Questions:

1. Overall in the last 30 days, how much difficulty did [name of person/you] have with personal relationships or participation in the community?
2. In the last 30 days, how much difficulty did [name of person/you] have in dealing with conflicts and tensions with others?

Response categories:

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

Vignettes:

1. [Charlie] can join in any community activities that interest him, whenever he wants to, without any restrictions. He gets on well with everybody and enjoys meeting new people.***
   
   
2. [Lorna] lives in a home for intellectually impaired adults. She has a full and active social life with the other members of the institutions. She also works several hours a day. Her family takes her out every weekend on trips and on family occasions.
   
   
3. [Jeremy] plays on a local football team for fun, with practices or games two times a week. Other than that, he finds it difficult to make new friends and generally stays at home with his family.
   
   
4. [Jim] is confined to a wheelchair and lives in a small village where most buildings do not have ramps. Although he has no difficulties leaving his house, and can make friends easily, it is difficult to move freely in and out of public buildings with his wheelchair which limits his going out to public functions.
   
   
5. [Elizabeth] has difficulty climbing up and down the stairs and walking. She is not able to go out as much as she would like to but has many friends who come and visit her at home. Her friends find her a source of great comfort.***
   
   
6. [Diana] has been deaf since childhood and uses sign language with her family and close friends. Since she needs to write things down to get people to understand her she avoids community gatherings. She occasionally gets angry with strangers but is able to quickly control her irritation.
   
   
7. [Sarah] has had a stroke in childhood and struggles to communicate with people outside of her family. She has a close friend who takes her out to the cinema once a month. She's considered odd and gets upset when people do not understand what she's trying to say.
   
   
8. [Rose] is an elderly lady who lives on her own and does not have any relatives. She never leaves the house. Someone does the shopping and cleaning for her once a week. She is easily irritated and upset while talking to her maid.
   
   
9. [Henry] suffers from panic attacks in the presence of crowds and in public places. He feels at ease only in small gatherings with close friends. He avoids getting into arguments as he fears he will have a panic attack.
   
   
10. [Johanna] gets on well with the people she knows but has no close friends. She has not spoken to her mother in 5 years and does not want to see her. Because of this tension, her family usually excludes her from family gatherings.***
    
    
11. [Nobu] is blind and lives in a remote rural area. His family does not allow him to leave the house because they fear he will get hurt. His family tells him that he is a burden to them. Their criticism upsets him and he cries.***
    
    
12. [John] does not feel comfortable interacting with people he does not know or taking part in community events. He does not get on well with his family and always has arguments whenever they meet.
    
    
13. [Mary] only has a close relationship with her caregiver. She has no relationships with anyone else even with members of her family. She tends to avoid people as far as possible.
    
    
14. [Amala] suffered a stroke three months ago. Her friends do not come and visit anymore as Amala cannot communicate with them. She is constantly upset and shouts at her family members which causes them to avoid her.***
    
    
15. [Peter] has been arrested twice in the last year for getting in fights at bars. He does not have any friends and spends his evenings on his own.
    

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