1. As a caregiver, do you ever wake up in the morning & wish you had not?                  _____

2. Are you afraid to admit you are beginning to dislike the person you care for?            _____

3. Sometimes do you get the urge to run away & never come back?                                 _____

4. Do you think about getting sick (injured) so you would be hospitalized for rest?      _____

5. Do you often have trouble going to sleep at night?                                                         _____

6. Do you sometimes drink too much alcohol  out of sheer frustration?                            _____

8. Do you think the person you care for may be taking advantage of you?                      _____

9. Do you think the person you care for has become indifferent to  your comfort?         _____

10. Have your friends disappeared since you have become a caregiver?                          _____

11. Is the care recipient occassionally jealous when you do something recreational?     _____

12. Have you realized you no longer have much to talk about with the your charge?     _____

13. Have your children &/or other relatives stopped visiting your home?                        _____

14. Are you eating too much, or too little?                                                                              _____

16.  Do you have fantasies about finding someone else to spend time with?                   _____

17.  Do you find yourself depressed or in a bad mood these days?                                   _____

19.  Do you find yourself driving more carelessly than before you

       became a full-time caregiver?                                                                                             _____

20.  Has caregiving diminsihed your sexual realtionship?                                                   _____

21.  Do you feel stuck because of a promise or wedding vow?                                          _____