FORM A: FOR SELF-ADMINISTRATION BY THE RESPONDENT (revised 4-2000)

DUKE HEALTH PROFILE (The DUKE)

Copyright © 1989-2012 by the Department of Community and Family Medicine,
Duke University Medical Center, Durham, N.C., U.S.A.

Date Today: Name: ID Number:_________

Date of Birth: Female Male____

INSTRUCTIONS: Here are some questions about your health and feelings. Please read each
question carefully and check () your best answer. You should answer the questions in your
own way. There are no right or wrong answers. (Please ignore the small scoring numbers next
to each blank.)
No, doesn't
Yes, describes Somewhat describe me
me exactly describes me at all
1. I like who I am . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ________ 12 ________11 ________10
2. I am not an easy person to get along with . . . . . . . ________20 ________21 ________22
3. I am basically a healthy person . . . . . . . . . . . . . . . . ________ 32 ________31 ________30
4. I give up too easily . . . . . . . . . . . . . . . . . . . . . . . . . . ________40 ________41 ________42
5. I have difficulty concentrating . . . . . . . . . . . . . . . . . ________ 50 ________51 ________52
6. I am happy with my family relationships . . . . . . . . . ________62 ________61 ________60
7. I am comfortable being around people . . . . . . . . . . ________72 ________71 ________70

TODAY would you have any physical trouble or difficulty:

None Some A Lot
82 81
8. Walking up a flight of stairs . . . . . . . . . . . . . . . . . . ________ ________ ________80
9. Running the length of a football field . . . . . . . . . . ________92 ________91 ________90

DURING THE PAST WEEK: How much trouble have

you had with: None Some A Lot
________ 102 ________ ________100
101
10. Sleeping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Hurting or aching in any part of your body. . . . . . . ________112 ________111 ________110
12. Getting tired easily . . . . . . . . . . . . . . . . . . . . . . . . . . ________ 122 ________121 ________120
13. Feeling depressed or sad . . . . . . . . . . . . . . . . . . . . ________ 132 ________131 ________130
14. Nervousness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ________142 ________141 ________140

DURING THE PAST WEEK: How often did you:

None Some A Lot
15. Socialize with other people (talk or visit
with friends or relatives). . . . . . . . . . . . . . . . . . . . . . ________ 150 ________151 ________152

16. Take part in social, religious, or recreation

activities (meetings, church, movies,
sports, parties). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ________ 160 ________161 ________162

DURING THE PAST WEEK: How often did you:

None 1-4 Days 5-7 Days
17. Stay in your home, a nursing home, or hospital
because of sickness, injury, or other health problem. ________172 ________171 ________170
 MANUAL SCORING FOR THE DUKE HEALTH PROFILE
Copyright 1994-2012 by the Department of Community and Family Medicine
Duke University Medical Center, Durham, N.C., U.S.A.

Item Raw Score* To calculate the scores in this column the raw scores
8 = ______ PHYSICAL HEALTH SCORE must be revised as follows:
9 = ______ If 0, change to 2; if 2, change to 0; if 1, no change.
10 = ______
11 = ______ Item Raw Score* Revised
12 = ______ 2 = ______ ______ ANXIETY SCORE
Sum = x 10 = 5 = ______ ______
7 = ______ ______
Item Raw Score* 10 = ______ ______
1 = ______ MENTAL HEALTH SCORE 12 = ______ ______
4 = ______ 14 = ______ ______
5 = ______ Sum = x 8.333 =
13 = ______
14 = ______ Item Raw Score* Revised
Sum = x 10 = 4 = ______ ______ DEPRESSION SCORE
5 = ______ ______
Item Raw Score* 10 = ______ ______
2 = ______ SOCIAL HEALTH SCORE 12 = ______ ______
6 = ______ 13 = ______ ______
7 = ______ Sum = x 10 =
15 = ______
16 = ______ Item Raw Score* Revised
Sum = x 10 = 4 = ______ ______ ANXIETY-DEPRESSION
5 = ______ ______ (DUKE-AD) SCORE
GENERAL HEALTH SCORE 7 = ______ ______
10 = ______ ______
Physical Health score = ______ 12 = ______ ______
Mental Health score = ______ 13 = ______ ______
Social Health score = ______ 14 = ______ ______
Sum = ÷ 3= Sum = x 7.143 =

PERCEIVED HEALTH SCORE PAIN SCORE

Item Raw Score* Item Raw Score* Revised

3 = x 50 = 11 = ______ x 50 =

Item Raw Score* SELF-ESTEEM SCORE DISABILITY SCORE

1 = ______
2 = ______ Item Raw Score* Revised
4 = ______ 17 = x 50 =
6 = ______
7 = ______
Sum = x 10 =

* Raw Score = last digit of the numeral adjacent to the blank checked by the respondent for each item. For example, if the second
blank is checked for item 10 (blank numeral = 101), then the raw score is "1", because 1 is the last digit of 101.

Final Score is calculated from the raw scores as shown and entered into the box for each scale. For physical health, mental health,
social health, general health, self-esteem, and perceived health, 100 indicates the best health status, and 0 indicates the
worst health status. For anxiety, depression, anxiety-depression, pain, and disability, 100 indicates the worst health status
and 0 indicates the best health status.

Missing Values: If one or more responses is missing within one of the eleven scales, a score cannot be calculated for that
particular scale.