I. MYSELF (W14, 2003)

I1 How strongly do you agree or disagree with each of the following statements? (Circle one number for each)

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly Agree

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MEI1A14 I feel I have a number of good qualities.

MEI1B14 I certainly feel useless at times.

MEI1C14 I feel I do not have much to be proud of.

MEI1D14 There is really no way I can solve some of the problems I have.

MEI1E14 I take a positive attitude toward myself.

MEI1F14 On the whole, I am satisfied with myself.

MEI1G14 Sometimes I feel that I'm being pushed around in life.

MEI1H14 I have little control over the things that happen to me.

MEI1I14 I am useful to society.

MEI1J14 I can do just about anything I really set my mind to do.

MEI1K14 I am helpful to others.

MEI1L14 What happens to me in the future mostly depends on me.

MEI1M14 I often feel helpless in dealing with the problems of life.

MEI1N14 There is little I can do to change many of the important things in my life.

MEI1O14 At times I think I am no good at all.

MEI1P14 I wish I could have more respect for myself.

MEI214 I2 In general, would you say your health is (Circle one number):

1 Excellent

2 Very good

3 Good

4 Fair

5 Poor

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I3 Think about your goals, both things you want to improve and the things you are satisfied with and want to maintain. How do you go about accomplishing what you want in life? Please circle A or B below, indicating the one statement in each pair that best describes your behavior.



A.      I always focus on the most important goal at a given time.

B.      I am always working on several goals at once.


A.      When I canít carry on as I used to, I direct my attention, like usual, to all my goals.

B.      When I canít carry on as I used to, I direct my attention to my most important goal


A.      When I can no longer do something in my usual way, I think about what I am able to do under the circumstances.

B.      When I can no longer do something in my usual way, I donít think about it very long.


A.      Even when I really consider what I want in life, I wait and see what happens instead of committing myself to just one or two particular goals.

B.      B. When I think about what I want in life, I commit myself to one or two important goals.


A.      When I canít do something as well as I used to, I accept the change and donít ask for help.

B.      When I canít do something as well as I used to, I ask someone else to do them for me.


A.      I consider exactly what is important to me.

B.      I take things as they come and carry on from there.


A.      I think about exactly how I can best realize my plans.

B.      I donít think long about how to realize my goals, I just try to achieve them.


A.      Only I know the best way to get ahead, I donít look to other people as models.

B.      When I want to get ahead, I use other successful persons as role models.


A.      I make every effort to achieve a given goal.

B.      I prefer to wait for a while to see if things will work out by themselves.


A.  When something doesnít work as well as usual, I donít spend much time thinking about it.

B.  When something doesnít work as well as usual, I look at how others do those things and try and emulate them.


A.  When things donít go so well, I leave it without pursuing it further.

B.  When things donít work so well, I pursue my most important goal first


A.      When things donít work the way they used to, I look for other ways to make things work.

B.      When things donít work the way they used to, I accept the way things are now and donít try and change them.

I4 During past month, how much of the time: Circle one number for each.

1 None of the time

2 A little of time

3 Some of the time

4 Most of the time

5 All of the time

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MEI4A14 Have you felt that the future looks hopeful and promising?

MEI4B14 Have you been under any strain, stress, or pressure?

MEI4C14 Have you generally enjoyed the things you do?

MEI4D14 Have you felt tired, worn out, or exhausted?

MEI4E14 Have you felt downhearted and blue?

MEI4F14 Have you felt tense or ďhigh strungĒ?

MEI4G14 Have you felt cheerful, lighthearted?

MEI4H14 Have you felt depressed?

MEI4I14 Have you been in low or very low spirits?

MEI4J14 Have you felt lonely?

MEI4K14 Has your daily life been full of things that are interesting to you?

MEI4L14 Do you wake up feeling fresh and rested?

J1 What is your birth date?

BIRTMO14 Month




H. Life Events (W14, 2003)