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Survey Templates COVID 19 Health Evaluation Surveys 20 Mental Health Survey Questions for Questionnaire + Sample Template

20 Mental Health Survey Questions for Questionnaire + Sample Template

This free Mental Health Survey Template consists of questions and examples that help evaluate a person’s overall mental health. Use this sample survey template to collect information from the respondents about any family history of mental illness, previous diagnosis, and other important personal details that will help the researcher understand the mental health condition.


Please take a few minutes to fill out this survey on the overall status of your mental health. We value your feedback and your responses will be kept confidential. Thank you for your input.

Gender:
Age: 
During the past 4 weeks, have you had any problems with your work or daily life due to your physical health?
During the past 4 weeks, have you had any problems with your work or daily life due to any emotional problems, such as feeling depressed, sad or anxious? 
Overall how would you rate your mental health?
Have you felt particularly low or down for more than 2 weeks in a row?
During the past two weeks, how often has your mental health affected your relationships?
How often do you experience below?
Never
Once in a while
About half the time
Most of the time
Always
Calm and peaceful
Energetic
Gloomy
Angry
Have you ever been diagnosed with a mental disorder before?
When did you last get your mental health examination done?
Is there a history of mental disorder in your family?
If "Yes", please select which of the family member(s) has/had a history of mental illness.
Does your health limit you in doing daily activities? 
Very less
Moderately
Very much
No problem
Light physical activities
Moderate physical activities
Heavy physical activities
Have you seen a therapist in the recent past?
Are you currently taking any medication?
How many hours do you sleep per day?
How is your quality of sleep?
What is your marital status?
Are you a heavy smoker?
Are you alcoholic?
How often do you feel positive about your life?

Why use this survey questionnaire to conduct a mental health survey?

Mental health is as important as physical health. Mental health includes a person’s emotional, psychological, and social well-being. It affects how a person thinks, feels, and also acts. Having sound mental health is important as it determines how a person can handle stress, make sound choices, and how he/she interacts with others. Mental health is important for the social well-being of a person at every stage in life, from childhood to adolescence and even beyond. Here are some of the important reasons why you should conduct a mental health questionnaire:

  1. To know the availability of mental care: Researchers can deploy this survey to understand the availability of health care and also to know if it is adequate. Health care is a growing concern across the globe. More and more people are being diagnosed with some of the other mental health issues. In testing times like these, it is important a person receives immediate help and attention. Through this survey, a researcher can know if the facilities are available to the respondents or not.
  2. Areas of mental health care that can be improved: Once the respondents fill in the survey, the data obtained can be analyzed to know if there is an area of improvement, that needs immediate attention. It is important that patients experiencing mental discomfort are treated with care and perseverance. Through this survey, researchers can obtain information if there are any loopholes in the system and how to address these issues effectively.
  3. To know the most common mental disorders: The survey questions on mental health help the respondents fill in the elaborate details about what kind of mental disorder are they experiencing. It is important to know yourself first, so you can get the right medical attention. Respondents of this survey can fill in details and the researcher can know and the types of mental disorders people are experiencing.
  4. To identify population segments prone to a certain disorder: Some mental disorders can be due to geographic locations, food, contaminated air etc. The reasons can be many. By deploying this survey researcher can know what are the reasons for a particular segment of people are prone to certain mental illness.
  5. Financial obligations resulting from mental illness: Mental illness can be quite disturbing for the families of the people suffering from it. It not only affects their regular routine but may also affect the professional life. According to many scientific studies, people suffering from mental illness tend to skip their work or not be able to cope up with the work environment and the related stress. This can lead to a loss in paydays and also other financial obligations like borrowing money etc. To know more about these issues, it is important for researchers to get first-hand information from respondents.