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    Self-Reporting Questionnaire (SRQ) 25: Participant ID No.

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    Stace Diane Deane Stefan
    The document appears to be a self-reporting questionnaire called the SRQ-25. It contains 25 questions about physical and mental health symptoms a participant may have experienced in the last 30 days. For each question, the participant is to answer "Yes" if the symptom applied to them, or "No" if it did not. The questions cover a range of issues including headaches, appetite, sleep, nervousness, digestion, thinking ability, mood, daily functioning, and possible psychotic symptoms.

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    Self-Reporting Questionnaire (SRQ) 25: Participant ID No.

    Uploaded by

    Stace Diane Deane Stefan
    2K views2 pages
    The document appears to be a self-reporting questionnaire called the SRQ-25. It contains 25 questions about physical and mental health symptoms a participant may have experienced in the last 30 days. For each question, the participant is to answer "Yes" if the symptom applied to them, or "No" if it did not. The questions cover a range of issues including headaches, appetite, sleep, nervousness, digestion, thinking ability, mood, daily functioning, and possible psychotic symptoms.

    Original Title

    SRQ (2)

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    The document appears to be a self-reporting questionnaire called the SRQ-25. It contains 25 questions about physical and mental health symptoms a participant may have experienced in the last 30 days. For each question, the participant is to answer "Yes" if the symptom applied to them, or "No" if it did not. The questions cover a range of issues including headaches, appetite, sleep, nervousness, digestion, thinking ability, mood, daily functioning, and possible psychotic symptoms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    2K views2 pages

    Self-Reporting Questionnaire (SRQ) 25: Participant ID No.

    Uploaded by

    Stace Diane Deane Stefan
    The document appears to be a self-reporting questionnaire called the SRQ-25. It contains 25 questions about physical and mental health symptoms a participant may have experienced in the last 30 days. For each question, the participant is to answer "Yes" if the symptom applied to them, or "No" if it did not. The questions cover a range of issues including headaches, appetite, sleep, nervousness, digestion, thinking ability, mood, daily functioning, and possible psychotic symptoms.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Self-Reporting Questionnaire (SRQ) 25

    Participant ID No.:

    The following questions are related to certain pains and problems that may
    have bothered you in the last 30 days. If you think the question applies to you
    and you had to describe the problem in the last 30 days, answer YES. On the
    other hand, if the question does not apply to you and you did not have the
    problem in the last 30 days, answer NO.

    1. Do you often have headaches? Yes (1) No (2)


    2. Is your appetite poor? Yes (1) No (2)
    3. Do you sleep badly? Yes (1) No (2)
    4. Are you easily frightened? Yes (1) No (2)
    5. Do your hands shake? Yes (1) No (2)
    6. Do you feel nervous, tense or worried? Yes (1) No (2)
    7.Is your digestion poor? Yes (1) No (2)
    8.Do you have trouble thinking clearly? Yes (1) No (2)
    9.Do you feel unhappy? Yes (1) No (2)
    10.Do you cry more than usual? Yes (1) No (2)
    11.Do you find it difficult to enjoy your daily activities? Yes (1) No (2)
    12.Do you find it difficult to make decisions? Yes (1) No (2)
    13.Is your daily work suffering? Yes (1) No (2)
    14.Are you unable to play a useful part in life? Yes (1) No (2)
    15.Have you lost interest in things? Yes (1) No (2)
    16.Do you feel that you are a worthless person? Yes (1) No (2)
    17.Has the thought of ending your life been on your mind? Yes (1) No (2)
    18.Do you feel tired all the time? Yes (1) No (2)
    19.Do you have uncomfortable feelings in your stomach? Yes (1) No (2)
    20.Are you easily tired? Yes (1) No (2)
    21.Do you feel that somebody has been trying to harm you in some Yes (1) No (2)
    way?
    22.Are you much more important person than most people think? Yes (1) No (2)

    23.Have you noticed any interference or anything else unusual Yes (1) No (2)
    with your thinking?
    24.Do you ever hear voices without knowing where they come Yes (1) No (2)
    from or which other people cannot hear?
    25.Have you ever had any fits, convulsions or falls to the ground, Yes (1) No (2)
    with movement of the arms and legs, biting of the tongue or loss
    of consciousness?
    Duration of interview__________minutes______

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