1. ... have you felt low in spirits or sad?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
2. ... have you lost interest in your daily activities?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
3. ... have you felt lacking in energy and strength?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
4. ... have you felt less self confident?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
5. ... have you had a bad conscience or feelings of
guilt?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
6. ... have you felt that life was not worth living?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
7. ... have you had trouble concentrating, e.g. reading
the newspaper or watching
TV?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
8a. ... have you felt very restless?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
8b. ... have you felt subdued or slowed down?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
9. ... have you had trouble sleeping at night?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
10a. ... have you suffered from reduced appetite?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
10b. ... have you suffered from increased appetite?
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All the time
Most of the time
slightly more than half the time
Slightly less than half the time
Some of the time
At no time
I do not understand the statement
Year you were born:
Select your year of birth
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1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1957
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
My YOB not on list
Gender:
Select your gender
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Male
Female
not listed
Marital Status:
Select your current marital status
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single - never married
married -- no small children at home
married with small children in home
marred w/ older child/teen at home
divorced -- no children at home
divorced with small children at home
divorced w/older child/teen
widowed no children at home
widowed with small children at home
widowed w/ older child/teen at home
seperated -- no children at home
seperated with small children at home
seperated with older child/teen at home
life mate -- no children at home
life mate with small children at home
life mate w/ older child/teen at home
Marital Status not listed above
Do you consider yourself to be a home maker (house
wife/husband)?
Select your home maker status
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NO
YES 4 hrs / day or less
YES 4 to 8 hrs per day
YES more than 8 hrs per day
not on list
I do not understand question
Highest grade completed:
Select Highest Grade Completed
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1st (elementary school)
2nd (elementary school)
3rd (elementry school)
4th (elementry school)
5th (elmentry school)
6th (elementry school)
7th (Junior High)
8th (jJunior High)
9th (High School Freshman)
10th (High School Sophmore)
11th (High School Junior)
12th (High School Senior) NO DIPLOMA
High School Diploma
13th (college freshman)
14th (college sophmore) NO DEGREE
AA/AS or Vocational Certificate
15th (College Junior)
16th (College Senior) NO DEGREE
Baccalaurate Degree
17th (Masters-1)
18th (Masters-2) NO DEGREE
Masters Degree
19th
Educational Developmental Specialist
20th
21th NO DEGREE -- ABD
Doctoral Degree
Post Doctorial Work
My highest grade not on list
Residence Type:
Select your *MAIN* residence type
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Farm or Ranch I own
Farm or Ranch that I rent
House on lot that I own
House that I rent
Apartment, co-op, or condo I own
Appartment, co-op or conco I rent
Trailer I own on lot I own
Trailer I own on lot I rent
Trailer I rent on lot I own
Trailer I rent on lot I rent
With friends or relatives
Shelter
Car or Van
Street
not on list
Residence Location:
Select your *MAIN* residence location
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Rural -- no close neighbors
Suburban -- not in city limits
Small Town < 2,500 people
Medium Town 2,501 - 10,000 people
Large town/city > 10,000 people
Major urban area
Not on list
Current Employment Status:
Select your current working time per week
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Full Time Student
Retired
full time home maker
Full Time 40 hrs or more per week
Part Time 30 to 39 hrs/wk
Part Time 20 to 29 hrs/wk
Part Time 10 to 19 hrs/wk
Part Time less than 10 hrs/wk
Currently Unemployed
Not on list
I do not understand this question
Employment Type:
Select you current *MAIN* type of employment
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retired
Farmer or Rancher
employee of company or corporation
owner of company or corporation
Licensed independent professional
Self Employed
Full Time Student
Full Time Home Maker
Not on list
Employment duration:
How long have you been in your current employment?
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retired
Just started -- less than 30 days
30 to 90 days
90 days to 6 months
6 months to 1 year
1 to 5 years
5 to 10 years
More than 10 years
Not on list
Employment Location:
Select your *MAIN* employment location
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retired
Rural -- no close neighbors
Suburban -- not in city limits
Small Town < 2,500 people
Medium Town 2,501 - 10,000 people
Large town/city > 10,000 people
Major urban area
Not on list
Employment Commuting Distance (one way):
Select your one-way commuting *DISTANCE* home to work
retired
Very close -- easy walking distance
Up to one mile
1 to 5 miles
6 to 10 miles
10 to 20 miles
20 to 50 miles
50 - 100 miles
more than 100 miles
Not on list
Employment Commuting Time (one way):
Select your one-way commuting *TIME* home to work
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retired
5 minutes or less
6 to 15 minutes
16 to 30 minutes
31 minutes to one hour
1 to 2 hours
2 to 3 hours
More than 3 hours
Not on list