In the past two weeks, including today: | None | Little | Moderate | A lot | Too much |
---|---|---|---|---|---|
1. How much difficulty have you had taking care of yourself? | 0 | 1 | 2 | 3 | 4 |
2. How much difficulty have you had taking care of your household responsibilities? | 0 | 1 | 2 | 3 | 4 |
3. How much difficulty have you had concentrating (on any task)? | 0 | 1 | 2 | 3 | 4 |
4. How much difficulty have you had talking to others? | 0 | 1 | 2 | 3 | 4 |
5. How much difficulty have you had in taking care of the children in the house? | 0 | 1 | 2 | 3 | 4 |
6. How much difficulty have you had in visiting friends, neighbours or relatives? | 0 | 1 | 2 | 3 | 4 |
7. How much difficulty have you had doing other tasks outside of the house? | 0 | 1 | 2 | 3 | 4 |