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Thank you foryourcontinuing participation in ourstudy ofstress and health.
W e would be very gratefulifyou could com plete this furtherquestionnaire w hich
w illbring us up to date w ith any changesto yourlife circum stances,any new
illnesses you m ay have had,and youruse ofhealth services.
The answ ers 'o 'hese questions w ill,of eourse, be kep' s'riotly
eonfidential.T he s'udy results w illnever be in a form w hieh oan reveal
your identik .
W hy repea' the Aam e questions evee 'im e?
Som e people ask us w hy the sam e questions keep appearing in questionnaires.
There are severalreasons forthis.
*Som e questions are aboutevents - forexam ple,yourdate ofretirem entor
changes to yourm aritalstatus -thatm ighthappen to people atanytim e inthe
study.
* O therquestions are designed to track changes in yourhealth orpersonal
circum stances overtim e.
*Som e questions are abouta specific period -forexam ple,the Iast4 w eeks or
the Iast 14 days.These questions m ay Iook fam iliarbutthey are specific to that
period before filling in the questionnaire.
Rereating tnese questions m eans thatthe c'aesltonnaire Iooks very long.
W e apologise forthis,butdo hope thatyou understand w hy it's so im portant.
M ostofthe questions can be answ ered by putting a tick in the
box nextto the answ erthatapplies to you,Iike this:
vesLz
NoE(1
orsom etim es you have to w rite a num berin the box,
forexam ple Z P
Som e questions don'tapply to everybody.This questionnaire indicates w here you
need to skip questions,and guides you to the nextapplicable question.
W e m ay contaM you to clarify yourresponses to som e questions.
Ifyou have any questions,please callus on freephone 0800 068 1562.
t
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7
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,
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Sectlon ï:Abou'yourheaIth
Please entertoday's date:
Day
'
)t'
$.?
,
klh.;....
.
M onth
Year
2
JDOC
JM OC
0
0
JYOC
In generalw ould you say yourhealth is:
Please tickone
JG ENHLTH
Excellent
,
Very good
a
G ood
a
Fairr-7,
poorr---,1
a fom pao d to one yearago,how w ould you rate your
health in generalnow ?
Please tick one
JH LTHN OW
Muchbetternowthanoneyearagor-,
1
SomewhatbetternowthanoneyearagoI-l
a
AboutthesameasoneyearagoI--al
Somewhatworsethanoneyearago(---1
Muchworsethanoneyearago1-1
The follow ing item s are aboutactivities you m ightdo
during a typicalday.Does your heal'h now Iim i'you
in these activities? Ifso,how m uch?
(a)Viporousactivities,suchasrunning,Iiftingheavy
objects,participating in strenuous sports
(b)M odera'e activities,such as movinga table,pushing
a vacuum cleaner,bow ling orplaying golf
Pleasetick one box
foreach question
Yes, Yes, No,not
Iim ited Iim ited Iim ited
a lot a Iittle atalI
1
2
3
.
,
JACTIVOI
<
Z. Z, Z, 2ACTI
V02
r-1 JACTIVO3
(@)Lifting orcarrying groceries
(i) W alking one hundo d yae s
Z, JACTI
VO4
Z, 2ACTlV05
L1 JAcTI
vn6
E1 JAcTlvnz
Lj JACTIVO8
U- JAcTIv09
Q) Bathing and dressing yourself
N JAcTIv10
(d)Clim bing severalflightsofstairs
(e)Climbing one flightofstairs
(f) Bending,kneeling orstooping
(g)W alking m oO than one m ile
(hlW alking halfa m ile
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Z,
Z'
L,
L,
Z,
Z,
E1
E(
1
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DuringtheMastfourweekshaveyouhad anyofthefollowing
problem s w lth yourw ork orotherregulardaily activities
as a O sul'@#your physioalhealth?
Please tick one
answerforeach question
Yes No
(a)Cutdown the am ountof'im e you spentonwork or
otheractivities
(blAoeom plished Iessthanyouwould Iike
(c)W ere Iim ited in the kind ofwork orotheractivitiesyou could do
(d)Had diWilulk pedorm ing yourworkorotheractivities
(forexam ple,ittookextra effort)
Z
EZ
EZ
Z
U JNKHLn'
L1 JNKHLOZ
Q JNKHLO3
Z 2NKHL04
* DuringtheMastfourweekshaveyouhadanyofthefollowing
problem s w lth yourw ork orotherregulardaily activities as a resul'
ofany em otionalproblem s (such asfeeling depressed oranxious)?
Pleasetickone
answerforeach question
Yes No
(a)CutdowntheamountofMmeyouspentonworkorotheractivities U1 I-l
a JNKEMOI
wlaooomplis.edIessoanyouwouldIike
rn,1-1
- JNKEMnZ
(o)oidn'tdoworkorotueractivitiesasoaxfullyasusual
,1--n- JXKEMa:
Duringthepas'fourweekstowhatextenthaveyourMhysicalhealth
oremotionalqroblemsintederedwithyournormalsoclalactivities
w ith fam ily,frlends,neighbours orgroups?
JHLSO C
r
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Please tick one
Notatall
1
Slightly
,
M oderately
a
Quite a bit
4
Extrem ely
s
l
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: How m uch bodily pain have you had during the pas'fourw eeks?
Pleasetick one
None
,
Very m ild
a
M ild
a
M oderate
,
Severe
,
Very severe
:
JBO DPA IN
E9 i
D
nt
ue
ri
r
n
fe
gre
thwi
ep
th
as
y:
ou
fo
ru
nr
owe
rmaelk
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s,r
hko(
winc
mu
lud
ci
hng
dib
do
pta
hiwo
n rk
Pleasetick one
Notatall ,
outside the home and housework)?
A Iittle bit
,
M oderately
a
JPAININT
Quite a bit ,
Extremely
s
: How m uch ofthe tim e during the pastfouew eeks: Pl
ease tick one box foreach question
AI1
ofthe
tim e
M ost A good Som e A little None
ofthe bi
tof ofthe bitof ofthe
tim e the tim e tim e the tim e tim e
N, IQ IQ IQ V1 IQ JTIME01
(b)Haveyou beena verynervousperson? U1 U1 U1 S, 7R
S 2TIME02
(ç)Haveyoufeltsodowninthedumpsthat
U'1 U-1 U'l
a U1 U1 FR 2TlME03
nothingcouldcheeryouuq?
(a)Did you feelfullofIife?
V
(d)Haveyou feltcalm and peaceful?
(e)Did you havea Iotofenergy?
(f) Haveyoufeltdow nheaded and Iow?
(g)Didyoufeelw ornout?
(h)Have youbeen ahappyperson?
!
(i) Didyoufeeltired?
Z
Z
Z'
Z'
Z'
L,
Z'
Z'
Z'
Z'
Z
L,
Ul
Z'
Z'
Z'
Za
L,
Z'
Z'
Z'
Z'
Z
L.
Zs
Z'
Z'
Z'
Zs
L1
Ul2T1ME04
Z'2TlME05
Z'2TlME06
Z'JTIME07
Z 2TlME0B
L1JTIMEns
3
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4ï During the pastfourw eeks,how m uch ofthe tim e has your
physiealheal'h or em otionalpx blem s intedered w ith
yoursocialactivities(Iikevisiting friends,
relatives,etc)?
Pleasetick one answer
AII
ofthe
tim e
JHLEMSOC
M ost Som e A Iittle None
ofthe ofthe bitof ofthe
tim e
time the tim e tim e
1
2
3
@.
5
-
ï2 Please choose the answ erthatbestdescribes how 'eue orfalse
each ofthe follow ing statem ents is foryou: Pl
easetick one box foreach question
Defini
tely M ostly
'tqt!:
(a)Iseem iogetsicka Iittle easierthan
(b)I'mashealthyasanyoneIknow
(e)Iexpectmyuealthtogetworse
(d)Myhealthisexcellent
r7,
r-1
,
U-1
M ostly Defini
tely
know
-
,
otherpeople
Don't
p
tçl?.
2
false
a
Iza
r7,
r-)
4
I''--l
1-7
U'al
/4
E-7
(-7
false
5
JSIC K EAS
INsJHLTHAN
1-7 JHLTHwRS
1-7 JsuvsExc
M edioaloonsultation
How m any tim es have you consulted yourG P
in the Iast 12 m onths?
Enternum ber
JG PVISYR
(a)Doyou haveany Iongstanding illness,diseases ormedicalconditionsforwhichyou have
soughttreatmentintheIast12 m onths? (Longstanding meansanything thathastroubled
you overaperiod oftime orthatis likelyto affectyou overa period oftim e).
JLO NG ILL
ves
,
No
(b)Ifyes,please Iistbelow
(i
)
JLONGILI
(ï/i)
JLONGIL6
(ii)
JLONGILZ
(h/ii)
JLONGIL;
(iii
)
JLONGIL3
(h/iii)
JLONGIL8
(i JLoNblL4
(i)()
JLONG IL9
(v) JLO NG ILS
(X)
JLO NGLIO
hr)
4
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2
Goto
(a)
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T
15 (a)This questionconcernsany medicinesthatyou may havetaken
during the lastfourteen days.Have you been taking any m edicines,
tablets,tonics orpills w ithin the Ias'foue een days?
JPRESDO C
l
yes
,
No z GotoQ.(a)
W as this
prescribed
(b)Ifyes,please Iistanym edicinesbelow
JPRSDRG I
(
i
)
bya doctor? And the reasons fortaking them
Yes No
/ /
JPRES DC I
JPRSDRGZ
(i)
Yes No
/ /
JPR ESD CZ
JPRSDRG3
(ii
)
YeS No
gg ((g
JPRESDC3
(ih/)
JPRSDRG4
Yes No
L L
JPRESDC4
JPRSDRGS
(
V)
YeS NO
(J Z
JPR ESDCS
JPRSDRG6
(
Vi
)
Yes NO
gyjj;
JPR ES DC 6
JPRSDRG;
(vii
)
YeS NO
gkjgkj
JPRESDC;
JPRSDRG8
(
vii)
Yes No
gg gg
JPRSDRG:
JPRESDCB
JPRESDC:
JPRSDRIO
JPRESDIO
JPQSDRII
JPR ESD II
JPRSDRIZ
JPRESDIZ
JPRSDRI3
JPRSDRI4
JPRESDI3
JPRSDRIS
JPRESD IS
JPRESD I4
5
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This seotion oonoerns ehes' pain and other aspee's of heae disease
(a)Since danuaa 2006 haveyou had anypain ordiscomfortinyourchest?
JCHPAIN
Yes
,
No
,
Go to
:
(b)Ifyes:
Do you getthis pain ordiscom fod w hen you w alk uphillorhurG ?
JCHPUPH
vesE(j
,
NoEqz
q
(c)Doyou getitwhenyouwalk atan ordinarypace onthe Ievel?
JCHPLEV
vesL,
NoL.
(dlW hen you getany pain ordiscomfod inyourchest,whatdoyoudo?
Please tick one
JCHPACT
Stop
,
slow dow n
.
continueatthesamepacer-1
(e)Doesitgo awaywhenyoustandstill?
vesr-q,
JCHPSTOP
No
a
GO to (g)
(; Ifyes,how soon?
Pleasetick one
JCHPTIME
In 10 m inutes orIess
,
M ore than 10 m inutes
2
(glw here do yougetthis pain ordiscomfo/? M arktheplacets)withanX on the diagram .
JCHPSITI
Right
Left
JCHPSIT6
JCH PSITZ
JCH PSIT;
JCHPSIT3
JCHPSIT8
JCHPSIT4
JC HPSIT:
JCHPSITS
6
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Frontview
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ï7 (a)Sinee danuary2096 haveyouhad asevere pain acrossthe
frontofyourchestIasting halfan hourorm ore?
JCH PEXT
Yes
,
No , GotoSïB
(b)lfyes:
Did you talk to a doctoraboutit?
JGHPDOC
vesr-q
,
No
z
Goto(d)
(o)Ifyes:
W hatdid he/she say itw as?
JC HPD IAG
(d)How manyoftheseattackshaveyou had?
Enternumber
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JCHPNUM
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Tests and treatm ents
ïB These questionsconcern any testls)or'O atm entls)you may havehadforchest
pain orheartdisease.sinçe danuary 2006 have you had anyofthefollowing? (Please
answerYes orNo to each question)
Ifyes:Please give year,hospital,tow n and the nam e ofthe consultantforeach occasion.
(a)Anexercise/stressEGG hearttracing whilstwalking orrunning
on atreadm ill(notaspartoftheStress& HeaIth Study)
Yearsince 2006
Hospi
talnam e,Town
Consultant
Hospi
talnam e,Town
Consul
tant
JEXECG1yesr-I
, z o ()
No1--,1 JExEcovl
Yearsince 2006
JEXECGZ Yesr-j 2 o o
No1-1
2 JEXECGYZ
:
(h)Angiogram orX-ray ofyourcoronac arteries(a dyetestofthe arteries)
Yearsince 2006
Hospitalnam e,Tow n
Consultant
JAGRAM1yesg-7 z o o
NoN2 JAGRAMYI
Yearsince 2006
!
Hospitalnam e,Town
Consultant
JAoRAu2vesr-q
, 2 o o
NoN, JAGRAMYZ
(l)Angioplastyofcoronaa arteries(balloontreatm entforangina)orinsedion ofa stent
Yearsince 2006
Hospi
talnam e,Town
Consultant
JAPLAS1 Yesr-1 2 c c
NoU1, aAeuAsvl
Yearsince 2006
JAPLASZ Yesr-,
1 z c c
sor7, JApuAsyz
8
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'
Hospi
talname,Tow n
Consultant
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(d)Coronac arterybypass graft(GABG)operation
Yearsince 2006
Hospi
talname,Town
Consultant
Hospi
talnam e,Tow n
Consultant
JCABGI YesH, z c c
No71
, JcAsoyl
Yearsince 2006
JCABGZ Yes(S, z c c
NoF-,l JcAsow
(e)An admissionto hospitalwith chestpain,angina orhead atlack
Yearsince 2006
Hospitalnam e,Tow n
Consultant
Hospitalnam e,Town
Consultant
JADMCHIYesU1 2 c c
Nor'-,
-l JAoMcHv1
Yearsince 2006
JADMCHZYesrS, g c c
NoE-,1 JADMCHYZ
(: Otherhea/ testsoroperations,oradm issionsto hospitalforotherhead trouble
(notas partoftheStressand HeaIthStudy).
Yearsince 2006
Hospitalname,Town
Consul
tant
JOHTOAIYes(S, z c c
so71
, JouvoAvl
Ifyesto (f),pleasespecify(forexample,24 hourECG,pacem aker,thallium scan,
echocardiogram,orrestingECG notdoneaspartoftheStress& HeaIthstudy)
JO HTO A T1
JO HTOA T6
JOHTOATZ
JO HTOAU
JOHTOAT3
JOHTOAT8
.
-.
..
.
JOHTOAT9
JO HTO A T4
JOHTOATS
9
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19 (a)sineeJanuag 2006 hasadoctortoldyouthatyou
havehadanglna? JANG
Yesr-1,
Nor;a
(blsinee Januao 2096 hasadoctortoldyou thatyou
have had a head auack lmyooae ial
infaot/eoxnaœ thxmbosis)?
JMI
YesU1
NoSj
(ç)Since January 2906 haveyou had anyotherhead 'rouble
suspected orconfirmed? (Forexample,valve disease,
congenitalheartdiseaseorirregularheartbeat)
JOHT
vesr-q
,
sog5,
lfyes,please specify
JO HTDXI
JO HTDX3
JOHTDXZ
JO HTDX4
1 (a)Haveyoubeen adm itted to hospital(including asa daycase)inthe Ias'42 m onths?
(thisexcludesoutpatientappointments)
JHSADMYR
Yes ,
No 2 Goto 24
(b)Ifyes,please specifythe num beroftim es:
Enternum ber
JHSA DM NO
andthp reasonforhospitalisationls)and the dates:
Cause 1
JHS IRS N
M onth
Year
2
Cause 2
JHSZRSN
JHSIM NTH
M6hih
JH#ZMNTH
JHS3RSN
JHS4RSN
JHS3M NTH
Month
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JHS4M NTH
0
Year
0
o
JHS3YR
Year
2
-
0
JHSZYR
M onth
2
cause 4
0
JHSIYR
Year
2
Cause 3
O
o
O
JHSW R
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These questions are abou' neurolog iealsym ptom s
2ï (a)Haveyoueverhad a slurred speech orproblem stalking to
som ebody because yourm outh w as unable to articulate
w ords orsentences correctly?
JNSTA LK
vesr-q
,
No
2
Don'tknow
a
Go to 22 (a)
(b)Ifyes,please briefly describesym ptomsand theirduration:
JNSTA SY M
JNSTADUR
(c)Wereyoutreated orseen byadoctorforthesesym ptoms?
JNSTADOC
vesr-,
q
No
a
Don'tknow
a
Go to 22 (a)
(d)1:yes,please give the month,year,GP practice/hospitalnam e,townand
the nam e ofthe doctor/consultant.
M onth
JNSTAM I
M onth
JNSTAM Z
Year
GP practice/Hospitalnam e,
Tow n
Doctor/consultant
GP practice/Hospitalnam e,
Tow n
Doctor/consultant
JNSTAYI
Year
JNSTAYZ
11
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(e)Ifyes,please givethem onth,year,GP practioe/hospitalnam e,town and
the nam e ofthe doctor/consultant.
M onth
Year
GP practi
ce/Hospi
talnam e,
Town
Doctor/consul
tant
G P practice/Hospitalnam e,
Town
Doctor/consul
tant
JNSVISM I JNSVISYI
M onth
JNSVISMZ
Year
JNSVISYZ
23 (a)Sinçe danuary 2096 have you beentold bya doctorthatyou have
had a stx ke ortransien'ischaem iç auack (m inistroke/TlA)?
vesr-,
q
JSTRO KE
No
z
Don'tknow
a
Go to 24
(b)Ifyes,was itfor:
Please tick one
JHTDRDG N
Stroke
,
TransientlschaemicAttack(ministrokexlA) a
Other(p/easespecify) a
(c)Brieflydescribesym ptomsand 'heirduration:
JSTRKSYM
JSTR KD UR
s.
(dlW ereyoutreated orseen bya doctorforthese symptom s?
JSTRKDOC
vesr-q
,
No
2
Don'tknow
a
Goto 24
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(e)lfyes,please givethe m onth,year,GP practice/hospitalnam e,tow nand
the nam e ofthe doctor/consultant.
M onth
JSTRKMI
M onth
JSTRKM Z
Year
GP practice/Hospita!nam e,
Tow n
Doctor/consul
tant
G P practice/Hospitalnam e,
Tow n
Doctor/consud
tant
JSTRKYI
Year
JSTRKYZ
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'
j
!
Q eneralheaIth questions
Please read this carefully.W e should Iike to know ifyou have had any m edicalcom plaints,and how
yourhealth has been in generalovee 'he pas' few w eeks.Please answ erALL questions on the
follow ing pages sim ply by indicating the answ erw hich you think m ostnearly applies to you.
Rem em berthatw e w antto know aboutyourpresen'and reoen'com plaints,notthose you had in
the past.Itis im podantthatyou tœ to answ erALL the questions.
Have y@u O @en'Iy...
.
.
..
JGHQ OI
pj
aasetickopeboxforeach question
Better
Sam e
Rather
M uch
'
than
as
usual
usual
Beenabletoconcentrateonwhateveryou'redoing? 1S,
JGHQ02
<
Lostm uch sleep overw orry?
JGHQ03
@
Been having restless,disturbed nights?
Not
at
aII
1
Not
at
aII
1
Iessthan Iessthan
usual
usual
U,
No m ore
Rather
M uch
than
more than m ore than
usual
usual
usual
2
3
4
No m ore Rather
M uch
than
more than m ore than
usual
usual
usual
2
3
M ore so
sam e
than
as
usual
usual
usual
usual
Beenmanagingtokeepyourselfbusyandoccupied?U1
,
I
--l
a
Ual
71
JG HQ04
JG HQ05
28 Beenge/ingoutofthehouseasmuchasusual?
JG HQO6
M ore so Aboutthe
than
same as
usual
Rather
4
M uch
lessthan lessthan
Less
M uch
than
Iessthan
usual
usual
usual
About
the
sam e
Rather
Iess
well
M uch
Iess
well
About
the
sam e
Less well
than
usual
M uch
less
well
77.
F-1
U1
Better
than
most
* Been m anaging as w ellas m ostpeople w ould
in yourshoes? '
JG HQOT
Felton the w hole you were doing things w ell?
JGHQ08
Better
than
usual
1
F-1
,
M ore Aboutthe
Less
M uch
satisfied same as satisfied
less
than usual usual than usual satisfied
Been satisfied w ith the way youdve carried
outyourtaskts)?
1
2
3
4
tt
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JGHQ O9
Been able to feelw arm th and affection for
those nearto you?
JG HQ IO
33 Been finding iteasy to geton w ith otherpeople?
JGHQII
Better
than
usual
1
Better
than
usual
1
Feltthatyou are playing a usefulpartin things?
JG HQI3
*
Feltcapable ofm aking decisions aboutthings? .
JGHQ I4
Fel
tconstantl
yunderstrain?
JG HQIS
2
3
Aboutthe
Less
sam e as wellthan
usual
usual
2
3
M uch
I
ess
well
4
M uch
Iess
w ell
4
M ore Aboutthe Lesstim e
M uch
tim e than sam e as
han
Iess than
.t
usual
usual
usual
usual
Spentm uch tim e chatting w ith people?
JGHQ IZ
Aboutthe
Less
sam e as wellthan
usual
usual
ED
M ore so
than
usual
1
More so
than
usual
1
Not
at
alI
L
Sam e
Less
as
usefulthan
usual
usual
2
Sam e
as
usual
2
Nomore
3
Less
so than
usual
3
m ore than
usual
Z.
L
No more
at
alI
than
usual
4
M uch
Iess
capable
4
Rather Muchmore
than
usual
Not
M uch
Iess
useful
Rather
than
usual
Much
m ore than m ore than
usual
usual
: Feltyou couldn'tovercom e yourdifficulties?
JGHQ IG
Not
at
aI1
No m ore
Rather
M uch
than
m ore than m ore than
usual
usual
usual
39 Been finding Iife a struggle aIlthe tim e?
JGHQ I;
M ore so
than
usual
Sam e
as
usual
Less so M uch Iess
than
than
usual
usual
uj Beenableto enjoyyournorm alday-to-day
activities?
1
-
JGHQ I8
Not
at
aIl
Been taking things hard?
16
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1
2
3
4
No m ore Rather
M uch
than
m ore than m ore than
usual
usual
usual
F'7
71
N,
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j-
JGHQI9
Not
at
alI
1-7
(-1
,
M ore so
than
usual
Sam e
as
usual
Less able
than
usual
M uch
Iess
able
Not
No more
Rather
M uch
at
alI
than
usual
Been getting scared orpanickyforno good reason?
à
JG HQ20
No m ore Rather
M uch
than
m ore than m ore than
usual
usual
usual
1
,
Been able to face up to yourproblem s?
JG HQZI
FoundeveY hinggettingontopofyou?
1
Not
JGHQ 22
at
aII
Been feeling unhappy and depressed?
1
Not
at
ëlIl
JG HQ23
J @ Been Iosing confidence in yourself?
1
Not
at
aII
gg jjagy
t ABeent
hi
nki
ngofyour
sel
fasawor
t
hl
essper
son?
JGHQ 25
AI
FeltthatIife is entirely hopeless?
JGHQ26
: @
Been feeling hopefulaboutyourow n future?
JG HQ27
I Been feeling reasonably happy,aIIthings
considered?
JG HQ28
Been feeling nervous and strung-up aIIthe tim e?
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1
7-1
,
2
77
r-1
,
than
usual
;h
M ore so Aboutthe
than
sam e as
usual
usual
2
M ore so Aboutthe
than
sam e as
usual
usual
Not
at
aII
5
N,
71
,
(-1
77,
No m ore Rather M uch m ore
than
m ore than
than
usual
usual
usual
Nom ore
q
71
.
No m ore Rather
M uch
than
m ore than m ore than
usual
usual
usual
at
aII
1
U1
,
No m ore Rather
M uch
than
m ore than m ore than
usual
usual
usual
Not
1
m orethan m ore than
usual
usual
2
7-1
r7,
Rather
Much
m ore than m ore than
usual
usual
3
Less so
than
usual
3
Less so
than
usual
3
4
M uch
Iess
hopeful
4
M uch Iess
than
usual
4
No m ore
Rather
M uch
than
m ore than m ore than
usual
usual
usual
7-1
,
77,
N,
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JGHQ29
Not
No m ore
Rather
M uch
than
m ore than m ore than
usual
usual
usual
at
aII
FeltthatIifeisn'tworthIiving?
r7
1
Not
at
aII
JGHQ3O
N,
No m ore
Rather
M uch
than
m ore than m ore than
usual
usual
usual
Found attim esyoucouldn'tdo anl hing because
1
yournerves w ere too bad?
77
P
l
e
a
s
e
t
i
c
k
o
n
e !
2
Overthe Iast12 m onths w ould you say yourhealth has been?
3
4
Verygood(S,
JHLTHY R
Good
a
Average
a
Poor
4
Very poor
s
5
h
o
u
r
s
6
o
h
r
l
P
e
s
a
s
e
t
i
,
c
k
o
n
e !
How m any hours ofsleep do you have on an
average w eek-night?
JSLEEP
56 How often in the past m onth did you:
ours
a
7 hours
a
8 hours
4
9 hours orm ore
,
Please tick one box foreach question
Not
1-3
4-7
8-14 15-20 21-31
ata11 days days days days days
.
(blW ake up sevùraltim espernight?
rR, U1 rR' rR' rRs JSLPFALL
7-1 F-.
1 F-1 F-1 N, LJSLPWAKS
(o)Havetrouble staying asleep (including
waking fartoo early)?
'
U1, U1, FR, F7, U1, UJSLPSTAY
(a)Havetrouble fallingasleep?
<
(dlWakeuqafteryourusualamountofsleep
feeling tlred and w orn out?
(e)Havedisturbpd orrestlesssleep?
18
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Z' Z' Z' Z' Z' UJSLPWAKT
Z Z' Z' Z' Z' D SLPDI
ST
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N
Do you snore?
JSNORE
vesN,
No
z
Don'tknow
3
Go to 64
'jj lf#ousnore,yoursnoringis:
$
JSNORHOW
i -soqHowoftendoyousnore?
JSNORO FT
Please tiok one
As I
oud as breathing
,
As Ioud astalking
a
Louderthantalking
g
Very Ioud
,
Don'
tknow
,
Please tick one
Alm ostevery day
!
3to'
4 times a w eek
:!
1 to 2 times a w eek
a
1to2timesamonthr-41
Never/almostnever47,
oon'tknow 1-7
60 Doesyoursnoring botherotherpeople?
JSNO R BO T
!
vesr-)
,
Nog-l
,
Don'
tknowI
za
6$ Has anyone noticed thatyourbreathing pauses during yoursleep?
JSLBRPAU
xmosteveryday(--,)
ato4timesaweekUl
a
1to 2 times a w eek
a
1 to 2 tim es a m onth
,
Never/alm ostnever
,
Don'tknow
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6
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62 Are you tired aûersleeping?
Pleasetick one
Alm ostevery day
,
3 to 4 times a w eek
2
1 to 2 tim es a w eek
a
1 to 2 tim es a m onth
4
Never/alm ostnever
s
JSLTIRAS
Areyoutired during :he day(duringyour
usualwakingtim e)?
JSLTIRDD
w:
Please tickone
Alm osteveryday
,
3 to 4 tim esa w eek
a
1to 2 tim esa w eek
,
1 to 2 tim es a m onth
,
Never/alm ostnever
s
Have you everfallen asleep w hile driving?
Yesr-I
,
xmostr-j
JSLDRIVE
No
a
Notapplicable
,
b6Y1d
Hi
e
ff
r
i
e
cu
al
r
te
iea
sf
wi
ewthet
v
heers
ye
da
by
ec
aa
cu
ti
s
ve
i
ti
o
ef
sa
.P
pl
e4
h
asi
e
ca
te
l
,
ll
me
usni
f
ta
yl
o
,e
umo
hav
ti
e
oa
na
ny
lor
m em ory problem .Exclude any difficultles you expeotto last
Iessthan three m onths.
(a) Dressing,including putting onshoes and socks
(b) W alking acrossa room
(o) Bathing orshowering
(d) Eating,suçh ascutting upyourfood
(e) Gettingin oroutofbed
(: Using the toilet,including ge/ing upordown
Yes No
L,L,JADLI
C1L.JADLZ
U,U,JADLZ
Z'Z'2ADL4
Z'Z'JADLS
JA D L6
(g)Usingamaptofigureouthowtogetaroundinastrangeplace (
Z,l
zaJAoL7
(h) Preparing a hotmeal
Z'Z'JADLB
(i) shoppingiorgroceries
E1L1JADLS
Q) Makingtelephonecall
s
Z,Z,JADLI:
w) Takingmedioation
(I) ooinqworkaroundtuehouseorgarden
ra ra aAousc
(m)Managingmoney,suchaspayingbillsandkeepingtrackofexxnsesr-1U-jJADLI3
E11
Z1J
AD
L
'
11
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66 Sinçe danuaa 2096 have you been told by a doctorthatyou have,
orhave had,any ofthe follow ing?
Please tick one answerperrow
JO ST ART
Yes No
Ifyes,whatw as the year?
(a)Osteoadhritis (Iwearand tear'arthritis)
r--1lr--,1Year 2 o o
JRHE ART
Z,U. vear 2 o o
(b)Rheumatoid adhritis
JOST-AYR
JRHE-AYR
K
(e)Gout
JGOUT
(d)Osteoporosis
JO ST PO R
L1L, Year 2 o o
Z1Z2 Year 2 0 O
(e)Diabetes
JDIABET
U,L, Year 2 o o
JGouT-vR
JOST-PYR
JDIABYR
BT Thediagram below showstheupperbodydivided into areas.Pleaseanswerquestions(a)-(e)
below foreach body area.Body areas are notsharply defined and certain parts overlap.You
should decide foryourse: w hich area,ifany,is orhas been affected.
Have you had pain or
a problem in any of
the areas below ?
(a)Neck
(b)Shoulders
(* Upperback
(d)Elbow/forearm
(e)Lowerback
During the
Iast12
m onths?
M ore than three tim es or
Iasting m ore than 1 w eek
in the Iast 12 m onths?
During the
Iast14 days?
Yes No
Yes No
Yes No
Z,I
L1JPNNI2M Z,Z.JPNN-OD Z,ZaJPNNI4D
Z,Z2JPNSIZM Z,ZaJPNS-OD Z,ZaJPNSI4D
/,/,JpNuB12M 1,EjJexus-oo1,/,apxusl4o
(U,(U.JPNAIZM (U,(laJPNA-OD J-1
,(UaJPNAI4D
(D,ED,JPNLBIZM (D,(D,JeNus-oo(D,(;.JPNLBI4D
(: i) Have you had pain ora problem in yourHAND/W RIST
during the Iast12 m onths?
L,U. JPNHWIZM
ii)Have you had PAINCBURNING ?NUM BNESSITING LING !
.
.
SW ELLIN G ,orLOSS OF CO LOUR in yourHAND/W RIST
m ore than three tim es orlasting m ore than 1 week in
the Iast12 m onths?
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Yes No
Yes No
U,Z, JPNHw-oq
-
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This seotion çonoerns pain in 1he Iegs
hsl(a)DoyougetanypainsineitherIegonwalking?
JLEPAIN
-yesra
No
z
Go to .* .
(b)Ifyes:
Does this pain everbegin w hen you are standing stillorsitting?
JLESTAND
ves((j
,
NoElq
a
(o)Do #ougetthispain inyourcalforcalves?
JLECALF
vesEqJ
,
NoEla
q
(d)Do you getitw henyouwalkuphillorhurœ ?
JLEPUPH
vesr,
NoL,
(e)Do you getitwhenyou walkatan ordinary pace onthe Ievel?
JLEPLEV
ves((;
,
NoEqq
a
(: Doesthis pain everdisappearwhile you are stillwalking?
JLEDISWK
ves((j
,
NoElq
z
(glW hatdo you do ifyou getitwhenyouare walking?
Please tick one
JLEPACT
Stop
,
Slow down
,
Continue atthe sam e pace
a
(hlW hathappen: to itifyoustand still?
Pleasetick one
JLEPTIM E
22
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Usually continues m ore than 10 m inutes
,
Usually di
sappears in 10 m inutesorIess
2
l
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1
691a
Hr
ate
sr
a
iedsoo
cf
ty
oo
ru
ev
I
eg
rs
to(i
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d
nt
yeor
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eib
oad
tio
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)?
ulati
oninthe
Year
Hospi
talnam e,Town
Consul
tant
JlNcuAu ves1-1
,
NoU-1
. JINCLAYR
.
g
ft
z..
y
j
k-
.
- .
on 3:A bout yourIIfesl le
,
-,-è
u.
-
E xercise
W e w ould Iike to know aboutyouractivities in yourfree tim e and atw ork that
involvephysicalactivik.
Thinking aboutthe days ofthe PAST W EEK.
(a)On average,forhow Iong did youwalk outside yourhome/workplace?
(Ifyoudid notwalk,please enterzero(:00')intheboxesineachrow.)
Forexam ple 1 hour30
m inutes,not90 m inutes
JW LKOUTA
O n each w eekday
JW LKOUTB
on eachweekend day
(b)Onaverage,forhow long didyou oyqle?
(lfyoudid notcycle,pleaseenterzero (00')inthe boxesineach row.)
JPEDCYCA
On each weekday
JPEDG YC B
O n each w eekend day
Hours
M inutes
Hours
M inutes
23
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Otherphysicalactivities in the PAST FOUR W EEKS
Please indicate the num berofoeeasions and 'otaltim e spenton each ofthe activities Iisted.
W rite in othertypes ofactivity notlisted,as applicable.
(a)SPORTS AND GAM ES
Football
Occasionsinthepast4 weeks(pleasetickone)
(including coaching, None 1-2 3-4 5-10 11-15 16-20 21+
etc)
77 77, 77 U1, U1, 77, 77 JsoccERF
Totalhours inthe past4weeks(p/easetickone)
None
9
1-1?
2-3
4-5
6-10
11+
U1. U1 U1, U1 7R, U7, 7R. JSOCCERH
Golf
Occasionsinthepast4weeks(please tickone)
None
L
1-2
3-4
5-10 11-15 16-20 21+
L
L
L
L
E; U JGOLFF
Totalhours inthepast4 weeks(p/easetickone)
None
9
1-1?
2-3
4-5
6-10
11+
U'1 U1, 7-,1 F'1 7-,1 7-,1 N. JGoLFH
Sw im m ing
Occasions inthe past4weeks(
please tickone)
None
V
1-2
3-4
5-10 11-15 16-20 21+
V
V
V
V4 Vs V
2SWlMF
Totalhouréinthe past4 wee'
ksrp/ease tickone)
None
?
V
V
1-1?
2-3
4-5
6-10
11+
V
V
V
Vs U1 2SWlMH
Othersports and
Other,activity 1(pleasespecify)
gam es activitiesfor
exam ple,aerobics, JSPORTII
JSPORTIZ
JSPORTI3
ballroom dancing,
keeqfit,jogging,
tennls.
-
.--
-
.- -
-
.
Occasionsinthepast4weeks(pleasetickOne)
None
1-2
()
1
3-4
5-10 11-15 16-20
2
3
4
($
21+
6
JS PO RTIF
Totalhours inthe past4weeks(p/ease tickone)
None
V
24
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?
V
1-1?
2-3
4-5
6-10
11+
V
V
V
V
Ve 2SPORT1H
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Othersports and
gam es activities for
exam ple,aerobics,
ballroom dancing,
keeqfit,jogging,
tennls.
Other,activity2(p/easespecify)
JSPO RTZI
JSPO RT22
JSPO RT23
Occasionsinthepast4weeks(p/easetickone)
None
1-2
3-4
5-10 11-15 16-20 21+
EZ EZ Ei L
EZ E1 L
2s?ORT2F
Totalhoursinthepast4weeks(p/easetickone)
None
?
0 V
1-17
2-3
V
U1
4-5
6-10
11+
4 Vs R
2SPORT2H
(b)GARDENING
W eeding,hoeing,
Occasions inthe past4weeksfp/ease tickone)
pruning (not
mowing)
None
1-2
3-4
5-10 11-15 16-20 21+
JW EEDF
0
1
2
3
4
5
6
Totalhoursinthepast4weeks(p/easetickone)
None
()
M anualIaw n
m ow ing
9
1-1?
1
2
2-3
4-5
3
4
6-10
11+
5
6
JW EEDH
Occasionsinthepast4weeks(p/easetickone)
None
0
1-2
3-4
1
2
5-10 11-15 16-20 21+
3
4
5
6
JMOW F
Totalhours inthepast4weeks(p/easetickone)
None
?
1-1?
2-3
4-5
6-10
11+
JM OW H
()
Othergardening for
exam ple,digging,
planting,clearing
ground,etc
1
2
3
4
5
6
(p/easespecify)
JGARDNII
JGARDNIZ
JGARDNI3
Occasions inthe past4weeks(p/ease tickone)
î None
1-2
3-4
5-10 11-15 16-20 21+
7-1 71 U7, U1 U1 71
, U1
.
JGARDNIF
Totalhoursinthe past4weeks(please tickone)
None
?
1-1?
2-3
4-5
6-10
11+
JGARDNIH
25
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(e)HOUSEW ORK
Carrying heavy
shopping
OccasionsIntnepast4weeks(p/easetickone)
None
1-2
3-4
5-10 11-15 16-20 21+
Vn U-1 S2 Sa U1 Ss V
JCARRYHF
Totalhoursinthe past4weeks(p/ease tickone)
None
?
1-1?
2-3
4-5
So Ul Sc Sa IQ
Cooking
6-10
11+
Ss Ss JCARRYHH
Occasions inthepast4 weeks(p/easet/ckone)
None
1-2
3-4
t
5-10 11-15 16-20 21+
7-1 N, V1
, 7-1 N, N, N. JCOOKF
I
Totalhours inthe past4weeks(
please tickone)
None
L
Hanging out
w ashing
?
L
1-1?
2-3
ED L
4-5
6-10
ED L
11+
Ei JCOOKH
Occasionsinthepast4 weeks(p/easet/ckone)
None
1-2
3-4
5-10 11-15 16-20 21+
N, U1 N, N
N, N, 77
JHANGWF
Totalhours inthe past4weeks(
please tickone)
None
?
1-17
2-3
4-5
6-10
11+
V0 V! V2 V3 V4 U1 V
Otherhousew ork for
exam ple,dusting,
ironing,hoovering
2HXKCWH
Otherhousework,activity1(p/easespecify)
JHOUSW II
JHOUSW IZ
JHOUSW I3
N
Occasionsinthepast4 weeks(p/easetickone)
None
1-2
3-4
Vo V1 V
5-10 11-15 16-20 21+
V
IV
Ss Ul 2HOUYW1F
Totalhoursinthepast4weeks(
pleasetickone)
None
?
1-1?
2-3
4-5
6-10
11+
E--,1 F-.1 r-,1 F-,1 7-,
1 r-1 E--,1 JHOUSWIH
26
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1
1
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Otherhouseworkfor Otherhousework,acti
vity2(p/easespecify)
exam ple,dusting,
JHOUSW ZI JHO USW 22 JHO USW 23
ironing,hoovering
- -
-
%
<-
Occqsionsinthe past4weeks(p/ease tickone)
None
1-2
3-4
So V, S
5-10 11-15 16-20 21+
Va Ul Vs Vs 2HOUSW2F
Totalhoursinthepast4weeks(p/easetickone)
None
EQ
?
1-1?
2-3
4-5
6-10
11+
N, U-.l N, 71 77 N, JuouswzH
(d)DO-IT-YOURSELF
M anualcar
w ashing
Occasions inthepast4 weeks(p/easet/ckone)
None
1-2
3-4
5-10 11-15 16-20 21+
U-1 N, U-,1 N, N, N, N, JCARwASF
Totalhoursinthe past4weeks (
please tickone)
None
?
Vo V
Painting/decorating
1-1?
2-3
4-5
6-10
11+
V
Va F-1 Ss U-1 2CARWASH
Occasions inthepast4 weeks(p/easetickone)
None
1-2
3-4
5-10 11-15 16-20 21+
V1 N, U'1 S, r-1
. N. U-,1 2PAlDECF
Totalhoursinthepast4weeks(p/easetickone)
None
?
1-1?
U'1
' N. IQ
OtherDIY for
exam ple,household
repairs,w oodw ork,
bricklaying
2-3
4-5
6-10
11+
N' N' N' 77
2PAIDECH
@/easespecify)
JD IY II
JD IY12
JD IY 13
Occasionsinthe past4weeks(p/easetickone)
None
R
l
1-2
3-4
5-10 11-15 16-20 21+
U1 Va Va V
V
V
2D'Y1F
Totalhours inthepast4weeks(pleasetickone)
None
?
Vo V
1-17
2-3
4-5
6-10
V
V
I-1 V
11+
V
JD1Y1H
27
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(e)ADDITIONAUOTHER Additional/otheractivity1(p/easespecik)
JPHYSAII
JPHYSAIZ
.
JPHYSAI3
h-
.----
.
Occasionsinthe past4weeks(please tickone)
None
1-2
3-4
1
2
0
5-10 11-15 16-20 21+
3
4
5
JPHYSAIF
6
Totalhours inthepast4 weeks(pleasetickone)
None
?
1-1?
2-3
4-5
6-10
11+
JPHYSAIH
O
1
2
3
4
5
6
Additional/otheractivity2(p/easespecify)
JPHYSAZI
JPHYSA 22
JPHYSA 23
Occasionsinthepast4weeks(
pleasetickone)
None
1-2
3-4
1
2
0
5-10 11-15 16-20 21+
2
4
5
JPHYSA ZF
6
Totalhoursinthe past4 weeks(p/ease t/ckone)
None
V
?
S
1-1?
2-3
4-5
6-10
11+
V
V
R
Vs Ul 2PHYSA2H
72 How m any tim es a w eek do you engage in vigorous physical
activity enough to m ake you out
.
ofbreath,andforhow Iongintotal?(p/easespecifytheactivlty)
JVIG OB1
JvIG o B2
JvlG O B3
JVIG OB4
JVIG O B5
Occasions inthepast4 weeks(p/easet/ckone)
None
1
2
3
4
5
6+
N, F-1 U1
. N, F1 U1 N, JVIG-0BF
Totalhoursinthe past4weeks(p/easetickone)
None
9
1
Vo V
V
1?
V
2
IV
2?
3+
V
Ve 2VlG-0BH
73 How would you describe yourusualw alking pace?
Please tick one box onl
y
JWLKPACE
28
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sl
owpace(Iessthanamph)N,
steadyaveragepacer-zl
BriskpaceU-a
)
Fastpace(over4mph)N,
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sm oking habits
74 (a)Do you sm oke now (including cigarettes,cigars ora pipe)?
JSM OKE
vesU-,)
No
2
Goto
(a)
Social
/occasionalsmokerUl
a
IfYes orSooial/o ccasionalsm oker...
Enternum ber
(b)How m anycigarettesdoyou smoke perday?
75 (a)Ifnotacurrentsmoker,did yousmokein the past?
JSM KPAST
JC IG N UM
vesEqq,
No
,
Goto
. (a)
lfYes...
(b)How oId wereyou whenyoustopped smoking?
Age
JSM KSTO P
N-
D rinking habi's
76 (a)Inthe past12 m onthshaveyoutaken an alcoholic drink?
Pleasetick one
Tw ice a day orm ore
,
Daily oralm ostdail
y
a
O nce ortwice a w eek
a
O nce ortwice a m onth
,
Specialoccasions only
,
No
,
JALCYR
5
,
(b)IfNo,have youalways beena non-drinker?
JNONDRNK
Yes ,
Goto . (a)
NoU.
29
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''''n
r7y,(a)HaveyouhadJALCW
analcohKol
icdrinkinthelastsevendays?
IfYes...
vesg(j
,
No a GotoJ
F
-'
j
s(a)
In the lastseven days,how m any ofeach ofthe follow ing drinks have you had?
Pl6ase rem em berthata drinkpoured athom e couldbe equivalentlo 2 or3pub m easures.
Ifnone,please indicate 0.
(b)Spirlts (W hisky,gin,rum ,brandy,vodka etc)orliqueurs? Measures
(o)W ine (includingsherry,pod,verm outh)?
(d)Beer(including Iagerand cider)?
JSPRTW K
Glasses
JW INEW K
Pints
JBEERW K
Yes No
-y
a-4(a)Haveyoueverfeltthatyououghttocutdownonyourdrinking? C1
,I-l
a JDRNKCUT
(ulsavepeopleannoyedyoubycriticisinsyourdrinking?
1a,ra aonxKAxx
(ç)Haveyoueverfeltbadorguiltyaboutyourdrinking?
U'1(
--21 JDRNKGLT
(d)Haveyoueverhad adrinkfirstthing in the morning to steadyyour 1- )r--l
nerves orgetrid ofa hangover?
30
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l 1l1 21
JDRNKHNG
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Food habi's
.
(a)W hattypeofbread do youeatm ostfrequentlp
pleasetickone
whiter--,1
wholemeal/2
Granaryorwheatmeal(--j
otherbrown(-1
,
80thBrownandwhiteI'--sl
Donoteatbreadr7,
JB REA D
(b)W hattypeofm ilkdoyou usually use?
Pleasetick one
Do notuse m ilk
,
ChannelIslandsw hole m ilk
a
W hole m ilk
a
Sem i-skim m ed m ilk
,
Skim m ed m ilk
s
JM ILKTYP
Other(p/easespecify) ,
l
Bo How often do you eatfresh fruitorvegetables?
Pleasetickone
JFRUIW G
Seldom ornever
!
Lessthan once a m onth
z
l-3tim esa m onth
a
1-2 tim es a week
,
3 to 4 tim es a w eek
s
5-6 tim es a W eek
,
Daily
,
2 orm ore tim esdaily
a
: Are yôu trying to Iose w eightatpresent?
JD IETNO W
vesE(j
,
NoEla
q
31
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-
.:,
:'
o
S eetion a:A bou' vour
Iife in qener
al
*-'
''
-
'.
--
-.
')
è'
''
;
,..
- --- .
82 . Is the accom m odation in w hich you Iive...
Pleasetick one
JACCOM
Ow ned outright
,
Qortgaged a
Rented from Iocalauthority,housing association orHAT
a
Rented privately
,
A care hom e
,
IYY.
lo
Ht
o
hwerma
menmb
yce
arso
af
re
yo
nu
orma
hou
ll
s
yeahvo
al
i
d
la
?bl
eforusebyyouor
Please tick one
None
a
1
,
2
z
M ore than 2
3
JCAR
I: (a)Do you have apetathome?
ves((q,
JPET
No z GotorB
-V5
(b)Ifyouhave a petathom e,whatkind ofpetls)
Please tick as m anythatapply
do you have?
DOg
1
Cat
a
JPETTYPE
FishF'
-l
a
BirdU,)
other(
p/easespeciy)7-1
Please tickone
Not
Slightly Fairly
Very
attached attached attached attached
(e)Howattacheddoyoufeeltothesepets?
32
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L
U
L
(D, JPETATTA
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F'
85 Think ofthis Iadderas representing w here people stand in oursociety.
Atthe 'op ofthe Iadderare the people w ho are bestol - those w ith the m ostm oney,m ost
education and bestjobs.
Atthe bou om are the people w ho are w orstoff- those w ho have the Ieastm oney,Ieast
education,and theworstjobsornojob.The higherup youare onthis Iadder,thecloseryou
are to the people atthe very top and 1he Iow eryou are,the closeryou are to the people atthe
very bottom .
W here w ould #ou place yourselfon this Iaddee
please plaee a Iae e 1X'on 'he rung (no'in be- een)w here you 'hink you stand.
JLA D
j,
,
33
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Inoom e and finances
Manyofyouareapproachingretirementage,orhaveretired.PreviouslywereliedonyourCivil
Servlce grade to indicate yourincom e.How ever,CivilService grade is notas clearan indicatorof
householdincomeandwealthasbeforeandtherearemanyofyoutowhom itno Iongerapplies.
W e w ould therefore veœ m uch appreciate yourhelp in com pletlng the follow ing questions.
As w i'h aIIotheequestions,'he inform ation you provide w illbe kep' strictly confidential
and used for s'udy purposes only.
86 How often does ithappen thatyou do nothave enough m oney to alord
the kind offood orclothing you/yourfam ily should have?
Please tick one
JFAMPRBS
Always
,
Often
a
Som etim es
a
Seldom
Never
:
4
s
How m uch difficulty do you have in m eeting the paym entofbills?
Please tick one
Very great
!
Great
2
Som e
a
Slight
,
Very little
,
JFAM PRB6
34
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F
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Inn How manypeople(includingyourselflcontributedtoyourhouseholdfinanceswithincome
I-v from any source (any source Includes wages orsalaryfrom work,moneyfrom asecondjob or
oddjobs,incom efrom savingsorinvestments,rentorproperty,pensions,benefitsand/or
maintenanceetc.)overthe Iast42 m onths?
JINC H HNO
Num berofpeople
89 W hattotalincom e (including yourown)hasyourhousehold
received in the Ias' ï2 m onths from the above sources?
Please tickone
JINC H H
Lessthant9,999r-1
,
t1o,ooo-E14,999(----a
q
c1s,ooo-c19,999I
--al
:20,000-:24,999(-7,
c2s,ooo-ca4,999I-'-sl
cas,ooo-c49,999r-,l
:50,000-:69,999r---v
-l
:70,000-:99,999(---a
q
Morethancloo,oooI--al
90 Ifyou sold aIIthe assets yourhousehold ow ns,forexam ple,yourhouse,car,caravan,boat,
house contentsandjewellery,cashed inyoursavingsand investments,and paid offallyour
debts(includingyourm ortgage),how m uch m oneydo you thinkyou would have?
Please tick one
JASSETHH
? *
.
Lessthan:49,99:r--,1
:50,000-:99,999r;z
t1oo,ooo-t199,99(Na
:200,000-:299,999r-1
,
c3oo,ooo-t399,999g---q
s
:400,000-t499,999(---sl
%00,000-:999,999r-j
Morethancl,ooo,oooI
--l
s
35
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@ Ifyou sold aIlthe assetsyourhousehold own (forexam ple,yourcar,caravan,boat,house
contentsand jew ellery)EXCEPT THE HOUSE IN W HIGH YOU LIVE,cashed in yoursavings
and investments,and paid offaIIyourdebts(excluding yourm ortgage),how m uch m oneydo
you think you w ould have? Please indicate one cate oc u
Please tickone
uessthant9,999r-1
,
E1o,ooo-t19,999r'-l
t2o,ooo-c39,999Ual
t4o,ooo-cs9,999U-,l
c6o,ooo-t79,999I'---l
:8o,000-:99,999l---l
c1oo,ooo-c249,999g7,
:250,000-:499,999g'7
Morethantsoo,ooor'7
JASSETXH
Your household
Doyou provide regularcareforanyofthefollowing? (Thisdoes notincludecare
provided aspartofa paidjob)
pjeaseanswereachcategory
Yes No lfyes!forhow many hours perweek.
(FuIItlmeequals168hotJJ?)--.-...
(a)Children
JCARCH gj gua
JCARGC 7
(
..
/
.1
.)Uj
z
.u
(b)Grandchildren
(o)Disabled orilIpartner/spouse
JCARSP (j,(Ja
(d)Disabled oriIIparent
JCA RPA
(e)Otherdisabled oriIIrelative
JC A RR L
JCARFR
JCARSPHR
JCA R PA H R
121122
'
=
(f1 Disabled orillfriend
JCARCHHR
JCARGCHR
k
ED,EZ,
ZCARRLHR
x<.
JCARFRHR
!
(
36
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... ow-
Your oivilstatus
ha(alAreyoumarr
i
ed/cohabiting/i
nacivilpadnership?
JMARCOH
V
Yes
,
Go to @.
NoL,
o,
(b)Ifno'married/cohabiting/in a civilpa/nership,areyou
Please tick one
JNO TM A R
Single,nevermarried
,
W idow ed
u
Divorced
s
Go to *a
separatedr-1
(c)Ifw idowed/divorced/separated oryou haveIosta padnerw hatyeardid this Iasthappen?
JW DSYEAR
Year
This Seçlion çonçerns people in your Iife w ho you feelolose 'o and from
whom you oan obtain suppod (either em otionalorpraotieal)inoluding olose
relatives and good friends.
ez How m anypeopledoyou feelvery close to? (ltdoesnotmaher
where theyIiveorwhetheryou haveseenthem recently).
JCPNO
Numberofpeople
@ W ho have you feltçlosestto in the last12 m onths? Please describe in term s oftheir
relationshipto you:(forexample,W IFE,SON,AUNT,BOYFRIEND,MALE FRIEND,FEMALE
FRIEND).Rememberthesearejustexam plesand wewould Iike you to write inw hoeveryou
feelclosestto.
W RITE IN THE PERSON YOU ARE CLO SEST TO HERE:
Closestperson
JCPI
Thinking aboutthe pprson you are closestto,please tellus how you w ould rate the practical
and em otionalsupportthey have provided foryou IN THE LAST 12 M O NTHS.
Please tickone box foreach question
Not
A
Q uite A great
atalI Ii
ttle a Iot deal
(a)How m uchin the Iast12m onthsdid this persongive you
information,suggestionsandguidanee'ha'mu
found helpful?
1S, f-l
z I
-al 1-1
4
JCPSUPAI
(b)Ho
wmuchinihelast12monthscouldyourelyonthis (--! j--2j j---3q L,
person (wasthisperson therewbenyouneeded him/her)? '
JGPSUPBI
(o)f
Ho
eewlgmu
oocdhain
both
ue
tyIa
osutrs
1e
2lf
mo
? nthsdidthispersonmakeyou j---'
-j N2 j'
--3
-j L,
JCPSUPCI
(d)How much inthe last12m onthsdidyou shaee interests,
hobbies and fun w ith this person?
'
2
3
24
JFjSUMDI
yy
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Pleasetick one boxforeachquestion
Not
A
Q uite A great
ataII little a Iot deal
(e) How m uchin the Iast12m onthsdid this person giveyou
1
w orries,px blem s and s'eess?
2
3
L,
JC PS UPEI
(f) How m uchinthe Iast12m onthsdid youwan'to oonfide
in (talkfrankly,sharefeelingswith)this person?
1
2
3
?GPGONFI
(g) How m uch in the Iast12m onthsdid you confide in this
person?
JCPCONGI
(h) How much inthe Iast12m onthsdidyou'rus'this person
w ith yourm ostpersonalw orries and problem s?
ED
2
3
4
JC PC O N HI
(i) How much inthe Iast12m onthswould you have Iiked 'o
have confided m ore in this person?
JCPCONIAQ) How m uch intheIast12m onthsdidtalkingtothisperson
m ake things w orse?
JCPSONJI
k) How m uch intheIast12m onthsdid he/shetalk about
his/herpersonalw orries w ith you?
JCPCO NKI
(I) How m uch inthe Iast12m onths didyou need practical
help from this person with m ajorthings (forexample,
look afleryou when ill,help withfinances,children)?
(m )How m uch inthe Iast12 monthsdid thispersongive you
praoticalhelp with m ë or'hings?
L.
JC PRA CLI
r--n r-a r--n r- n
1 11 1 21 1 31 1 41
JC PRAC M I
(n)Ho
mow*mu
prc
ahct
in
iota
hl
ehle
al
sptwi
12th
mo
ma
ntjhos
rwo
thinuglds?
youhaveIiked
7-1 77, 71 77
JCPRA C NI
(o) How m uch inthe Iast12 monthsdid this persongive you
praoticalhelp withsm allthingswhen you needed it(for
example,chores,shopping,watering plantsetc)?
,
,
a
4
JCPRACO I
Please tick one boxforeach question
Hardly Som e Often
everto ofthe
never tim e
96 (a)How oftendoyoufeelyou lack com panionship?
,
(b)How oftendoyoufeelisolatedfrom others?
(ç)How oflendoyoufeelIeftout?
(d)How oftendoyoufeelintunew iththe people around you?
38
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ED
Z
Z
Z
ED
Z
Z
Z
ED
Z
Z
Z
JCOMPAN
J'SOLATE
JLEFTOUT
JINTUNE
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97 Please read each ofthe follow ing statem ents below and indicate the extentto w hich you
agree w ith each statem ent.Tœ to be as accurate and honestas you can as you answ erthe
questions.Try notto Ietyouransw erto one question influence youransw erto other
questions.There are no correctorincorrectansw ers.
Please tickone boxforeach question
Absolutely Som ew hat Cannot Som ew hat Absolutely
disagree disagree
say
agree
agree
(a)Ifeelthatitis impossibleto reach
the goals Iw ould Iike to strive for
1
L, JHOPELSI
(blThe future seem sto me to be
hopelessandIcan'tbelievethat U1
,
Z5 JHOPELSZ
(o)h
II
oop
oeka
fo
nd
rwa
enrt
dhu
tosi
tahsemfuturewith N,
L, JHOPELS3
(d)c
Imi
ang
'thma
tas
kewe
thli
lnggiv
sebu
ep
tte
br
ef
coaruseI N,
Z, JHORELS4
things are changing forthe better
m yself
(e)AIIIcan seeahead ofm eis
unpleasantness ratherthan
pleasantness
(f)wa
Thi
yng
Iwa
sjunstttwo
hem
n'tto
workoutthe r7
Z5 JHOPELSS
L. JHOPELS6
39
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98 How do you feelaboutyourIocalarea,thatis everyw here w ithin a 20 m inute w alk orabouta
m ile ofyourhom e? Please tick one box on each Iine.
The closeryourtick is to a statem entthe m ore strongly you agree w ith it.
Pl
easetick one box on each Iine
(a)lreallyfeelpartofthis area
(blvandalism and gralitiarea
big problem in this area
JA R PA RT
1
2
lfeelthatIdon'tbelong in
s
, thjs area
:
v vandalism and graffitiin this
JA RVA NDA
1
There is no problem w ith
area
(e)IoftenfeelIonely Iiving inthis
area
(d)Mostpeople in thisarea can
be trusted
JARLO NEL
1
-
-
Ihave neverfeltIonely Iiving
s
, jn thjs area
u,r-'JARTRUST u-ra,u
Mo
et
srt
up
st
eeodpleinthisareacan't
(e)wa
Peolkpa
lelowo
neuin
ldtb
he
isaafre
aa
idatfoter 77,I'Va JARDARK r-'elr'7 a
pl
eoonpelef
ine
thei
l
ssaar
fe
ewa
aaft
lk
ei
rndgark
dark
(: M ostpeople in thisareaare
friendly
(g)People inthisareawilltake
advantage ofyou
j-'-j
JARFRIEN g-j
,g-ju
Mo
ofs
rj
t
epne
dojypleinthisareaare
g-n,g-JARADVAN lsr-,1a
pj
e
woa
pyl
e
st
in
ret
a
ht
is
yo
au
ref
awi
airl
yll
(hlThisarea iskeptveG clean
g-7,gy-JARCLEAN Z,g--jT
ju
hs
i
sraar
n
ed
ar
i
sb
u
ab
l
wisahysfullof
(i) Ifyouwere introuble,there
77,U JARHELP r-l
,r'7 n
I
foyb
oo
udwe
yi
n
reth
in
ista
rore
ua
bl
wh
e,t
o
herei
s
are Iots ofpeople in this area
w ho w ould help #ou
40
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w ould helpyou
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99 Here is a Iistofstatem ents thatpeople use to describe theirIives
orhow theyfeel.W e w ould Iike to know how often,ifatall,you think
they apply to you.
Pleasetick one box on each Iine
Often Som e- Not Never
tim es oflen
(a)MyagepreventsmefromdoingthethingsIwouldIik:todo U1 g---al rsa (S,JCASPI
(b)Ifeelthatwhathappenstomeisoutofmycontrol
gS, (Sa gsa g---1JCASPZ
(e)Ifeelfreetoplanforthefuture
r-1
, I--al I--al r--,1JCASP3
Z,
(e) Ican do the thingsthatIwantto do
L,
(: Familyœsponsibilitiespreventmefrom doingwhatIwanttodo Z,
(g) IfeelthatIcan pleasem yselfin whptIdo
U,
(h) M yhealth stopsm efrom doing whatIwantto do
L.
(i) Shortageofm oneystopsmefrom doing thingsIwantto do L,
q) IIookforwardto each day
L,
(d) lfeelIeQ outofthings
(k) Ifeelthatmy Iife has no meaning
(I) IenjoythethingsIdo
(m)Ienjoybeing inthecom panyofothers
(n) Onbalance,IIookbackon myIifewith asenseofhappiness
(o) Ifeelfullofenergythese days
(p) Ichoose to do thingsthatIhave neverdone before
(q) Ifeelsatisfied with theway my Iifehasturned out
(r) IfeelthatIife isfullofopportunities
(s) Ifeelthatthefuture Iooksgood form e
Z,
L,
Z.
L,
L,
L,
L,
Z.
L,
Z,
Z,
L,
L,
L,
Z.JCASP4
L.JcAsps
Z.JCASP6
L,JcAsp7
L.JcAsp8
L,JcAsP9
L,JcAsp1e
N JcAspll
L. L, L, L.JcAS?'2
N JcAsP13
Z,JcAspl4
ED JcAsels
U
E1 E; EZ ED JcAspl6
L L L L JcAsplz
L1 E1 EZI EZ acAsel.
U L L L JcAspla
41
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ï00 In yourspare tim e are you involved in any ofthe follow ing activities?
How often have you taken partin these activities
in the Iast12 m onths?
Pleasetickone boxoneachIine
W eekly M onthl
y Less
often
AO you involved in any of 'he follow ing?
Never
L. L, L, Z,
(b) PositionsofoWice (forexam ple,schoolgovernor,
L
councillor)
JseAposF
(o)voluntarywork
JSPAVOLF
L. L, L, L.
(d)Courses and education/evening classes JSPAEDNF L, L. L, L,
(e) Culturalvisitsto statelyhomes,galleries,theatres,
cinem a orlive m usic events
JSPA CU LF
'
L
L
(: Socialindoorgames,cards,bingo,chess,JSPAGAM F Z1 Z. Z, Z,
JSPAVSTF
(g)Visiting friendsand relatives
L, E1 L, L.
JSPAPUBF
(h) Going to pubsandsocialclubs
Z, Z, L, Z,
(i) Individualoccupations(forexam ple,reading,Iistening
L, E1
to m usic)
JSPASOLF
'
(a) Religiousactivities/observance
JSPARLG F
g) Household tasks(forexample,DIY,maintenance.
decorating)
JSPAHHTF
L
(k) Practicalactivities,m aking thingswithyourhands
(forexam ple,pottery,drawing)
JSPAHANF
L L
L, L, U, L,
L1 E1 Z. Z.
(I) Gardening
JSPAG DNF
(m)Using ahom ecom puterforleisure JSPACO M H
42
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L
L
L
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I
The sentences thatfollow concern yourfeelings and behaviouroverthe pastw eek.
Please read the statem ents carefully and tick one box foreach statem entthatbest
describes how often you feltthis w ay during the pas'w eek.
Please tick one box oneach Iine
Rarel
y or
none of
the tim e
Som e Occasionall
y M ost
ora orm oderate orallof
li
ttle of am ount the tim e
(lessthan thetime oftime
(5-7
1day) (1-2days) (3-4days) days)
(a) Iwas bothered bythingsthatusuallydon't
r-al JDPNOI
botherm e
(b) Idid notfeelIike eating,my appetitewaspoor
c
1
a
L,
H,
U,
U,
E1
Z
Z'
Z'
Z'
L,
U,
EZ,
Z,
L,
EZ,
Z.
Z'
Z'
Z'
Z'
L,
L,
ED, JDeN02
I
Z, JDPNO3
L, JDPNO.
U, JDPNOS
ED, JDPNO:
Z, JDPN07
L, JDeNn8
EZ, JDPNO:
Z, JDPNIO
Z' JDPN1$
Z'
m 2DPN12
Z' JDPN13
Z' JDPN14
L, JDPNI5
L, JDPNI6
L,
u
77- JDP
RNI;
8
Z'
Z1
Z'
Z'
Z' JDPN19
Z' JDPN20
(e)wi
lfeth
l
tt
hh
ea
lp
tI
fr
coomulmy
dno
fa
tmi
shl
ayka
enodffr
ti
h
ee
nd
bs
lueseven F-1
,
(d)IfeltthatIwasjustasgoodasotherpeople
I--l
o
(e) lhadtrouble keeping my mind onw hatlwas
r--l
(#) Ifeltdepressed
L,
U,
U,
L,
L,
Z'
Z.
Z'
Z'
doing
(g) IfeltthateveY hing Ididwasan effod
(h) lfelthopefulaboutthefuture
(i) Ithoughtmy Iife had been afailure
:) Ifeltfeadul
(k) Mysleep wasrestless
-
(I) lwashappy
(m )Italked Iessthan usual
(n) IfeltIonely
--
l ol
(o) Peoplewere unfriendly
(p) Ienjoyed life
(q) Ihad cl ing spells
(r) Ifeltsad
(s) Ifeltthatpeopledisliked m e
(') Icould notgetgoing
43
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l !
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j
>
.
Twr
..
L
?.
/?-.
.
.
,
Section 4:Aboutyour past and present w ork
.
yj
i'è'
..,
. .
(a)Areyoustillworking asa civilservant?
Yes
,
JCSSTILL
No ,
Go to 1 (a)
(b)Inw hich M inista/Departm entdoyouw ork?
(c)W hichofthefollowing isclosestto yourcurrentgradeintheCivilSe- ice?
please tick one
AdministrativeAssistant(AA) ,
JCSCLGD
Administrati
veOfficer(AO) a
Executive Officer(EO) a
HigherExecutiveOfficer(HEO) ,
SeniorExecutive Offi
cer(SEO) s
Grade 7
o
Grade 6
,
Grade 5
a
Grade 4
:
Grade 3
,o
Grade 2
,,
Go to 1O9
Grade 1 12
ïoa (a)W hendid you Ieavethe civilservice?W asit:
JLR2005
On orbefore 31stDecem ber2005
,
G o to 4o6
Onorafter1stJanuary2006Sz
(b)Please give the datewhenyou Ieftthe CivilService:
44
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M onth
Year
JLRM ONTH
JLRYEA R
!
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r
1:41Whichofthefollowi
ngi
scl
osesttoyourI
astgradei
ntheCi
vilServ
ice?
Pleasetick one
AdministrativeAssistant(AA) ,
JLRCLGD
Administrative Officer(AO) a
ExecutiveOfficer(EO)I
-qa
HigherExecutiveOfficer(HEO)g'--1
SeniorExecutiveOfficer(SEO)Uqs
Grade 7
,
Grade 6
v
Grade5(-)
Grade4No
Grade 3
,0
Grade21-S,,
Grade1U1
,a
By w hich route did you Ieave the C'vilService?
Please tickone
JLRRO UT
Retirem entat60
,
Voluntary Earl
y Retirem ent
z
Retirementon heal
th grounds
a
VoluntaryGompulsoryRedundancyU1
RedundancyUl
s
TransfertocompanythroughprivatisationS:
LefltotakeapostoutsidetheCivilServiceUl
Lefttobecomeself-employed(Sa
Other(pleasespecify)I'Qa
JLRROUTO
l
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4
5
r
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i4os Are you in Daid em ploymentNOW (includingself-em ployment
oremploymentafterretirement)?
Yes
JLR EM PL
,
Goto ï0B (a)
NoLz
ï07 Ifyou are notcurrently in paid em ploym ent,
would you classify yourselfas:
Please tick one
Unem ployed seeking work
,
Retired
a
Long term sick/disabled
a
Looking afterfam ily orhom e
,
JLRN E
Other(pleasespecify) s
*
46
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Go to I*
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:1 (a)W hatistheexacttitle ofyourm ain paid job,including thoseofyou who are
self-em ployed? (Ifyouhave m ore than onejob,the m ainjob iseitherthe one
in w hich the m osthours are w orked,orifyou do equalhours itis the one
thatisthe highestpaid.)
P/easegive thefulltitleby which thejob isknownand givetherankorgrade ifyouhave one.
J108
(b)W hatkind ofwork do you do in it?(Iistthe mainthingsyoudo inthejob)
(c)Are you an em ployee orself-em ployed?
Please tick one
JLR EM PEE
Employee ,
Self-employed
z
Goto(:
Goto(d)
(d)Ifyouare self-em ployed,doyou em ployotherpeople?
JLREMPPL
vesE(q,
No
z
Go to I-
(e)How m anypeople do you em ploy?
Please tickone
JLREPPLN
1-24
1
25 orm ore
z
Go to . -
(f) Ifyouare an em ployee,areyou:
Please tick one
JLRECHAR
A manager
,
Go to (g)
A forem an orsupervisor a
None ofthe above
s
Go to '*
(g)How manypedpledoyoumanageorsupervise?
Please ti
ck one
JLRECHNO
1-24
,
25 orm ore
a
47
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ï09 WewouldIiketoknow aboutanyworkorotheractivitiesthatyoucurrentlydoprimarilyfor
self-fulfillm ent,to keep physically and m entally active orinvolved in the Iocalcom m unlty,or
forthe benefitofsociety.This w ork is Iikely 'o be for Iiu le orno pay.Please tellus how
often you take partin the follow ing and feelfree to add any activities thatare notIisted in the
spaces provided.
Pl
easetick one box foreach question
Neveror O nce Once a O nce a 2-4 5 days
alm ost every month week days a a week
never few orm ore
w eek orm ore
m onths
JSFCO NSU (a)consultancywork
JsFBooKs (b)W riting bookts)
(e)Charitywork(forexample,fundraising,
JFSCHARI working ina charityshop)
JSFENVIR
(d)Environmentalwork (forexample,
thinning woodland)
C1 2 3 84 5 6
1 92 3 1 5 6
L, L, L, L, L. L.
L, L, U, L. U, L.
7
JSFPOLIT (e)Politicalw ork(forexam ple,serving as
a jocalcouncillor)
(; Com m unitywork(forexam ple,sitting
JSFCOMMU onthecommitteeofaIocalclubor
uoard ofGovernors)
ED
L. U, Z, U, U.
U1, gsz I--al
(g)Other(p/easespecify)
JsFoTH1
FR, U1. F7,
JSFOTHIF
(h)Other(p/easespecify)
JsFoTH2
FR
S
S
JS FO THZF
(i) Other(p/easespecify)
JSFOTH3
77, V,1 V1
JS FOTH 3F
q) Otherrp/easespecify)
JsFOTH4
-
- -
S, Sa Sa
JSFO TH4F
(k)Other@/easespecify)
N SFOTHS
U1 IQ
S,
J>FOTHSF
(I) Other(pleasespecify)
asFoTHs
EZ. EZ, EZ,
JSFOTHGF
48
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# This questionnaire was com pleted...
Pleapetickone
Independently
r
JCO M PLET
W ith assistance (forexam ple,ifyou havetrouble
writing orhave Iostyoureyesight) '
By som eone else on m y behalf
,
P lease use 'he spaoe below 'o add any fue her oom m en's
JCM T Q1
JCM T Q2
JCM T Q 3
JCM T Q4
JCM T Q5
JCMT Q6
JCMT Q7
JCMT- QB
JCMT CAT
T hank you for oom pleting this questionnaire
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