1.
During the past 2 weeks, how difficult has it been to you:
Keep the house/apartment clean or uncluttered.
2. Manage your finances, such as cashing checks, balancing your checkbook, paying bills on time.
3. Remember important things.
4. Get your shopping done (such as for food, clothes, or household items).
5. Pay attention when interacting with others.
6.
During the past 2 weeks, how often have you felt:
Overwhelmed.
7. Anxious.
8. Depressed.
9. You have not been able to meet others' expectations of you (either at home or work).
10. You annoyed people.
11. Getting things done requires too much effort.
12. People are frustrated with you.
13. You have overreacted in difficult or stressful situations.
14. Your energy is well spent (has positive results).
15. Able to enjoy time spent with others.
16. You can successfully manage your life.
17. As productive as you would like to be.
18.
During the past 2 weeks, how troubled have you been by:
Tension in relationships.
19. Not having quality time to spend with others.
20.
During the past 2 weeks, how bothered have you been by:
Feeling fatigued.
21. Fluctuations (ups and downs) in your emotions.
22.
During the past 2 weeks, how much of a problem has it been for you to:
Complete projects or tasks (either at work or home).
23. Get started with tasks you don't find interesting.
24. Balance multiple projects.
25. Get things done on time.
26. Keep track of important items (such as keys, wallet).
27.
During the past 2 weeks, how often have you felt:
Good about yourself.
28. People enjoy spending time with you.
29. Your intimate relationship is going well emotionally.