these tasksI find some of these tasks difficult, but I manage to do them on my ownMany of these tasks are difficult, and I need help to do themI cannot do these tasks by myself at all.

2. LIFE SATISFACTION

Q5 - How content are you with your life?

ExtremelyMainlyModeratelySlightlyNot at all

Q6 - How enthusiastic do you feel?

ExtremelyVerySomewhatNot muchNot at all

Q7 - How often do you feel happy?

All the timeMostlySometimesAlmost neverNever

Q8 - How often do you feel pleasure?

AlwaysUsuallySometimesAlmost neverNever

3. MENTAL HEALTH

Q9 - How often do you feel depressed?

NeverAlmost neverSometimesOftenVery oftenAll the time

Q10 - How often do you have trouble sleeping?

NeverAlmost neverSometimesOftenAll the time

Q11 - How often do you feel angry?

NeverAlmost neverSometimesOftenAll the time

Q12 - Do you ever feel like hurting yourself?

NeverRarelySometimesOftenAll the time

Q13 - How often did you feel in despair over the last seven days?

NeverOccasionallySometimesOftenAll the time

Q14 - And still thinking about the last seven days, how often did you feel worried?

NeverOccasionallySometimesOftenAll the time

Q15 - How often do you feel sad?

NeverRarelySome of the timeUsuallyNearly all the time

Q16 - When you think about whether you are calm and tranquil or agitated: I am

Always calm and tranquilUsually calm and tranquilSometimes calm and tranquil, sometimes agitatedUsually agitatedAlways agitated

4. COPING

Q17 - Thinking about how much energy you have to do the things you want to do: I am

Always full of energyUsually full of energyOccasionally energeticUsually tired and lacking energyAlways tired and lacking energy

Q18 - How often do you feel in control of your life?

AlwaysMostlySometimesOnly occasionallyNever

Q19 - How much do you feel you can cope with life’s problems?

CompletelyMostlyPartlyVery littleNot at all

5. RELATIONSHIPS

Q20 - How much do you enjoy your close relationships (family and friends)?

ImmenselyA lotA littleNot muchI hate it

Q21 - Your close relationships (family and friends) are:

Very satisfyingSatisfyingNeither satisfying nor dissatisfyingDissatisfyingUnpleasantVery unpleasant

Q22 - How often do you feel socially isolated?

NeverRarelySometimesOftenAlways

Q23 - How often do you feel socially excluded or left out?

NeverRarelySometimesOftenAlways

Q24 - Your close and intimate relationships (including any sexual relationships) make you:

Very happyGenerally happyNeither happy nor unhappyGenerally unhappyVery unhappy

Q25 - Thinking about your health and your relationship with your family:

My role in the family is unaffected by my healthThere are some parts of my family role I cannot carry outThere are many parts of my family role I cannot carry outI cannot carry out any part of my family role.

Q26 -Thinking about your health and your role in your community (that is to say neighbourhood, sporting, work, church or cultural groups):

My role in the community is unaffected by my healthThere are some parts of my community role I cannot carry outThere are many parts of my community role I cannot carry outI cannot carry out any part of my community role.

6. SELF WORTH

Q27 - How much of a burden do you feel you are to other people?

Not at allA littleA moderate amountA lotTotally

Q28 - How often do you feel worthless?

NeverAlmost neverSometimesUsuallyAlways

Q29 - How much confidence do you have in yourself?

Complete confidenceA lotA moderate amountA littleNone at all

7. PAIN

Q30 - Thinking about how often you experience serious pain: I experience it

Very rarelyLess than once a weekThree to four times a weekMost of the time

Q31 - How much pain or discomfort do you experience:

None at allI have moderate painI suffer from severe painI suffer unbearable pain

Q32 - How often does pain interfere with your usual activities?

NeverRarelySometimesOftenAlways

8. SENSES

Q33 - Thinking about your vision (using your glasses or contact lenses if needed):

I have excellent sightI see normallyI have some difficulty focusing on things, or I do not see them sharply. E.g. small print, a newspaper or seeing objects in the distance.I have a lot of difficulty seeing things. My vision is blurred. I can see just enough to get by with.I only see general shapes. I need a guide to move aroundI am completely blind

Q34 - Thinking about your hearing (using your hearing aid if needed):

I have excellent hearingI hear normallyI have some difficulty hearing or I do not hear clearly. I have trouble hearing softly-spoken people or when there is background noise.I have difficulty hearing things clearly. Often I do not understand what is said. I usually do not take part in conversations because I cannot hear what is said.I hear very little indeed. I cannot fully understand loud voices speaking directly to me.I am completely deaf

Q35 - When you communicate with others, e.g. by talking, listening, writing or signing:

I have no trouble speaking to them or understanding what they are sayingI have some difficulty being understood by people who do not know me. I have no trouble understanding what others are saying to me.I am understood only by people who know me well. I have great trouble understanding what others are saying to me.I cannot adequately communicate with others