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National Emotional Health Survey

Tell us a little about yourself

Gender: Male Female Other

Children: Yes No

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Send me information about Emotional Health

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Just a few more questions

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SKIP

Has your pay been cut recently ? Yes No
Have you lost your job recently ? Yes No
Have you suffered from COVID ? Yes No
Has any of your family members or friends suffered from COVID ? Yes No
Has any one close to you passed away recently ? Yes No
In the recent past which of these activities have you done ?

Yoga
Meditation
Cooking
Housework
Gardening
Exercise
Teach Kids
Art/Craft
Learnt A New Skill
Others

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1 / 18

Q1. If you compare before COVID and now are you

More worried about your finances ?

Extremely
A lot
Moderately
A little bit
Not at all

2 / 18

Q2. If you compare before COVID and now are you

Generally more worried and anxious ?

Extremely
A lot
Moderately
A little bit
Not at all

3 / 18

Q3. If you compare before COVID and now are you

Having more difficulty is concentrating ?

Extremely
A lot
Moderately
A little bit
Not at all

4 / 18

Q4. If you compare before COVID and now are you

Being less productive ?

Extremely
A lot
Moderately
A little bit
Not at all

5 / 18

Q5. If you compare before COVID and now are you

More worried about your personal health and safety ?

Extremely
A lot
Moderately
A little bit
Not at all

6 / 18

Q6. If you compare before COVID and now are you

Being more bored ?

Extremely
A lot
Moderately
A little bit
Not at all

7 / 18

Q7. If you compare before COVID and now are you

Having more difficulty sleeping or sleeping too much ?

Extremely
A lot
Moderately
A little bit
Not at all

8 / 18

Q8. If you compare before COVID and now are you

Feeling more lonely or isolated ?

Extremely
A lot
Moderately
A little bit
Not at all

9 / 18

Q9. If you compare before COVID and now are you

Feeling more down or depressed ?

Extremely
A lot
Moderately
A little bit
Not at all

10 / 18

Q10. If you compare before COVID and now are you

More worried about the health and safety of family members or friends ?

Extremely
A lot
Moderately
A little bit
Not at all

11 / 18

Q11. If you compare before COVID and now are you

Feeling more frustrated that you cannot enjoy what enjoyed before ?

Extremely
A lot
Moderately
A little bit
Not at all

12 / 18

Q12. If you compare before COVID and now are you

More angry or irritated ?

Extremely
A lot
Moderately
A little bit
Not at all

13 / 18

Q13. If you compare before COVID and now are you

Feeling that the future seems darker or scarier ?

Extremely
A lot
Moderately
A little bit
Not at all

14 / 18

Q14. If you compare before COVID and now are you

Feeling more grief, sadness or sense of loss ?

Extremely
A lot
Moderately
A little bit
Not at all

15 / 18

Q15. If you compare before COVID and now are you

Having arguments with your partner ?

Extremely
A lot
Moderately
A little bit
Not at all

16 / 18

Q16. If you compare before COVID and now are you

Fearing more about losing your job ?

Extremely
A lot
Moderately
A little bit
Not at all

17 / 18

Q17. If you compare before COVID and now are you

Feeling more worried about your children’s future ?

Extremely
A lot
Moderately
A little bit
Not at all

18 / 18

Q18. If you compare before COVID and now are you

Over worked, exhausted or burnt out ?

Extremely
A lot
Moderately
A little bit
Not at all

Thank You for the taking the time.

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