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WHO/MSD/MER/02.2 English only Distr.: General WHOQOL-HIV BREF MENTAL HEALTH: EVIDENCE AND RESEARCH DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE DEPENDENCE WORLD HEALTH ORGANIZATION GENEVA Raw Score Transformed Score Domain 1 (6-Q3) + (6-Q4) + Q14 + Q21 ! + ! + ! + ! Domain 2 Q6 + Q11 + Q15 + Q24 + (6-Q31) !+ ! + ! + ! + ! Domain 3 (6-Q5) + Q20 + Q22 + Q23 ! + ! + ! + ! Domain 4 Q17 + Q25 + Q26 + Q27 ! + ! + ! + ! Domain 5 Q12 + Q13 + Q16 + Q18 + Q19 + Q28 + Q29 + Q
  WHO/MSD/MER/02.2English onlyDistr.: General WHOQOL-HIV BREF MENTAL HEALTH: EVIDENCE AND RESEARCHDEPARTMENT OF MENTAL HEALTHAND SUBSTANCE DEPENDENCEWORLD HEALTH ORGANIZATIONGENEVA RawScoreTransformedScoreDomain 1(6-Q3) + (6-Q4) + Q14 + Q21   !   + !   + !   + ! Domain 2Q6 + Q11 + Q15 + Q24 + (6-Q31) ! + !   +   !   + !   + ! Domain 3(6-Q5) + Q20 + Q22 + Q23  !   + !   + !   + ! Domain 4Q17 + Q25 + Q26 + Q27 !   + !   + !   + ! Domain 5Q12 + Q13 + Q16 + Q18 + Q19 + Q28 + Q29 + Q30   !   + !   + !   + ! + !   + ! + !   + ! Domain 6Q7 + (6–Q8) + (6-Q9) + (6-Q10) ! + !   + !   + !  2 Further copies of this document may be obtained from Department of Mental Health and Substance Dependence World Health OrganizationCH-1211 Geneva 27SwitzerlandCopyright © World Health Organization [2002]This document is not a formal publication of the World Health Organization (WHO), and all rights arereserved by the Organization. The document may, however, be freely reviewed, abstracted or reproduced,in part or in whole, but not for sale or for use in conjunction with commercial purposes.  3 ABOUT YOU Before you begin we would like to ask you to answer a few general questions about yourself: by circling the correctanswer or by filling in the space provided.What is your gender ?Male / FemaleHow old are you? (age in years)What is the highest education  you received?None at all / Primary / Secondary / TertiaryWhat is your marital status ? Single / Married/ Living as married / Separated / Divorced / Widowed How is your health ?Very Poor / Poor / Neither Poor nor Good / Good / Very GoodDo you consider yourself currently ill?Yes / NoIf there is something wrong with you, what do you think it is?  Please respond to the following questions if they are applicable to you: What is your HIV serostatus ? Asymptomatic / Symptomatic / AIDS convertedIn what year did you first test positive  for HIV? In what year do you think you were infected? How do you believe you were infected with HIV ? (circle one only):Sex with a man / Sex with a woman / Injecting drugs / Blood products / Other (specify)_________________   Instructions This assessment asks how you feel about your quality of life, health, or other areas of your life. Please answer all thequestions.  If you are unsure about which response to give to a question, please choose the one  that appears mostappropriate. This can often be your first response. Please keep in mind your standards, hopes, pleasures and concerns.We ask that you think about your life in the last two weeks.  For example, thinking about the last two weeks, a questionmight ask:  Not at all A littleA moderateamountVery muchExtremely 11 (F5.3) How well are you able to concentrate?12345 You should circle the number that best fits how well are you able to concentrate  over the last two weeks. So you  would circle the number 4 if you were able to concentrate very much . You would circle number 1 if you were not able to concentrate at all in the last two weeks.  4 Please read each question, assess your feelings, and circle the number on the scale for each question that gives the best answerfor you. Very poorPoorNeither poor nor goodGoodVery good1(G1) How would you rate your quality of life?12345 VerydissatisfiedDissatisfied Neither satisfied nor dissatisfiedSatisfiedVerysatisfied2 (G4) How satisfied are you with your health?12345The following questions ask about how much  you have experienced certain things in the last two weeks.  Not at all A littleA moderateamountVery muchAn extremeamount3 (F1.4) To what extent do you feel that physical pain prevents you from doing what you need todo?12345 4 (F50.1) How much are you bothered by any physical problems related to your HIV infection?12345 5 (F11.3) How much do you need any medicaltreatment to function in your daily life?12345 6 (F4.1) How much do you enjoy life?12345 7 (F24.2) To what extent do you feel your life to bemeaningful?12345 8 (F52.2) To what extent are you bothered by people blaming you for your HIV status12345 9 (F53.4) How much do you fear the future?12345 10 (F54.1) How much do you worry about death?12345  Not at all A littleA moderateamountVery muchExtremely11 (F5.3) How well are you able to concentrate?12345 12 (F16.1) How safe do you feel in your daily life?12345 13 (F22.1) How healthy is your physical environment?12345The following questions ask about how completely  you experience or were able to do certain things in the last two weeks.  Not at all A littleModeratelyMostlyCompletely14 (F2.1) Do you have enough energy for everydaylife?12345 15 (F7.1) Are you able to accept your bodilyappearance?12345 16 (F18.1) Have you enough money to meet your needs?12345 17 (F51.1) To what extent do you feel accepted by the people you know?12345 18 (F20.1) How available to you is the information thatyou need in your day-to-day life?12345
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