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Health Care Scale – 2020

Mental health survey

Please take a few minutes to fill out this survey on your overall state of mental health. We value your feedback and your responses. Thank you for your input.

I would like to begin the survey by asking you some questions about your general health.

  • Question of

    Have you had any problems with your work or daily life due to any emotional problems, such as feeling depressed, sad or anxious?

    • Yes
    • No
    • Don’t Know
  • Question of

    How often has your mental health affected your relationships?

    A worried/depressed kid
    • Very Often
    • Somewhat Often
    • Not So Often
    • Not At All
  • Question of

    Have you ever been diagnosed with a mental disorder before?

    Mental disorder
    • Yes
    • No
  • Question of

    Can you able to adapt when changes occur?

    Changes ahead
    • Not True At All
    • Rarely True
    • Sometimes True
    • True Nearly All The Time
    • Don’t Know
  • Question of

    How many hours do you sleep per day?

    • Less Than 4
    • 4-6
    • 7-9
    • 9+
  • Question of

    How often do you feel positive about your life?

    Positive girl
    • Never
    • Once In A Life
    • About Half The Time
    • Most Of The Time
    • Always
  • Question of

    Overall how would you rate your mental health?

    Rate yourself
    • Excellent
    • Somewhat Good
    • Average
    • Somewhat Poor

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Written by Shraddha Diwan

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