Table 9 Questions of the centers of disease control health related quality of life-4 survey

1. Self-perceived health

 Would you say that in general your health is?

  Excellent

  Very good

  Good

  Fair

  Poor

2. Recent physical health

 Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?

3. Recent mental health

 Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

4. Recent activity limitation

 During the past 30 days for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?