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老年人心理健康調(diào)查問卷
1. What's your gender?
A male
B female
2. What's your age?
A 60-65 age
B 66-70 age
C 71-75 age
D Over 70 years old.
3. What is your marital status?
A married
B single
C divorce
D be widowed
4. Do you have any children?
A Yes
B no
5. What's your living situation?
A live in solitude
B Live with your family.
C nursing home
D other
6. What is your main source of income?
A pension
B Child support
C Own property
D other
7. Do you feel lonely?
A often
B once in a while
C never
8. How is your health?
A very good
B common
C Very bad
9. Have you ever had psychological counseling?
A Yes.
B not
10. Do you participate in social activities regularly?
A Yes
B no
11. How satisfied are you with your life?
A Very satisfied.
B be satisfied
C common
D Dissatisfied
12. Have you ever felt depressed or anxious?
A often
B once in a while
C never
13. Do you find life boring?
A often
B once in a while
C never
14. How many hours do you sleep every day?
A Less than five hours.
B 5~7 hours.
C More than seven hours.
15. Are you interested in developing new hobbies and skills?
A yes.
B not have
16. How do you usually get psychological support?
A family
B friend
C community service
D Professional psychological consultation
17. How important do you think mental health is to the elderly?
A Very important.
B important
C common
D unimportance
18. Have you ever received psychological counseling or treatment in the past year?
A Yes
B no
19. What do you think of your ability to cope with pressure?
A very strong
B common
C Weaker
20.Have you ever participated in any lectures or activities related to mental health of the elderly?
A Yes
B no
21. How do you usually relax yourself?
A sports
B read
C watch TV
D Communicate with friends.
22.How much do you know about mental health services for the elderly?
A Very well.
B Generally understand.
C not familiar with
23. Do you think the current mental health service can meet the needs of the elderly?
A Yes.
B No
24. Do you have any other suggestions or ideas you want to add?
25. What kind of mental health support do you want?
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