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MENTAL HEALTH SURVEY

AGE GROUP
GENDER
1. What has been the average sleep time you are managing to get over the last few months?
2. How has been the quality of your sleep during the past few months?
3. Over the last six months has been your mood and emotions?
4. In the past few months how many times have you felt pressured because of stress related to work or family?
5. What type of emotions have you felt mostly during the last few months?
6. What is your level of anger most of the times?
7. How often are you able to stay focused on the present moment?
8. Do you turn to unhealthy food indulgences such as eating junk food, drinking excessively, or eating sugary foods/sweets when feeling overwhelmed?
9. Do you experience headaches or muscle tensions?
10. During work hours, do you have a hard time staying focused and concentrating on the task-at-hand?
11. Do you feel little interest or pleasure in doing things these days?
12. These days do you feel tired or have little energy?
13. These days do you feel you have a poor appetite or you are overeating?
14. Do you feel bad about yourself - or that you are a failure or have let yourself or your family down?
15. Are you experiencing trouble concentrating on things, such as reading the newspaper or watching television?
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