Questions:

1. Overall in the last 30 days, how much of a problem did [name of person] have with feeling sad, low, or depressed?
2. In the last 30 days, how much of a problem did [name of person] have with worry or anxiety?

Response categories:

1. None
2. Mild
3. Moderate
4. Severe
5. Extreme/Cannot Do

1. [Ken] loves life and is happy all the time. He never worries or gets upset about anything and deals with things as they come.***
   
   
2. [Karim] is always happy and positive even when things go wrong in his life and never gets depressed. Though he occasionally worries about his hearing loss, he enjoys life and tries to make the most of it.
   
   
3. [Henriette] enjoys her work and social activities and is generally satisfied with her life. She gets depressed every 3 weeks for a day or two and loses interest in what she usually enjoys but is able to carry on with her day to day activities.***
   
   
4. [Margaret] is happy most of the time but often worries about things in general, such as health, work, family, and losing the people she loves. Once or twice a month, she wakes up at night thinking about these things.
   
   
5. [Tamara] has mood swings. When she gets depressed, everything she does is an effort for her and she no longer enjoys her usual activities. These mood swings are not predictable and occur two or three times during a month.
   
   
6. [Shereen] is usually an outgoing and cheerful person who has many friends and enjoys going out. Three or four days a month, she feels sad all day so tends to avoid people.
   
   
7. [Tania] feels happy and enjoys things like hobbies or social activities around half of the time. Otherwise she worries about the future and feels depressed around one or two days a month.
   
   
8. [Eva] feels worried all the time about her health. She gets depressed once a week for a day or two, thinking about what could go wrong and all the illnesses she could get, but is able to come out of this mood if she concentrates on something else.
   
   
9. [May]'s father died a week ago. She is finding it hard to face up to each day and feels sad and empty. She weeps easily thinking about her father.
   
   
10. [Laura] has recently ended a relationship she had for 5 years. She feels very distressed and has been crying almost everyday for the past 2 weeks.
    
    
11. [Jan] feels nervous and anxious. He worries and thinks negatively about the future, but feels better in the company of people or when doing something that really interests him. When he is alone he tends to feel useless and empty.***
    
    
12. [Sylvia] feels sad and tearful several times a week and it is difficult to cheer her up. She has no job and has very few friends. Although she is not thinking of killing herself, she does not see any purpose in living.
    
    
13. [Nathan] has attacks of anxiety when he goes out of his house. So he leaves his home only once a week, and never by himself.
    
    
14. [Cedric] suffers from a chronic illness for which there is no cure. He is depressed every day and has lost interest in things he used to enjoy. He often wishes he was dead.
    
    
15. [Roberta] feels depressed most of the time. She weeps frequently and feels hopeless about the future. She feels that she has become a burden on others and that she would be better dead.***
    
    
16. [Vivian] has already had five admissions into the hospital because she has attempted suicide twice in the past year and has harmed herself on three other occasions. She is very distressed every day for the most part of the day, and sees no hope of things ever getting better. She is thinking of trying to end her life again.***
    

*** Included in the final World Health Survey instrument in 2002.