Questionnaire

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Read each item thoroughly. This questionnaire has 5 pages. Please print your responses by darkening or ticking in the circle.
Age*

Below 1818-2526-3536-4546-55Over 55
Sex*

MaleFemaleOther
Your role or roles? (Select all that apply)*

Undergraduate studentPostgraduate studentPostgraduate PhD studentTutor / Teaching / ResearchNon-academic work eg AdminNot at college or universityOther
How many consultations have you had with this doctor ?*

1 only2 - 34 - 56 - 1011 - 5050+
Are you seeing this doctor again?*

YesNoUnsure
How long ago did you FIRST see this doctor?*

< 1 month1 - 6 months6 - 12 months1 - 5 years5+ years
How long did it take to get your first appointment?*

1 - 2 weeks3 - 4 weeks1 - 2 months2 - 6 months> 6 months
How long did it take to get your first appointment?

12345
Have you ever attended another PSYCHIATRIST?*

Yes, 6+ visitsYes, < 6 visitsNo
Have you ever attended a PSYCHOLOGIST/s ?*

Yes, 6+ visitsYes, < 6 visitsNo
How often do you exercise?

1 – 2 times a week2 – 3 times a week3 - 5 times a week5 - 6 times a weekeveryday
Has anyone in your family been diagnosed with depression?

NoYes
If yes, what was the outcome? (Select all that apply)

Admission into mental health hospital/clinicPrescribed an antidepressantThere was no interventionCommitted suicide
What is your level of satisfaction with your living arrangement?

Very lowLowHighVery high
Please indicate your year of study.

1st (Freshman)2nd (Sophomore)3rd (Junior)4th (Senior)
In which School are you registered?

School of BusinessSchool of Education and HumanitiesSchool of Science and Technology and Allied HealthSchool of Social SciencesSchool of Theology and Religion
Are you satisfied with your choice to pursue this degree program?

NoYes
How many credit hours are you registered for this semester?

6 or fewer7 – 1112-1415-1617 or more
Do you consider your course load stressful?

NoYes
Do you feel stressed about your current financial situation?

NoYes

Please rate ...

	Very Poor	Poor	OK	Good	Very Good	NA
Parents
Spouse/partner
Employer support
Government Assistance for Tuition Expenses Program (GATE)
Scholarships andgrants
Loan
Other sources

There is little I can do to change many of the important things in my life

Strongly disagreeDisagreeNeither agree or disagreeAgreeStrongly agree
Part II

Please tick of shade the response that best describes you.
Type a question

I do not feel sad.I feel sadI am sad all the time and I can't snap out of it.I am so sad and unhappy that I can't stand it
Type a question

I am not particularly discouraged about the future.I feel discouraged about the future.I feel I have nothing to look forward to.I feel the future is hopeless and that things cannot improve
Type a question

I do not feel like a failure.I feel I have failed more than the average person.As I look back on my life, all I can see is a lot of failures.I feel I am a complete failure as a person.
Type a question

I get as much satisfaction out of things as I used to.I don't enjoy things the way I used to.I don't get real satisfaction out of anything anymore.I am dissatisfied or bored with everything.
Type a question

I don't feel particularly guilty.I feel guilty a good part of the time.I feel quite guilty most of the time.I feel guilty all of the time.
Type a question

I don't feel I am being punished.I feel I may be punished.I expect to be punished.I feel I am being punished.
Type a question

I don't feel disappointed in myself.I am disappointed in myself.I am disgusted with myself.I hate myself
Type a question

I don't feel I am any worse than anybody else.I am critical of myself for my weaknesses or mistakes.I blame myself all the time for my faults.I blame myself for everything bad that happens.
Type a question

I don't have any thoughts of killing myself.I have thoughts of killing myself, but I would not carry them out.I would like to kill myself.I would kill myself if I had the chance.
Type a question

I don't cry any more than usual.I cry more now than I used to.I cry all the time now.I used to be able to cry, but now I can't cry even though I want to
Type a question

I am no more irritated by things than I ever was.I am slightly more irritated now than usual.I am quite annoyed or irritated a good deal of the time.I feel irritated all the time
Type a question

I have not lost interest in other people.I am less interested in other people than I used to be.I have lost most of my interest in other people.I have lost all of my interest in other people
Type a question

I make decisions about as well as I ever could.I put off making decisions more than I used to.I have greater difficulty in making decisions more than I used to.I can't make decisions at all anymore
Type a question

I don't feel that I look any worse than I used to.I am worried that I am looking old or unattractive.I feel there are permanent changes in my appearance that make me look unattractiveI believe that I look ugly
Type a question

I can work about as well as before.It takes an extra effort to get started at doing something.I have to push myself very hard to do anything.I can't do any work at all.
Type a question

I can sleep as well as usual.I don't sleep as well as I used to.I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.I wake up several hours earlier than I used to and cannot get back to sleep.
Type a question

I don't get more tired than usual.I get tired more easily than I used to.I get tired from doing almost anything.I am too tired to do anything.
Type a question

My appetite is no worse than usual.My appetite is not as good as it used to be.My appetite is much worse now.I have no appetite at all anymore
Type a question

I haven't lost much weight, if any, lately.I have lost more than five pounds.I have lost more than ten pounds.I have lost more than fifteen pounds
Type a question

I am no more worried about my health than usual.I am worried about physical problems like aches, pains, upset stomach, or constipation.I am very worried about physical problems and it's hard to think of much else.I am so worried about my physical problems that I cannot think of anything else.
Type a question

I have not noticed any recent change in my interest in sex.I am less interested in sex than I used to be.I have almost no interest in sex.I have lost interest in sex completely
Should be Empty:

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Part II