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Question Index: Psychosocial


Questions

Year(s) Asked on Long Forms

(Click on year to view PDF of questionnaire.)
Amount of stress in your dailiy life? At home and At work x
Do you have an unreasonable fear of being in enclosed spaces such as stores, elevators, etc.? x
Do you find yourself worried about getting some incurable illness? x
Are you scared of heights? x
Do you feel panicky in crowds? x
Do you worry unduly when relatives are late coming home? x
Do you feel more relaxed indoors? x
Do you dislike going out alone? x
Do you feel uneasy traveling on buses or trains, even if they are not crowded? x

During the past 4 weeks:
- Do you feel full of pep?
- Have you been a very nervous person?
- Have you felt so down nothing could cheer you up?
- Have you felt calm and peaceful?
- Did you have a lot of energy?
- Have you felt downhearted and blue?
- Did you feel worn out?
- Have you been a happy person?
- Did you feel tired?

 x x x
Have you felt hopeless about the future?
 x
Have you thought about or wanted to commit suicide? x
Have you felt no interest in things? x
Did you have difficulty falling asleep or staying asleep? x
In general, would you say your health is (excellent, good, fair, etc.)? x
During the past 4 weeks, how much of the time have your physical health or emotional problems interfered with your social activities? x
True or False (and in between):
Over the past 4 weks I feel much the same as I've felt over the last year x x x
I seem to get sick a little easier than other people x x x
I am as healthy as anybody I know x x x
I expect my health to get worse x x x
My health is excellent x x x
Outside your employment, do you provide any regular care to any of the following? (and # of hours)
- Your children x x x
- Grandchildren x x x
- Disabled or ill spouse x x x
- Disabled or ill parent x x x
- Disabled or ill other person x x x
How stressful would you say it is to provide care to the individuals mentioned above? x x x
How rewarding is it? x
During the past 4 weeks, have you had any of the following problems with work/other regular activities?
- Cut down the amount of time spent on work/other activities x x x
- Accomplished less than you would like x x x
- Didn't do work or other activities as carefully as usual x x x
During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activites with family/friends/groups? x x x
How much bodily pain have you had during the past 4 weeks? x x x
During the past 4 weeks, how much did bodily pain interfere with your normal work? x x x
During the past 4 weeks, have you had any of the following problems with your work or other regular activities as a result of your physical health?
- Cut down on amount of time you spent on work or other activities x x x
- Accomplished less than you would like x x x
- Were limited in the kind of work or other activities x x x
- Had difficulty performing the work or other activities x x x
What is your work status? (retired, full-time, part-time, etc.) x x
Retired? At what age did you retire? x x
Overall, how is the quality of retired life vs. working life? x x
If you have been employed within the last 2 years, answer (agree/disagree) these questions:
My job requires that I learn new things x x
My job involves a lot of repetitive work x x
My job requires me to be creative x x
My job allows me to make a lot of decisions on my own x x
My job requires a high level of skill x x
On my job, I have very little freedom to decide how I do my work x x
I get to do a variety of different things on my job x x
I have a lot to say about what happens on my job x x
I have an opportunity to develop my own special abilities x x
My job requires working very fast x x
My job requires working very hard x x
My job requires lots of physical effort x x
I am not asked to do an excessive amount of work x x
I have enough time to get the job done x x
My job security is good x x
I am free from conflicting demands that others make x x
People I work with are competent in doing their jobs x x
People I work with take a personal interest in me x x
People I work with are friendly x x
People I work with are helpful in getting the job done x x
My supervisor is concerned about the welfare of those under her x x
My supervisor pays attention to what I am saying x x
My supervisor is helpful in getting the job done x x
My supervisor is successful in getting people to work together x x
My job security is good x
How steady is your work? x x
How likely is is that you'll lose your job in the coming years? x x
What is your religious heritage? x
How often do you go to religious meetings or services? x x x
How many hours/week do you participate in groups such as social or work group, church group, self-help group, charity, public service, or community group? x x x
How many living children do you have? x x x
How many of your children do you see at least once a month? x x x
Apart from children, closeness to other relatives? How many? x x x
How many close relatives do you see at least once a month? x x x
How many close friends do you have? x x x
How many of these friends do you see at least once a month? x x x
Is there any one special person you know that you feel very close to; someone with whom you can share feelings and confidences? x x
- How often do you see/talk with this person? x x
Can you count on anyone to provide you with emotional support (talking over problems, etc.)? None of the time, some, most, all, etc. x
How many people can you count on to provide you with emotional support? x
How do you feel about your standing in US society and your community? (Picture of a ladder, where participant is asked to mark the rung on which they perceive themselves to be, once each for US and community) x

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