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QUESTIONNAIRE

This document is a student mental health self-assessment with two sections. [1] The first section asks students to rate how often in the past week they have experienced various feelings on a scale from 1 to 5. [2] The second section asks students to list any current worries, concerns or problems they have in several areas of life such as accommodation, family, studies, emotional well-being and mental health. The self-assessment is intended to help students evaluate their current mental well-being and identify any problems or concerns.

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848 views3 pages

QUESTIONNAIRE

This document is a student mental health self-assessment with two sections. [1] The first section asks students to rate how often in the past week they have experienced various feelings on a scale from 1 to 5. [2] The second section asks students to list any current worries, concerns or problems they have in several areas of life such as accommodation, family, studies, emotional well-being and mental health. The self-assessment is intended to help students evaluate their current mental well-being and identify any problems or concerns.

Uploaded by

midnight sky
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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Student Mental Health Self-Assessment

Name: Section: Age:

Section One: Your Current Well-Being

Below are some statements about feelings and thoughts. Please circle the box that best describes

your experience of each.

None of Some of All of


STATEMENTS the time Rarely the time Often the time

I’ve been feeling optimistic about the future


1 2 3 4 5
I’ve been feeling useful
1 2 3 4 5
I’ve been feeling relaxed
1 2 3 4 5
I’ve been feeling interested in other people
1 2 3 4 5

I’ve had energy to spare


1 2 3 4 5
I’ve been dealing with problems well
1 2 3 4 5

I’ve been thinking clearly


1 2 3 4 5

I’ve been feeling good about myself


1 2 3 4 5
I’ve been feeling close to other people
1 2 3 4 5
I’ve been feeling confident
1 2 3 4 5

I’ve been feeling confident


1 2 3 4 5

I’ve been feeling loved


1 2 3 4 5

I’ve been interested in new things


1 2 3 4 5

I’ve been feeling cheerful


1 2 3 4 5

Student Mental Health Self-Assessment Questionnaire


Section Two: Current Problems or Concerns

[1] Have you any current worries/concerns/problems in the following areas of your life?

Accommodation:

Finances:

Physical Health

Family:

Friends:

Student Mental Health Self-Assessment Questionnaire


Partner / close relationship:

Social Life (e.g. lack of friends, isolated)

Studies (e.g. lectures, workload, deadlines):

Discrimination (e.g. bullying, harassment, racism):

Emotional wellbeing / mental health (e.g. adjusting to University life, homesickness, stress, depression, anxiety,
panic attacks, sleep problems, eating problems, self harm, alcohol/drug problem):

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