INNER-PEACE AND PHYSICAL HEALTH: PEACE OF MIND AND PHYSICAL HEALTH AMONG RHODE ISLAND OLDER ADULTS

The number of older adults increases globally year after year at an unprecedented rate, and so does their healthcare expenditure. This trend is similar in Rhode Island. The proportion of older adults relative to the general population is rising sharply in this smallest state in the US. The quality of later life and well-being of the older adults remains questionable for many, due to the increasing chronic disease burden associated with advanced age. The purpose of this research was to study the relationship between inner-peace and physical health, with the aim of developing a clearer picture to improve the health and well-being of older adults in the state of Rhode Island. Data were collected through the use of a self-report questionnaire method mailed to approximately 600 members of the Osher Lifelong Learning Institute at the University of Rhode Island in July, 2013. Two hundred and forty-five members participated by completing and return mailing the questionnaire. The findings overall confirm a small but significant correlation between inner-peace and physical health. This finding can contribute to a better understanding of the relationship between innerpeace and physical health of older adults.


Significance of the Problem
The health and well-being of older adults have been identified and recognized by the United Nations as one of the most pressing and universal social issues of our time (Antonucci, Okorodud & Akiyama, 2002). However, even after a decade there still exists a significant number of older adults who rank low, in both developing and developed countries, on the WHO-Five Well-being Scale, which includes items such as being happy and having lots of energy. The problems faced by today's older adults are not only their issues, but are also problems confronting our families, communities and countries (Antonucci et al., 2002). Therefore, if this situation remains unimproved, the poor health and well-being faced by current older adults may impact the health and well-being of our youths, adults and future generations of humankind.
Each individual seeks happiness and wishes to be happy, but happiness is highly inter-related with both physical and mental health (Abdel-Khalek, 2006). Mental health affects physical health (Holt & McClure, 2006), but the more the amount of inner violence, disharmony and negative emotions the lower our mental health scores.
Negative psychological states such as distress, depression, and anxiety have been found associated with higher risk of Type 2 diabetes, coronary heart disease, disability, and total mortality. Negative thoughts have been found to play a critical role in depression and psychological maladjustment (Wong, 2008). One's positive thoughts are found to be positively related to satisfaction with life and happiness (Ingram, Kendall, Siege, & Guarino, 1995). The richer we become in inner-peace, the healthier our mind becomes. This sense of wholeness and integration of mind and body, accompanied by a sense of inner harmony, is often reflected in the spiritual and wisdom traditions of both the East and West (Underwood & Teresi, 2002). The connection between health and emotions may be strong, particularly in the latter part of human life (Chida & Steptoe, 2008).

Problem Statement
As the number of older adults in the state of Rhode Island increases (US Bureau of the Census, 2010), there is greater concern and a higher need for a holistic approach to improve physical health and quality of aging. The unprecedented increase in the number of older people throughout this decade and the preceding decade is not because of major changes in our healthcare system or groundbreaking cure of diseases that occur during old age (Antonucci et al., 2002). Surprisingly, this increasing proportion of older adults is mostly attributed to the significant reduction in deadly childbirth and child mortality rates. The child mortality rate has been decreasing worldwide due to socioeconomic development and successful child survival interventions (Black, Cousens, Johnson, et al., 2010). Major infections and diseases that used to cause traditional childhood deaths are now either prevented or cured. However, improvement in child health is different from that of older adults.
International studies show that today, a high number of older adults still suffer from at least one chronic disease. In the US, the least physical active of any age group is older adults, who also generate the largest medical care expenditures (Nelson et al., 2007).
Although there is a growing awareness about integrated wholeness of a person, healthcare providers often assess the body, mind, and spirit as totally different entities and try to treat the disease instead of the patient (Garrett & Garrett, 1982). According to The World Health Organization, health is not merely the absence of disease or infirmity, but is a state of complete physical, mental and social well-being.
Dictionaries also specify both mental and physical dimensions when defining health (Ware Jr., 1987). An older person's life should not simply be a matter of survival, as there is much more to life and quality living (Clark, 1991). Multidisciplinary studies, supported by their findings, emphasize that aging cannot be reversed, but it can be enriched and enjoyed with good physical and mental health (Lee, Yoon, Lee, Yoon & Chang, 2012).
It is especially important to determine the relationship between inner-peace and physical health, because the complex health and well-being challenges that older adults faces today are also an urgent issue for the entire society. As every human being is a social animal, their aging takes place in families, communities, and countries rather than aging alone without impact on society. Therefore, there is a strong association between the health of older adults and the health of families and communities. Active social relations throughout one's life cycle, including old age, fulfill very important functions of emotional and instrumental support. After all, social isolation of individuals seems to be one of the main factors of risk in the psychological well-being and health of older adults (Portero & Oliva, 2007).
Over the years there have been many educational, medical, social, psychological, nursing, gerontology and other studies conducted on the Mind-Body-Spirit relationship (see Hungelmann, Kenkel-Rossi, Klassen & Stollenwerk, 1966, Miller, 1985, Targ & Levine, 2002. Based on these studies researchers have found a strong connection between the mind and body in general, and between one's affective state and physical health in particular. A positive state of mind has a strong impact on healthy people in terms of survival. For unhealthy individuals, a positive state of mind improves the patient's adaptation to physical illness and lowers mortality rates even in serious medical cases such as renal failure and HIV (Chida & Steptoe, 2008). On the other hand, people with negative mental thoughts can experience a negative effect on their health (Holt & McClure, 2006

Significance of this Study
Therefore, the purpose of this study is to examine the relationship between innerpeace and physical health of Rhode Island older adults. In this study, it was hypothesized that there is a significant correlation between inner-peace and physical health; and that inner-peace has a positive association with older adult's physical health. If these hypotheses are supported by this study, promoting inner-peace could potentially benefit the health and quality of life for an increasing number of older adults.

REVIEW OF LITERATURE
This study concerned the relationship between inner-peace and physical health among older adults. There are different ways of classifying older adults. However, this study employed a developmental perspective to the term "older adult" and defined the sample as individuals who are age 65 or older (Baltes & Smith, 2003). Although there is a number of studies on spirituality and physical health (Fry, 2000) and physical health and mental health (Phelan, Stradins & Morrison, 2001), there is still an important yet unabridged gap in studying the association between inner-peace and physical health in this fast-growing population of older adults.

Inner-Peace
Inner-Peace can be described in different ways based on individual understanding, but here it refers to a mental disposition free of negative thoughts and emotions with internal strength, stability, and peacefulness regardless of adverse external conditions (Lama, 2012). In earlier studies, researchers have found a strong impact of positive emotions and good mental attitudes -such as forgiveness, gratitude, optimism, faith, self-perception, and mindfulness -on different types and severity levels of health issues.
Researchers have shown an important connection between forgiveness and wellbeing. People who learn to forgive get significant inner relief as they reduce the amount of anger toward those whom they perceive as being unjust or even antagonistic to them (Huang & Enright, 2000). Thus, forgivers are emotionally far better and healthier than non-forgivers. In addition to its positive role on emotional health, forgiveness is also reported to have an effect on indicators of physical health such as blood pressure and hemodynamic responses (Waltman et al., 2009). People who score higher in forgiveness and self-efficacy are less likely to experience pain, suffering and disability. According to Carson et al. (2005), forgiveness is related to feeling less pain, specifically "patients scoring high on current forgiveness were much more likely to report lower overall scores on the affective pain and sensory pain scales" (p. 86).
Similarly, people with a sense of gratitude are found to experience fewer physical illness symptoms than those who do not practice gratitude (Emmons & McCullough, 2003). A sense of gratitude is also associated with higher experience of joy and happiness. After all, humans survive on the kindness of others, and we seek support from others whenever we face difficulties in life. We also receive health benefits throughout our life simply from human warmth and affection (Lama, 2012).
Optimism is also strongly related to positive health results, in the context of enormous health threats such as coronary heart disease, cancer and so on (Scheier & Carver, 1993). Recent studies, such as one on hip fracture recovery, show that positive expectations influence the physical healing and recovery of elderly patients (Levy, Slade & Kasl, 2002). Likewise, self-perception of aging has been found related to an older adult's health. Poor self-perception of aging has been documented to have a negative impact on subjective health in older adults (Moor, Zimprich, Schmitt, & Kliegel, 2006). On the other hand, older adults with more positive self-perception of aging were found to have better physical health and did not show a sharp decline in physical functioning over time, compared to those adults with negative self-perception of aging (Sargent-Cox, Anstey & Luszcz, 2012).
A study conducted recently with a large sample of nationally representative older adults in the US found a strong association between posttraumatic stress and individual health conditions. Those older adults with lifetime posttraumatic stress are found to have a high rate of negative health conditions and poorer physical functioning (Pietrzak, Goldstein, Southwick, & Grant, 2012). In another study, it was found that people with posttraumatic stress disorder spend more time in bed, because of disability days and illness, even when they are treated for diseases. These findings strongly suggest that older adults with posttraumatic stress disorder experience grave Faith in religion or spirituality is negatively associated with experiencing loneliness, depression, and anxiety, regardless of demographic variations in age, gender, and education (Kalkstein & Tower, 2009). An increasing number of researchers in mental health, gerontology and medicine agree on a positive relationship between faith and physical health (Wallis, 1996). Spiritual practice may also contribute to improving the quality of life by reducing adverse medical symptoms (Kass, Friedman, Leserman, Zuttermeister & Besnon, 1991). Mindfulness meditation, for instance, has been found to be effective in clinical use for medical patients to reduce their pain and pain-related behaviors (Kabat-Zinn, Lipworth & Burney, 1985).
All these positive emotions and mental attitudes are closely related to an individual's inner-peace. Hence, one's inner-peace may be able to bring positive health benefits, not only for oneself, but also for the family and community at large.

Physical Health
Physical health refers to a general state of physical well-being in which a person is physically fit to perform work and social or other regular daily activities without limitations or interference from pain. Physical health is most commonly measured according to limitations in personal performance or ability to perform mobility, selfcare activities such as dressing and eating, and more vigorous physical activities (Ware Jr., 1987).
Poor physical health has long been recognized to be one of the most important risk factors for depression in older adults, (Geerlings, Beekman, Deeg and Tilburg, 2000). According to Kannus, Sievänen, Palvanen, Järvinen, and Parkkari (2005), many people who are aged 65 or older suffer injuries resulting from falls. Therefore, falling is a major public-health concern representing one of the main causes of longstanding pain, disability, functional impairment, and death in older adults.
However, regular physical activities could help reduce the risks of fall, anxiety, depression and diseases such as cardiovascular, thromboembolic stroke, type 2 diabetes, osteoporosis, obesity, breast cancer and hypertension (Haskell et. al. 2007).
One's physical health status may also be negatively influenced by personal involvement, experience or exposure to violent activities in life. The World Health Assembly declared violence as a major public health issue in the year 1996 (Krug, Mercy, Dahlberg, and Zwi, 2002). Among different types of violence, battering is a significant direct and indirect risk factor for various physical health problems often seen in health-care settings (Campbell, 2002). War is another significant factor that leaves serious adverse effects on health and well-being. A study conducted on 921 male military veterans who were of age 65 at the time of study showed that both combat exposure and posttraumatic stress disorder (PTSD) were correlated with their poorer health (Schnurr and Spiro III, 1999).
The 2002 World Health Organization report on violence and health stated that about 4400 people die every single day because of deliberate acts of collective, interpersonal or self-directed violence. Thousands more including older adults are injured or suffer from non-fatal health impacts as a result of being the victim or witness to violent acts that also devastate families and lead to huge costs in medical treatment (Krug, Mercy, Dahlberg, and Zwi, 2002). In general both physical and mental exercise can create a positive impact on physical health of older adults. Physical exercises and activities have positive and beneficial effects on some mental and physical health outcomes (Penedo, Frank, Dahn, and Jason, 2005). For example, researchers found that Tai Chi, a slow meditative physical exercise, if practiced three times a week for six months, is effective in decreasing the number of falls, fear of falling and risk for falling. Such programs help to improve physical performance and functional balance in physically inactive people aged 70 years or older (Li et. al., 2005). In addition, yoga was found to have positive results on its practitioners for both diseased and healthy populations. Yoga appears to be helpful in relieving several symptoms associated with kidney disease, diabetes, menopause and schizophrenia. (Ross and Thomas, 2010).
Mental exercise, such as meditation practices and maintaining positive emotions, might have powerful impacts on human physiology and physical health. A study on the alterations in brain and immune function produced by mindfulness meditation shows that a short mindfulness meditation program could produce noticeable positive impacts on the brain and functions of our immune system (Davidson et al. 2003).
Development of such positive emotions as love, forgiveness, contentment and hope might benefit the individual health through their effect on neural pathways that are attached to our immune systems and endocrine (Seybold and Hill, 2001).

Purpose of Study
The purpose of this study is to examine whether there is a correlation between inner-peace and physical health exist in Rhode Island older adults. The aim of this project is to identify a relationship that might assist older adults in improving their health and quality of life through inner-peace. The research questions that guided this study were (1) whether the inner-peace and physical health of older adults are correlated, and (2) whether there are demographic differences in the inner-peace and physical health of older adults.
The ultimate goal of this study is to contribute to efforts in creating a healthier and more peaceful world where all people, especially the growing number of older adults, can enjoy a meaningful quality of life in a beloved community.

Research Hypothesis
The primary hypothesis of this study was that there is a positive correlation between inner-peace and physical health in Rhode Island's older adults.

Instrumentation
Two primary scales were utilized in this study: (  (Saxena, 2006). The WHOQOL measurement system is suitable for evaluating the quality of life of adults in the US (Bonomi, Patrick, Bushnell and Martin, 2000). Although the strongest correlations were found with psychological and social domains and overall QoL, the SRPB facets that address issues such as inner peace, faith, hope, optimism, and spiritual connection were highly correlated with all of the WHOQOL domains (p < . 0 1 ) (Saxena, 2006). According to Skevington, Gunson and O'Connell (2012), the total score could range from a low of five to a high of 20. The WHOQOL-SRPB was found to have good internal consistency with overall reliability rate (α = 0.85). Inter-item correlation among these four items ranges from 0.65 to 0.76. In this study on Rhode Island older adults, the reliability among these four items was α = .91, with inter-item correlations that range from 0.62 to 0.73.
( population. Hence, a score of below 50 indicates health status that is below the average relative to the general U.S. population. The measure generally ranges from 20-70. At the lowest, the score indicates substantial limitations in self-care, physical, social and role activities, severe bodily pain, frequent tiredness, health rated as poor.
At the highest, the score indicates no physical limitations, disabilities or decrements in well-being, high energy level, and health rated as excellent. For the full WHOQOL-SRPB and SF12 survey, please refer to Appendix A.
Participants were asked to respond to the seven items listed above, and items were rated using a Likert ordinal scale. Only question number two is rated on 3-point Likert scale, while the remaining six questions are rated on a 5-point Likert scale. For example, in question one every participant was asked, "In general, would you say your health is:" and the available responses were 1 (Excellent), 2 (Very Good), 3 (Good), 4 (Fair), and 5 (Poor). For each totally completed instrument, the minimum score possible was seven (7) and the maximum score could be thirty-three (33 Additionally, analysis of variance (ANOVA) was explored to determine any differences that might have been attributed to gender, age and marital status.
Appropriate correlations and tests of group differences were employed.

RESULTS
In this section, a description of the sample is first discussed, followed by the correlational relationship between the two dependent measures, and demographic differences.

Sample Descriptive
Sample: Approximately 600 members of URI OLLI were mailed a self-report questionnaire for their voluntary participation in this study. There were 245 OLLI members, ranging from age 52 to 91, who completed and returned their survey forms.
Although the research was intended to focus on individuals 65 years and older, there were 32 participants (13.1%) of the total sample who were under the age of 65 (between age 52 and 64). This group of participants was included in analyses that examined correlational associations in the overall sample. The exact age of 68 participants (27.8% of total sample) could not be determined because they did not report their age. Given the characteristics and sample size of this group, these participants were included in the overall sample correlational and gender analysis to check for significant differences. Inner-Peace and Physical Health: Of the sample that was 65 and over (n=145), the mean of the WHOQOL-SRPB inner peace score was slightly higher at 3.79 (sd: 0.64). As for the Physical Core Summary of the SF12v2 measure, a score of 50 is the norm and 10 the standard deviation of the general U.S population. For our total sample, the mean PCS score was 50.75, which is slightly higher than the general U.S population. For our female participants, the mean PCS score was 50.99, slightly higher than the U.S. female sample (norm=49.19). For our male sample, the mean PCS score is 49.6, lower than the US male norm (norm=50.87). The QualityMetric software does not generate the standard deviation of the PCS score. Please refer to Table 3 for the inner-peace and physical core summary scores of participants.

Correlation between Physical Health and Inner-Peace
The first research question asked if there was an association between the innerpeace and physical health of older adults in Rhode Island.
It was found that at age 65 and over (n=145), the correlation between Inner-Peace and Physical Health was significant at r=0.185 (p<0.05). For the total sample (n=245, including participants who are below 65 years old), the correlation between Inner-Peace and Physical Health (r=0.173) was also significant at (p=0.007). Upon closer examination, it was found that the correlation between Inner-Peace and Physical Health differed by age. For the age groups below 80-91, the correlations were not significant. However, for the age group 80-91, the correlation (r=0.68) was significant at, p=0.000.
In addition, the correlation between Inner-Peace and Physical Health (r=0.18) was significant by gender for the total sample. For females (n=209), the correlation was (p=0.009). The correlation between Inner-Peace and Physical Health was not statistically significant when compared with marital status. Please refer to Table 4 for the correlations by demographic characteristics.

Demographic Differences
To answer the secondary research questions this study explored whether or not there were differences by the demographic variables of age, gender and marital status on Inner-Peace and Physical Health.
Inner Peace: For the total sample (n=245), females reported higher inner peace than males (mean difference =0.26, p=0.047). There were no statistically significant differences in inner peace scores by age, mean differences ranged from 0.01 to 0.25 (F=1.0, p=0.40) nor by marital status, mean differences ranged from 0.12 to 0.23 (F=1.81, p=0.145).
Physical Health: There were no significant differences in physical health by gender, mean difference was 0.97 (t=0.57, p= 0.56) and marital status, mean differences ranged from 1.37 to 3.13 (F=1.99, p=0.116). By age group, there were significant differences by age groups F=0.4191, p=0.003. The score of the oldest age group (80-91) was significantly lower than that of the 70-74 age group (Bronferroni post hoc mean difference =-6.5, p<0.05) and that of the 52-64 age group (Bronferroni post hoc mean difference =-8.8, p<0.01). Please see Table 5 for a summary of the Inner-Peace and Physical Health scores and their differences by demographic characteristics.

DISCUSSION
The research questions in this study explored whether (1) there is a correlation between Inner-Peace and Physical Health among Rhode Island older adults; (2) whether there is correlation between Inner-Peace and Physical Health and gender; (3) whether there is correlation between Inner-Peace and Physical Health and age; and (4) whether is a correlation between Inner-Peace and Physical Health and marital status?
Examining the data collected from 145 individuals of age 65 or above at the time of this survey from the Osher Lifelong Learning Institute at the University of Rhode Island, a small but statistically significant correlation was observed between Inner-Peace and Physical Health among older adults. In our study, the correlation between inner-peace and physical health is actually the strongest and most significant for the oldest group of adults (age 80-91).
According to Jung, the ego moves from extraversion to introversion as people get older. They shift their focus from the external world to the inner world, finding meaning in inner exploration in old age. This theory might explain why the group of oldest people in this study reported significantly higher scores in inner-peace than the younger group of people.
Similarly, Tornstam's Gerotrancendence theory suggests that older adults shift their perspective from a materialistic to a more cosmic and transcendent one, exploring spirituality and their inner selves. They become more selective in their meaningful relationships and less interested in material goods. According to Tornstam, gerotrancendent people move towards maturation and wisdom, redefining space, time, life, death and self. This entails a shift away from materialism, activity, superficial social contacts, rationality and preoccupation with the physical body. This might explain why older adults reported significantly higher inner-peace scores, despite their significantly lower physical health scores. This finding is also consistent with Erikson's ego integrity theory (Erikson, Erikson and Kivnick, 1986), in which an older adult is challenged to reach a fundamental acceptance of her or his personal life, regardless of how bad or good it has been, and be satisfied with the past.
No previous literature was found on correlation between inner-peace and physical health among older adults, but the finding from this study is consistent with previous research finding on correlation between health and emotions. Chida & Steptoe (2008) wrote that the connection between health and emotions may be strong, particularly in the latter part of human life. Based on their findings, the researchers suggested that positive psychological well-being has a positive effect on survival in both diseased and healthy populations.
In this study, females reported significantly higher scores in Inner Peace than the males. In addition, the correlation between Inner-Peace and Physical Health was significant for females. Inner harmony was reflected by the subjects' strong sense of satisfaction with self and life. In spite of limitations, failures, and ill health, self-esteem remained high, and they accepted themselves and their life situations with equanimity. The importance of positive attitude and self-determination was cited as important to maintaining inner peace. Subjects were observed to make their own decisions and to have a positive attitude even when terminally ill (Hungelmann, Kenkel-rossi, Klassen, and Stollenwerk, 1985). This result is consistent with an emerging notion that women are somehow naturally more peaceful, although they are equally capable of committing violence. The belief that women are more peaceful by nature is longstanding (Charlesworth, 2008).
There were no correlations found between Inner-Peace and Physical Health and marital status. As His Holiness, the 14 th Dalai Lama advised, Inner peace is the key.
"If you have inner peace, the external problems do not affect your deep sense of peace and tranquility. Without this inner peace, no matter how comfortable your life is materially, you may still be worried, disturbed or unhappy because of circumstances" (Lama, D., 1989). The findings from this study concur with this proposition that inner peace and physical health could be independent of one's circumstances such as marital status.

Limitations
This study addressed a research gap in the correlation between Inner-Peace and Physical Health, through the responses of a sample of Rhode Island older adults from diverse backgrounds. However, the findings from this study would not be able to clarify or help us determine if these two factors have a causal effect on the other.
There is also a potential bias in the sample collection, as all the participants are affiliated with Osher Lifelong Learning Institute at URI. This affiliation with a higher education institution may not be representative of the older adult population in Rhode Island, since people who were uninterested in lifelong learning are less likely to join OLLI. In addition, there were 68 participants who did not disclose their age on the survey due to an unwillingness or discomfort in doing so. As the SF12v2 form requires this information, this limitation perhaps could have been mitigated by placing the question at the end of the survey rather than at the beginning. The study would also have benefited from having more male participants.

Implications of Findings
The findings from this research provide implications for future research. This study showed that there is a small, but significant, correlation between Inner-Peace and Physical Health within this sample of Rhode Island older adults who belonged to the Osher Lifelong Learning Institute at URI. This finding leads to possible future research questions such as whether or not there is a cause and effect relationship between Inner-Peace and Physical Health. If so, which one of them serves as the cause and which one of them occurs as the result?
Another finding from this study is that older adults seemed to be able to maintain a high level of Inner-Peace even when their Physical Health score is low. This indicates that Inner-Peace is not necessarily dependent on good Physical Health.
Therefore, future studies may need to be carried out to investigate what makes it possible to maintain strong Inner-Peace despite one's increasing age. Yet, another question to research is why do females score significantly higher in Inner-Peace than males, although there is no significant difference in Physical Health score. Does gender plays a role in generating Inner-Peace?

Conclusion
A recent report on stress and health stated that stress is endemic in our culture, so too is heart disease. Over twelve million people in the United States have coronary heart disease, and 335,000 people a year die suddenly of coronary artery disease. An INTERHEART study has found that psychological stress is responsible for almost 40 percent of myocardial infarction (Sheps, 2011 I am studying the relationship between Inner-Peace and Physical Health among older adults (Age 65 or older) in the state of Rhode Island. If you decide to participate, you will be asked to complete surveys using the World Health Organization's Quality of Life Measure-Spiritual, Religious, and Personal Beliefs (WHOQOL-SRPB), and the Short Form 12 Health Survey (SF-12v2) questionnaires.
In particular, you will be asked questions about inner-peace and physical health. The study will take place during the Spring 2013 semester at OLLI, URI or we can also mail it to your given address if you choose. The questionnaires should only last about ten minutes. Although you probably won't benefit directly from participating in this study, we hope that others in the community in general and the field of education and gerontology will benefit from the outcomes of this study.
Participation is anonymous, which means that no one (not even the researchers) will know your answers. So, please do not write your name or other identifying information on any of the study materials. Taking part in the study is your decision. You do not have to be in this study if you do not want to. You may also quit being in the study at any time or decide not to answer any question you are not comfortable answering.

ABOUT YOU
Before you begin we would like to ask you to answer a few general questions about yourself by checking the correct answer or by filling in the space provided.
What is your gender? Female Male Age: ____ What is your marital status? Single Married Divorced Widowed The following questions ask how your Inner-Peace has affected different aspects of your quality of life in the past two weeks. For example, one question asks "How much are you able to feel peaceful when you need to?" If you were able to experience this completely, circle the number below "completely". If you were not able to experience this at all, circle the number below "Not at all". You should circle one of the numbers in between if you wish to indicate your answer lies somewhere between "Not at all" and "completely". Questions refer to the last two weeks.

SF-12v2™ Health Survey
This survey asks for your views about your health during the last 4 weeks. This information will help keep track of how you feel and how well you are able to do your usual activities. Please check off your chosen response with a pen or pencil.