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Mental Health Screening_English

Hi there!
 
We are glad you are here.
 
Below you will find some questions that measure our everyday behaviour and thoughts in different situations. Read the questions carefully and choose what is most appropriate for you from the options given. Do not think too much for any question and answer on the basis of what comes to your mind first.
 
Remember there are no right or wrong answers.
 
 
Please answer the personal details questions also. This information will be used for analysis and for:
i. Analysing your current needs to help you feel better and perform well.

ii. Supporting you in the best way possible with the right tools and techniques customized to your situation.
 
 
Hi there!
 
We are glad you are here.
 
Below you will find some questions that measure our everyday behaviour and thoughts in different situations. Read the questions carefully and choose what is most appropriate for you from the options given. Do not think too much for any question and answer on the basis of what comes to your mind first.
 
Remember there are no right or wrong answers.
 
 
Please answer the personal details questions also. This information will be used for analysis and for:
i. Analysing your current needs to help you feel better and perform well.

ii. Supporting you in the best way possible with the right tools and techniques customized to your situation.
 
 
Name:
Age
Gender
Sexual Orientation
Phone:
Grade (Class)
8
9
10
11
12
12+ (repeater)
School Board Medium
English
Hindi
Regional
Competitive Exam you are appearing for
Living Space
Staying arrangement
Socio-economic status
Do you have any physical ailments past or present.
Yes
No
If yes, please specify ( asthma, back pain, chronic stomach issues etc )
Do you have any mental health or psychiatric issues in past or at present?
Yes
No
If yes, please specify ( Depression, anxiety, Bipolar, OCD etc)
Do you have past or current family history of mental illnesses?
Yes
No
If yes, please specify?
Do you have a family history of suicide?
Yes
No
Yes
No
Have you been feeling sad and low most of the times?
Do you typically tend to rush into doing things without much thought?
Do you use alcohol or other substances frequently?
Have you had an experience where you heard, saw or felt things, that other people could not?
Do you feel like the things that used to bring you joy no longer make you happy?
Have you been feeling hopeless? (i.e., giving up, no reason to live)
Have you been feeling anxious or agitated?
Do you feel like you are trapped? (i.e., "this situation cannot be improved" or "this probelm cannot be resolved"
Do you feel like you are experiencing unbearable pain?
Have you been experiencing extreme mood swings?
Do you wish you were not alive?
Yes
No
Have you been thinking about taking your own life?
Yes
No
When did you last think about taking your life?
In the last 48 hours
This week
This month
This year
When you think about taking your own life, do you think it is something you might actually do?
Yes
No
How often do you think of taking your life?
Only one time
A few times
A lot
Have you thought about how you would take your own life?
Yes
No
Have you planned out the details of how you would take your own life? If yes, Please select all that apply
Giving things away
Writing a suicide note
Acquiring things (e.g. buying pills, poison or sharp objects, getting a saree or a long piece of cloth)
Others
If others please specify
Have you talked about dying or taking your own life with someone?
Yes
No
Do you believe you have enough reasons to live?
Yes
No
Have you tried to take your own life before?
Yes
No
If yes, please answer the following questions. When was the last time you tried to take your life (see options below)
Today
Yesterday
This week
This month
This year
Don't remember/ earlier than a year
If yes, has there been a time where you have tried to take your life, but something stopped you before you could do anything?
Yes
No
Also, has there been a time where you tried to take your own life but you changed your mind before you actually did anything?
Yes
No
Have you hurt yourself physically intentionally before?
Yes
No
If yes, please answer the following questions. When was the last time you intentionally hurt yourself (see options below)
Today
Yesterday
This week
This month
This year
Don't remember/ earlier than a year
At what age did you first intentionally harm yourself?
Do you intentionally hurt yourself in-
Private
In presence of others
Did something happen recently that was particularly stressful or upsetting for you? If yes, select all that apply:
Death of a close family member or friend
Relationship break up
Conflict with parents
Conflict with friends
Conflict with teachers
Parents’ separation or divorce
Personal injury or illness
Change in health of a close family member
Financial difficulties
Change in living conditions
Change of place
Change in eating habits
Change in sleeping habits
Failure in a recent/important test
Pressure from parents (or) teachers
Pressure to compete (or) perform well in academics
Others
How did these events make you feel?
Sad
Angry
Ashamed
Guilty
Embarrased
Disappointed
Helpless
Hopeless
Dejected
Yes
No
Have you been feeling isolated or intentionally withdrew yourself from other people?
Have you been feeling extremely overwhelmed? (i.e., like you can't take this anymore or deal with anything anymore)
Do you feel like you are a burden to your friends and family?
Do you find it pressurizing to manage expectations from parents, teachers or others?
Have you been eating too little or too much?
Have you been sleeping too little or too much?
Have your academic grades/marks been declining?
Have you not been attending classes regularly?
Do you believe that you can cope with the stresses of life?
Yes
No
Do you believe in God (or) Higher Power that gives you strength to carry on?
Yes
No
Can you tolerate being distressed or upset as well as most people?
Yes
No
Are there values that you believe are close and important to you? (e.g., love, honesty, loyalty etc)
Yes
No
Do you believe that your life has meaning (or) purpose?
Yes
No
Do you find the work (or) study you do joyful, interesting and valuable?
Yes
No
Who all do you share close relationships with (please share all that apply)
Parents
Friends
Teachers
Wardens
Family members
Pets
Others (Specify)
None
Specify others
Do you know/have access to help or resources in case of emergency? (e.g., 24x7 helplines etc)
Yes
No
Are you currently in touch with any mental health practitioner?
Yes
No
Are you currently preparing for competitive exams? (e.g., NEET, JEE etc) If yes, are you in this competitive journey for?
Self ambition
Other reasons
If other reasons, What are the reasons behind your choice of competitive exam? Please select all that apply
For my parents
For my family members
For my friends
For my teachers
Others
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