Form: Psychological General Well-Being Index, PGWBI

1. How have you been feeling in general during the past month?
In excellent spirits
In very good spirits
In good spirits mostly
I have been up and down in spirits a lot
In low spirits mostly
In very low spirits
2. How often were you bothered by any illness‚ bodily disorder‚ aches or pains during the past month?
Every day
Almost every day
About half of the time
Now and then‚ but less than half the time
Rarely
None of the time
3. Did you feel depressed during the past month?
Yes – to the point that I felt like taking my life
Yes – to the point that I did not care about anything
Yes – very depressed almost every day
Yes – quite depressed several times
Yes – a little depressed now and then
No – never felt depressed at all
4. Have you been in firm control of your behaviour‚ thoughts‚ emotions or feelings during the past month?
Yes‚ definitely so
Yes‚ for the most part
Generally so
Not too well
No‚ and I am somewhat disturbed
No‚ and I am very disturbed
5. Have you been bothered by nervousness or your “nerves” during the past month?
Extremely so – to the point where I could not work or take care of things
Very much so
Quite a bit
Some – enough to bother me
A little
Not at all
6. How much energy‚ pep‚ or vitality did you have or feel during the past month?
Very full of energy – lots of pep
Fairly energetic most of the time
My energy level varied quite a bit
Generally low in energy or pep
Very low in energy or pep most of the time
No energy or pep at all – I fell drained‚ sapped
7. I felt downhearted and blue during the past month.
None of this time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
8. Were you generally tense or did you feel any tension during the past month?
Yes – extremely tens‚ most or all of the time
Yes – very tense most of the time
Not generally tense‚ but did feel fairly tense several times
I felt a little tense a few times
My general tension level was quite low
I never felt tense or any tension at all
9. How happy‚ satisfied‚ or pleased have you been with your personal life during the past month?
Extremely happy – could not have been more satisfied or pleased
Very happy most of the time
Generally satisfied‚ pleased
Sometimes fairly happy‚ sometimes fairly unhappy
Generally dissatisfied or unhappy
Very dissatisfied or unhappy most or all the time
10. Did you feel healthy enough to carry out the things you like to do or had to do during the past month?
Yes – definitely so
For the most part
Health problems limited me in some important ways
I was only healthy enough to take care of myself
I needed some help in taking care of myself
I needed someone to help me with most or all of the things I had to do
11. Have you felt so sad‚ discouraged‚ hopeless‚ or had so many problems that you wondered if anything was worthwhile during the past month?
Extremely so – to the point that I have just about given up
Very much so
Quite a bit
Some – enough to bother me
A little bit
Not at all
12. I woke up feeling fresh and rested during the past month.
None of the time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
13. Have you been concerned‚ worried‚ or had any fears about your health during the past month?
Extremely so
Very much so
Quite a bit
Some‚ but not a lot
Practically never
Not at all
14. Have you had any reason to wonder if you were losing your mind‚ or losing control over the way you act‚ talk‚ think‚ feel or of your memory during the past month?
Not at all
Only a little
Some – but not enough to be concerned or worried about
Some and I have been a little concerned
Some and I am quite concerned
Yes‚ very much so and I am very concerned
15. My daily life was full of things that were interesting to me during the past month.
None of the time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
16. Did you feel active‚ vigorous‚ or dull‚ sluggish during the past month?
Very active‚ vigorous every day
Mostly active‚ vigorous – never really dull‚ sluggish
Fairly active‚ vigorous – seldom dull‚ sluggish
Fairly dull‚ sluggish – seldom active‚ vigorous
Most dull‚ sluggish – never really active‚ vigorous
Very dull‚ sluggish every day
17. Have you been anxious‚ worried‚ or upset during the past month?
Extremely so – to the point of being sick or almost sick
Very much so
Quite a bit
Some – enough to bother me
A little bit
Not at all
18. I was emotionally stable and sure of myself during the past month.
None of the time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
19. Did you feel relaxed‚ at ease or high strung‚ tight‚ or keyed-up during the past month?
Felt relaxed and at ease the whole month
Felt relaxed and at ease most of the time
Generally felt relaxed but at times felt fairly high strung
Generally felt high strung but at times felt fairly relaxed
Felt high strung‚ tight‚ or keyed-up most of the time
Felt high strung‚ tight‚ or keyed-up the whole month
20. I felt cheerful‚ lighthearted during the past month.
None of the time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
21. I felt tired‚ worn out‚ used up‚ or exhausted during the past month.
None of the time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
22. Have you been under or felt you were under any strain‚ stress‚ or pressure during the past month?
Yes – almost more than I could bear or stand
Yes – quite a bit of pressure
Yes‚ some – more than usual
Yes‚ some – but about usual
Yes – a little
Not at all

The presented answer sheet is not an original form and is not intended for printing or use as a handout.