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Mental Health Self-Assessment

This document appears to be a symptom questionnaire for assessing mental health. It contains 30 questions regarding common symptoms of depression, anxiety, stress, and potential psychosis. Respondents are asked to indicate whether they have experienced each symptom with a yes or no answer. The questions cover areas like mood, sleep, appetite, decision making ability, and experiences of hallucinations or delusions. The questionnaire will be scored to assess the severity and prevalence of symptoms reported.

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Jenny Alvarez
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97 views1 page

Mental Health Self-Assessment

This document appears to be a symptom questionnaire for assessing mental health. It contains 30 questions regarding common symptoms of depression, anxiety, stress, and potential psychosis. Respondents are asked to indicate whether they have experienced each symptom with a yes or no answer. The questions cover areas like mood, sleep, appetite, decision making ability, and experiences of hallucinations or delusions. The questionnaire will be scored to assess the severity and prevalence of symptoms reported.

Uploaded by

Jenny Alvarez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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SQR Symptom Questionnaire

NAMES AND SURNAMES:_____________________________________________________________AGE: ____________


BIRTHDATE:_____________________________ MARITAL STATUS:__________________________________________
OCCUPATION:____________________________ LEVEL OF EDUCATION:________________________________________

COMPANY:________________________________________________DATE:____________________________________

N° QUESTION YES NOT


1 Do you have frequent headaches?
2 Do you have a poor appetite?
3 Do you sleep badly?
4 Do you feel scared easily?
5 Do you suffer from hand tremors?
6 Do you feel nervous, tense or bored?
7 Do you suffer from bad digestion?
8 Are you unable to think clearly?
9 Do you feel sad often?
10 Do you cry a lot?
11 Do you have difficulty in enjoying your daily activities?
12 Do you have trouble making decisions?
13 Do you have trouble doing your job? Your job has been affected?
14 Are you unable to play a useful role in your life?
15 Have you lost interest in everyday things?
16 Do you think it is a useless person feel?
17 Have you had the idea of ending your life?
18 Do you feel tired all the time?
19 Do you feel unpleasant sensations in your stomach?
20 Do you get tired easily?
PUNTUACION DE LA S PREGUNTAS 1-20
21 Do you feel that someone has tried to hurt you in any way?
22 Are you a much more important than the other person think?
23 Have you noticed something strange interference or your thinking?
24 Do you hear voices without knowing where they come from or that other people can not hear?
25 Have you had seizures, fits or falls down with arm and leg movements: with bites tongue or loss
of consciousness?
PUNTUACION DE LAS PREGUNTAS 21-25
26 Do you feel that someone has tried to hurt you in any way?
27 Are you a much more important than the other person think?
28 Have you noticed something strange interference in your thinking?
29 Do you hear voices without knowing where they come from or that other people can not hear?
30 Have you had seizures, fits or falls down with arm and leg movements: with bites tongue or loss
of consciousness?
PUNTUACION DE LAS PREGUNTAS 26-30

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