EVESLE | ISI, WHO-5 & PSS Participant ID(Required)Your participant ID is your initials followed by the first 4 numbers of your birth-date. For example, John Smith was born January 23rd. His ID would be "JS2301" What timepoint are you completing this questionnaire?(Required) Screening (Pre enrolment) Baseline - Day 1 (in-clinic) Day 28 (at home) Final - Day 57 (In- clinic) Screening Number(Required)Please check your email to find the screening number or check with you trial coordinator. Product Number(Required)ISIInsomnia Severity IndexInsomnia Problem(Required)For each question, Please Select the number that best describes your answer. please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem.None (0)Mild (1)Moderate (2)Severe (3)Very severe (4)1. Difficulty falling asleep2. Difficulty staying awake3. Problems waking up too early4. How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern?(Required)Very Satisfied (0)Satisfied (1)Moderately Satisfied (2)Dissatisfied (3)Very Dissatisfied (4)5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?(Required)Not at all Noticeable (0)A Little (1)Somewhat (2)Much (3)Very Much Noticeable (4)6. How WORRIED/DISTRESSED are you about your current sleep problem?(Required)Not at all Worried (0)A Little (1)Somewhat 2)Much (3)Very Much Worried (4)7. To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY?(Required)Not at all Interfering (0)A Little (1)Somewhat (2)Much (3)Very Much Interfering (4)WHO-5Well-being IndexPlease indicate for each of the five statements which is closest to how you have been feeling over the last two weeks.Notice that higher numbers mean better well-being. Example. If you have felt cheerful and in good spirits more than half of the time during the last two weeks, select number three. All of the time (5)Most of the time (4)More than half of the time (3)Less than half of the time (2)Some of the time (1)At no time (0)1. I have felt cheerful and in good spirits2. I have felt calm and relaxed3. I have felt active and vigorous4. I woke up feeling fresh and rested5. My daily life has been filled with things that interest mePSSPerceived Stress Scale1. In the last month, how often have you been upset because of something that happened unexpectedly?(Required)Never (0)Almost Never (1)Sometimes (2)Fairly Often (3)Very Often (4)2. In the last month, how often have you felt that you were unable to control the important things in your life?(Required)Never (0)Almost Never (1)Sometimes (2)Fairly Often (3)Very Often (4)3. In the last month, how often have you felt nervous and stressed?(Required)Never (0)Almost Never (1)Sometimes (2)Fairly Often (3)Very Often (4)4. In the last month, how often have you felt confident about your ability to handle your personal problems?(Required)Never (4)Almost Never (3)Sometimes (2)Fairly Often (1)Very Often (0)5. In the last month, how often have you felt that things were going your way?(Required)Never (4)Almost Never (3)Sometimes (2)Fairly Often (1)Very Often (0)6. In the last month, how often have you found that you could not cope with all the things that you had to do?(Required)Never (0)Almost Never (1)Sometimes (2)Fairly Often (3)Very Often (4)7. In the last month, how often have you been able to control irritations in your life?(Required)Never (4)Almost Never (3)Sometimes (2)Fairly Often (1)Very Often (0)8. In the last month, how often have you felt that you were on top of things?(Required)Never (4)Almost Never (3)Sometimes (2)Fairly Often (1)Very Often (0)9. In the last month, how often have you been angered because of things that happened that were outside of your control?(Required)Never (0)Almost Never (1)Sometimes (2)Fairly Often (3)Very Often (4)10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?(Required)Never (0)Almost Never (1)Sometimes (2)Fairly Often (3)Very Often (4)
