Have you now (or have you during the past 12 months had) troubles with
| Never | Now and then | Relatively often | Constantly | |
|---|---|---|---|---|
| Restlessness | 0 | 1 | 2 | 3 |
| Concentration difficulties | 0 | 1 | 2 | 3 |
| Anxiety | 0 | 1 | 2 | 3 |
| Worries | 0 | 1 | 2 | 3 |
| Palpitation of the heart | 0 | 1 | 2 | 3 |
| Sleeping problems | 0 | 1 | 2 | 3 |
| Depression | 0 | 1 | 2 | 3 |