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WSAS

Rate how much your problem impairs your ability to function in each area. If retired or choosing not to work for reasons unrelated to the problem, tick 'not applicable' by choosing 0.

1. 1.Work — because of my problem my ability to work is impaired.

   • [0]0 — Not at all
   • [1]1
   • [2]2 — Slightly
   • [3]3
   • [4]4 — Definitely
   • [5]5
   • [6]6 — Markedly
   • [7]7
   • [8]8 — Very severely, I cannot function

2. 2.Home management — cleaning, tidying, shopping, cooking, looking after home/children, paying bills.

   • [0]0 — Not at all
   • [1]1
   • [2]2 — Slightly
   • [3]3
   • [4]4 — Definitely
   • [5]5
   • [6]6 — Markedly
   • [7]7
   • [8]8 — Very severely, I cannot function

3. 3.Social leisure activities — with other people, e.g. parties, outings, entertaining.

   • [0]0 — Not at all
   • [1]1
   • [2]2 — Slightly
   • [3]3
   • [4]4 — Definitely
   • [5]5
   • [6]6 — Markedly
   • [7]7
   • [8]8 — Very severely, I cannot function

4. 4.Private leisure activities — done alone, e.g. reading, gardening, hobbies, walking.

   • [0]0 — Not at all
   • [1]1
   • [2]2 — Slightly
   • [3]3
   • [4]4 — Definitely
   • [5]5
   • [6]6 — Markedly
   • [7]7
   • [8]8 — Very severely, I cannot function

5. 5.Family and relationships — form and maintain close relationships with others, including the people I live with.

   • [0]0 — Not at all
   • [1]1
   • [2]2 — Slightly
   • [3]3
   • [4]4 — Definitely
   • [5]5
   • [6]6 — Markedly
   • [7]7
   • [8]8 — Very severely, I cannot function