Instructions to Respondents:

This survey asks about how you are feeling and doing in different areas of life. Please check the box to the left of your answer that best describes yourself during the PAST WEEK. Please answer every question. If you are unsure about how to answer, please give the best answer you can.

During the PAST WEEK, how much difficulty did you have managing your day-to-day life?

No difficulty A little difficulty Moderate difficulty Quite a bit of difficulty Extreme difficulty

During the PAST WEEK, how much difficulty did you have coping with problems in your life?

No difficulty A little difficulty Moderate difficulty Quite a bit of difficulty Extreme difficulty

During the PAST WEEK, how much difficulty did you have concentrating?

No difficulty A little difficulty Moderate difficulty Quite a bit of difficulty Extreme difficulty

During the PAST WEEK, how much of the time did you get along with people in your family?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you get along with people outside your family?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you get along well in social situations?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you feel close to another person?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you feel like you had someone to turn to if you needed help?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you feel confident in yourself?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you feel sad or depressed?

None of the time A little of the time Half of the time Most of the time All of the time

During the PAST WEEK, how much of the time did you think about ending your life?

None of the time A little of the time Half of the time Most of the time All of the time

Thank you for taking our survey.

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1 of 17

BASIS-24 Assessment

During the PAST WEEK, how much difficulty did you have managing your day-to-day life?

During the PAST WEEK, how much difficulty did you have coping with problems in your life?

During the PAST WEEK, how much difficulty did you have concentrating?

During the PAST WEEK, how much of the time did you get along with people in your family?

During the PAST WEEK, how much of the time did you get along with people outside your family?

During the PAST WEEK, how much of the time did you get along well in social situations?

During the PAST WEEK, how much of the time did you feel close to another person?

During the PAST WEEK, how much of the time did you feel like you had someone to turn to if you needed help?

During the PAST WEEK, how much of the time did you feel confident in yourself?

During the PAST WEEK, how much of the time did you feel sad or depressed?

During the PAST WEEK, how much of the time did you think about ending your life?

During the PAST WEEK, how much of the time did you feel nervous?

During the PAST WEEK, how often did you have thoughts racing through your head?

During the PAST WEEK, how often did you think you had special powers?

During the PAST WEEK, how often did you hear voices or see things?

During the PAST WEEK, how often did you think people were watching you?

During the PAST WEEK, how often did you think people were against you?

Thank you for taking our survey.

Sign up for more info

BASIS-24 Assessment

During the PAST WEEK, how much difficulty did you have managing your day-to-day life?

During the PAST WEEK, how much difficulty did you have coping with problems in your life?

During the PAST WEEK, how much difficulty did you have concentrating?

During the PAST WEEK, how much of the time did you get along with people in your family?

During the PAST WEEK, how much of the time did you get along with people outside your family?

During the PAST WEEK, how much of the time did you get along well in social situations?

During the PAST WEEK, how much of the time did you feel close to another person?

During the PAST WEEK, how much of the time did you feel like you had someone to turn to if you needed help?

During the PAST WEEK, how much of the time did you feel confident in yourself?

During the PAST WEEK, how much of the time did you feel sad or depressed?

During the PAST WEEK, how much of the time did you think about ending your life?

During the PAST WEEK, how much of the time did you feel nervous?

During the PAST WEEK, how often did you have thoughts racing through your head?

During the PAST WEEK, how often did you think you had special powers?

During the PAST WEEK, how often did you hear voices or see things?

During the PAST WEEK, how often did you think people were watching you?

During the PAST WEEK, how often did you think people were against you?

Thank you for taking our survey.

Sign up for more info

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