MISSIONARY OUTCOME QUESTIONNAIRE (This question naire was design ed for broad sca le clinical use)

Name Age Date ID No.

Sex 9M 9F
Mission Months/weeks in Describe any health or other problems List any medications you are taking
mission
Instructions: Looking over the last week, including today, help us understand how you have been feeling. Read each item carefully and mark the box under the category
which best describes your current situation. The term “work” is defined as employment, school, housework, volunteer work, MTC work/class missionary work and so
forth. Please do not make any marks in the shaded areas.
PLEASE ANSWER THESE QUESTIONS ACCORDING TO HOW YOU Almost
HAVE FELT JUST THIS PAST WEEK Never Rarely Sometimes Frequent ly SD IR SR
Always
1. I get along well with others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 93 92 91 90 0
2. I tire quickly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
3. I feel no interest in things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
4. I feel stressed at work/school (Missionary work) . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
5. I blame myself for things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
6. I feel irritated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
7. I feel unhappy in my closest relationships (parents, companions, friends) 90 91 92 93 94 0
8. I have thoughts of ending my life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
9. I feel weak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
10. I feel fearful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
11. I have a hard time getting going in the morning . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
12. I find my work/school satisfying (missionary work and studies) . . . . . . . . 94 93 92 91 90 0
13. I am a happy person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 93 92 91 90 0
14. I work/study too much . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
15. I feel worthless. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
16. I am concerned about family tro ubles . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
17. I have problems because I say the wrong thing . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
18. I feel lonely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
19. I have frequent arguments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
20. I feel loved and want ed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 93 92 91 90 0
21. I enjoy my spare time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 93 92 91 90 0
22. I have difficulty concentrating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
23. I feel hopeless about the future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
24. I like myself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 93 92 91 90 0
25. Disturbing thoughts come in to my mind that I cannot get rid of . . . . . . . . 90 91 92 93 94 0
26. I feel a need to escape from others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
27. I have an upset stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
28. I am not working/studying as well as I used to . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
29. My heart pounds too much. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
30. I have trouble get ting along with friends and c lose acquain tances . . . . . . 90 91 92 93 94 0
31. I am satisfied with my life. ................................... 94 93 92 91 90 0
32. I have so many things to do I can’t seem to finish what I start . . . . . . . . . 90 91 92 93 94 0
33. I feel that someth ing bad is goi ng to happen . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
34. I have sore musc les . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
35. I feel afraid of open spaces, of driving, or being on buses, subways, etc. 90 91 92 93 94 0
36. I feel nervous. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
37. I feel my love relationships are full and complete(family, close friends) 94 93 92 91 90 0
38. I feel that I am not doing well at work/school (Mission) . . . . . . . . . . . . . . 90 91 92 93 94 0
39. I have too many disagreements at work/school. (Mission) . . . . . . . . . . . . 90 91 92 93 94 0
40. I feel something is wrong with my mind. . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
41. I have trouble fa lling asleep or stayi ng asleep . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
42. I feel blue (depressed) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0
43. I am satisfied with my relationships with others. . . . . . . . . . . . . . . . . . . . . 94 93 92 91 90 0
44. I feel angry enough a t school (Missi on) to do somethi ng I might regret . . 90 91 92 93 94 0
45. I have headaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 91 92 93 94 0

©1996. American Professional Credentialing Services LLC, 10421 Stevenson Rd. Box 346, Stevenson, MD 21153-0346 0 + 0 + 0
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