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Scoring and Next Steps

This questionnaire is meant to serve as a guide only, to assist physicians to help family members providing ongoing care to the chronically ill and disabled. To start, download and print a version of the questionnaire below and give it to your patient/caregiver to fill out.

Determining the score

  • Reverse score questions 5 and 15. (For example, a "No" response should be counted as "Yes" and a "Yes" response should be counted as "No".)
  • Total the number of "yes" responses.

Interpreting the score

A high degree of distress is likely:

  • If the total "Yes" score = 10 or more.
  • If the score on Question 17 (perceived stress) is 6 or higher.
  • If the score on Question 18 (perceived health) is 6 or higher.
  • If the answers are "Yes" to any of the following: Q1 (distractibility), Q4 (overwhelmed), Q9 (irritability), Q10 (sleeplessness), Q11 (crying spells), Q13 (back pain), Q14 (illness).

Next steps

Any "Yes" responses to the questions on the Caregiver Self-assessment Questionnaire suggest that:

  • The caregiver needs further assessment to determine the need for counseling/intervention.
  • The caregiver might benefit from a medical check-up or referral to their personal physician (suggest they take the questionnaire to show).
  • The caregiver might benefit from joining a support group.
  • The caregiver be encouraged to arrange some relief from caregiving.
  • The physician discuss available community resources and refer as appropriate.
  • The physician consider a referral to social services.