NSA: PANAS-SF & BSI-18

NSA: PANAS-SF & BSI-18

Time to complete: Approx. 3 minutes
Name

First NameLast Name
General Positive Emotion (31±7)
General Negative Emotion (16±6)
Global Severity Score (Less than 6/72)
BSI Somatization Score (Less than 2/24)
BSI Depression Score (Less than 2/24)
BSI Anxiety Score (Less than 2/24)
Date of Birth

MonthDayYear
Date
Last 4 digits of Social Security Number
This scale consists of a number of words and phrases that describe different feelings and emotions. Read each item and then mark the appropriate answer in the space next to that word.

Indicate the extent that you have felt this way over the past week.*

	Not At All	A Little Bit	Moderately	Quite a Bit	Extremely
Faintness or Dizziness
Pains in Heart or Chest
Nausea or Upset Stomach
Trouble Getting Your Breath
Numbness or Tingling in Parts of Your Body
Feeling Weak in Parts of Your Body
Feeling No Interest in Things
Feeling Lonely
Feeling Blue
Feelings of Worthlessness
Feeling Hopeless About the Future
Thoughts of Ending Your Life
Nervousness or Shakiness
Feeling Tense or Keyed Up
Suddenly Scared for No Reason
Spells of Terror or Panic
Feeling So Restless You Couldn't Sit Still
Feeling Fearful