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Questionnaire 1: Instructions: Check Yes or No

This document contains a questionnaire about stress and mental health. It asks for the respondent's name, age, year level and sex. It then has yes or no questions about sleep, appetite, anger, emotions, compulsions, fatigue, memory and social activity. It also asks if friends or family have commented on mood swings. Next it asks to check off potential stressors like academic pressure, relationships, social anxiety or family issues. Finally it lists ways people cope with stress like exercise, asking for help, problem solving or ignoring the stress.

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Leslee Joy Legurpa
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98 views1 page

Questionnaire 1: Instructions: Check Yes or No

This document contains a questionnaire about stress and mental health. It asks for the respondent's name, age, year level and sex. It then has yes or no questions about sleep, appetite, anger, emotions, compulsions, fatigue, memory and social activity. It also asks if friends or family have commented on mood swings. Next it asks to check off potential stressors like academic pressure, relationships, social anxiety or family issues. Finally it lists ways people cope with stress like exercise, asking for help, problem solving or ignoring the stress.

Uploaded by

Leslee Joy Legurpa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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QUESTIONNAIRE 1

Name: _______________________________ Age:__________


Year level: ________________ Sex:___________

Instructions: Check yes or no:


YES NO
Are you sleeping more or less than usual or can’t fall asleep?
Do you wake up only after a few ours and can’t go back to sleep?
Have you lost or gained weight without any change in your diet or exercise regime?
Do you always think about food or are you disgusted by food?
Do you have difficulty managing anger, controlling your temper?
Do you feel more emotional?
Do you experience compulsive/obsessive behaviors?
Do you have chronic fatigue, tiredness, or lack of energy
Are you having difficulty "keeping track"?
Do have difficulty in remembering of things?
Did you love to go out with friends and now you don't or do you shun social activity?
Has more than 1 of your friend or relatives commented that you have mood swings and
erratic behavior?
Do you have unexplained physical symptoms like chronic back pain, headaches,
palpitations, neck pain, gastrointestinal problems (pain, diarrhea)?

Instructions: Check the situations that apply to you.


 Academic-related stressors
___Afraid of getting poor marks
___Feel like there is a large amount of content to be learnt every module and there is not enough time
___Feel of incompetence during discussions
___Have difficulty understanding the content or things read
___Have difficulty adapting to problem based curriculum
___ Feel anxious that you will not be able to answer questions from doctors
 Intrapersonal and interpersonal-related stressors
___Have high expectations of self
___Have conflicts with other students
___Experienced verbal or physical abuse by other classmates or teachers
___Feel like there is lack of guidance from the teacher
___Have difficulty talking to patients during extraction of history and PE
 Social-related stressors
___ Afraid of facing illness or death of patients
___ Have difficulties in talking in front of other people (eg. Pbl sessions and feedbacks)
___ Have high expectations from family
___Having family problems like parents’ divorce or death of a close relative
___Miss family and feel homesick, feel unfamiliar with new environment
 Drive and desire related stressors
___Unwillingness to study medicine or was forced by parents or relatives
___Having financial difficulties
___Feel like there is lack or insufficient time to relax
___Have difficulty managing time and resisting distractions

Instructions: Check the actions you take when you are stressed.
___Exercise (eg. walking, jogging) __ Drink alcohol or smoke
___Ask others to help or assist you __ Get angry at other people
___Engage in problem solving to solve the cause __ Socially withdraw from other people
___Think of it as a way to improve self __ Think of suicide
___Directly attempting to change the source of stress __ Engage in misdemeanor or rebel
___Distance yourself from the source of stress __ Ignore the cause of stress
___View the problem through a religious perspective __ Procrastinate
__ Manage emotions so that you do not get too __ Engage in wishful thinking or daydream to
upset or lose control escape problem

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