WHODAS 2.0

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Patient Name*

Age

Date

This questionnaire asks about difficulties due to the mental health conditions/concerns for which you are seeking help. Think back over the past 30 days and answer these questions thinking about how much difficulty you had doing the following activities. For each question, please select the response that best describes your situation.

Understanding and communicating*

In the last 30 days, how much difficulty did you have in:

	None	Mild	Moderate	Severe	Extreme or cannot do
D1.1 Concentrating on doing something for ten minutes?
D1.2 Remembering to do important things?
D1.3 Analyzing and finding solutions to problems in day-to-day life?
D1.4 Learning a new task, for example, learning how to get to a new place?
D1.5 Generally understanding what people say?
D1.6 Starting and maintaining a conversation?

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D1 - Raw Domain Score

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D1 - Average Domain Score

Getting around*

In the last 30 days, how much difficulty did you have in:

	None	Mild	Moderate	Severe	Extreme or cannot do
D2.1 Standing for long periods, such as 30 minutes?
D2.2 Standing up from sitting down?
D2.3 Moving around inside your home?
D2.4 Getting out of your home?
D2.5 Walking a long distance, such as a kilometer (or equivalent)?

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D2 - Raw Domain Score

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D2 - Average Domain Score

Self-care*

In the last 30 days, how much difficulty did you have in:

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D3 - Raw Domain Score

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D3 - Average Domain Score

Getting along with people*

In the last 30 days, how much difficulty did you have in:

	None	Mild	Moderate	Severe	Extreme or cannot do
D4.1 Dealing with people you do not know?
D4.2 Maintaining a friendship?
D4.3 Getting along with people who are close to you?
D4.4 Making new friends?
D4.5 Sexual activities?

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D4 - Raw Domain Score

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D4 - Average Domain Score

Life activities—Household*

In the last 30 days, how much difficulty did you have in:

	None	Mild	Moderate	Severe	Extreme or cannot do
D5.1 Taking care of your household responsibilities?
D5.2 Doing most important household tasks well?
D5.3 Getting all of the household work done that you needed to do?
D5.4 Getting your household work done as quickly as needed?

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D5 - Raw Domain Score

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D5 - Average Domain Score

Life activities—School/Work*

If you work (paid, non-paid, self-employed) or go to school, complete questions D5.5–D5.8, below. Otherwise, skip to D6.1.
Because of your health condition, in the past 30 days, how much difficulty did you have in:

	None	Mild	Moderate	Severe	Extreme or cannot do
D5.5 Your day-to-day work/school?
D5.6 Doing your most important work/school tasks well?
D5.7 Getting all of the work done that you need to do?
D5.8 Getting your work done as quickly as needed?

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D5 - Raw Domain Score

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D5 - Average Domain Score

Participation in society*

In the past 30 days:

	None	Mild	Moderate	Severe	Extreme or cannot do
D6.1 How much of a problem did you have in joining in community activities (for example, festivities, religious, or other activities) in the same way as anyone else can?
D6.2 How much of a problem did you have because of barriers or hindrances around you?
D6.3 How much of a problem did you have living with dignity because of the attitudes and actions of others?
D6.4 How much time did you spend on your health condition or its consequences?
D6.5 How much have you been emotionally affected by your health condition?
D6.6 How much has your health been a drain on the financial resources of you or your family?
D6.7 How much of a problem did your family have because of your health problems?
D6.8 How much of a problem did you have in doing things by yourself for relaxation or pleasure?

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D6 - Raw Domain Score

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D6 - Average Domain Score

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Total - Raw Domain Score

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Total - Average Domain Score

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Summary

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