Mental Health Questionnaire Pre-course

  • Mental Health Questionnaire Pre-course

    Please complete this form before the start of the first swimming session
  • Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
    Feeling nervous, anxious or on edge
    Not being able to stop or control worrying
    Worrying too much about different things
    Trouble relaxing
    Being so restless that it is hard to sit still
    Becoming easily annoyed or irritable
    Feeling afraid as if something awful might happen
    GAD7
  • Not at all (0)Several days (1)More than half the days (2)Nearly every day (3)
    Little interest or pleasure in doing things
    Feeling down, depressed, or hopeless
    Trouble falling or staying asleep, or sleeping too much
    Feeling tired or having little energy
    Poor appetite or overeating
    Feeling bad about yourself — or that you are a failure or have let yourself or your family down
    Trouble concentrating on things, such as reading the newspaper or watching television
    Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
    Thoughts that you would be better off dead or of hurting yourself in some way
    PHQ 9
  • Work and Social Adjustment Scale

    People’s problems sometimes affect their ability to do certain day-to-day tasks in their lives. To rate your problems look at each section and determine on the scale provided how much your problem impairs your ability to carry out the activity.
  • Not at all (0)1Slightly (2)3Definitely (4)5Markedly (6)7Very Severely (8)N/A
  • Not at all (0)1Slightly (2)3Definitely (4)5Markedly (6)7Very Severely (8)N/A
  • Not at all (0)1Slightly (2)3Definitely (4)5Markedly (6)7Very Severely (8)N/A
  • Not at all (0)1Slightly (2)3Definitely (4)5Markedly (6)7Very Severely (8)N/A
  • Not at all (0)1Slightly (2)3Definitely (4)5Markedly (6)7Very Severely (8)N/A