1. What is your gender?

2. What is your age?

3. In which region are you living now?

4. What is the highest level of education you have completed?

5. What is your dietary pattern?

6. On an average week, how many times do you exercise at least 20 minutes?

7. In the past 7 days, how many times did you eat breakfast?

8. On an average week, how many times a day do you eat whole grain products?

9. On an average week, how many times a day do you consume dairy products?

10. On an average week, how many times a day do you consume coffee or other sources of caffeine?

11. On an average week, how many times a day do you consume fruits?

12. On an average week, how many times a day do you consume flaxseed, and or nuts?

13. On an average week, how many times do you eat rice, and or pasta?

14. On an average week, how times do you eat meat, chicken, or turkey?

15. On an average week, how many times do you eat dark green leafy vegetables?

16. On an average week, how many times do you eat beans?

17. On an average week, how many times do you eat fish and shellfish (including sardines and tuna)?

18. On an average week, how many times do you eat fast foods or pre-made food?

19. On an average week, how many times do you take multivitamin supplements?

20. On an average week, how many times do you take fish oil supplements?

21. How often do you consume yogurt, fat free and regular (1 cup)

22. How often do you consume milk, whole and skim (1 cup)

23. How often do you consume the following types of cheese: parmesan, swiss, gruyere, reduced fat mozzarella, blue cheese, cottage cheese (1/2 cup)

24. How often do you consume lean beef or lamb (4-6 oz)

25. How often do you consume the following fish: salmon, tuna, shrimp, cod (4-6 oz)

26. How often do you consume roasted chicken or turkey (4-6 oz)

27. How often do you consume eggs (1)

28. How often do you consume raw oats (1 cup)

29. During the past month, about how often did you feel hopeless?

30. During the past month, about how often did you feel nervous?

31. During the past month, about how often did you feel restless or fidgety?

32. During the past month, about how often did you feel so depressed that nothing could cheer you up?

33. During the past month, about how often did you feel that everything was an effort?

34. During the past month, about how often did you feel worthless?

35. In the last month, how many times have you been upset because of something that happened unexpectedly? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

36. In the last month, how often have you felt that you were unable to control the important things in your life? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

37. In the last month, how often have you felt nervous and “stressed”? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

38. In the last month, how often have you felt confident about your ability to handle your personal problems? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

39. In the last month, how often have you felt that things were going your way? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

40. In the last month, how often have you been able to control irritations in your life? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

41. In the last month, how often have you been angered by things outside of your control? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

42. In the last month, how often have you found that you could not cope with all the things that you had to do? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

43. In the last month, how often have you felt that you were on top of things? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

44. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? 0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

MENTAL DISTRESS TOTAL