| Are you basically satisfied with your life? | yes | no |
| Have you dropped many of your activities and interests? | yes | no |
| Do you feel that your life is empty? | yes | no |
| Do you often get bored? | yes | no |
| Are you in good spirits most of the time? | yes | no |
| Are you afraid that something bad is going to happen to you? | yes | no |
| Do you feel happy most of the time? | yes | no |
| Do you often feel helpless? | yes | no |
| Do you prefer to stay at home, rather than going out and doing new things? | yes | no |
| Do you feel you have more problems with memory than most? | yes | no |
| Do you think it is wonderful to be alive now? | yes | no |
| Do you feel pretty worthless the way you are now? | yes | no |
| Do you feel full of energy? | yes | no |
| Do you feel that your situation is hopeless? | yes | no |
| Do you think that most people are better off than you are? | yes | no |