Welcome to your Mental Health Checkpoint test The following questions aim to understand your thoughts and feelings. Please take a few moments to complete the following questionnaire, which is designed to understand how you've been feeling and functioning over the past few weeks. Read each question carefully and select the response that best reflects your recent experience compared to your usual state. There are no right or wrong answers, and your honest responses will help provide an accurate picture of your current mental well-being. Answer every question, even if some seem similar—each one is important. Try to respond based on your immediate impression rather than overthinking. Your answers will remain confidential and are meant to support self-awareness or guide further discussion with a professional if needed. Estimated Time: 5 - 7 minutes Suitable For: Adults and Adolescents Name Email Phone Age Gender Choose Gender Male Female Others District Name Are you feeling perfectly well and in good health? Better than usual Same as usual Worse than usual Much worse than usual None In the past week, I have felt the need for a good tonic or medicine to feel better. Not at all Occasionally Quite often Very often None Have you been feeling run down and out of sorts? Not at all Occasionally Quite often Very often None Have you felt that you are ill? Not at all Occasionally Quite often Very often None In the past week, I have been having/feeling headaches or head pains. Not at all Occasionally Quite often Very often None In the past week, I have been feeling tightness or pressure in my head. Not at all Occasionally Quite often Very often None In the past week, I have been having hot or cold spells. Not at all Occasionally Quite often Very often None Did you lose much sleep over worry? Not at all Occasionally Quite often Very often None Did you have difficulty staying asleep once you were off? Not at all Occasionally Quite often Very often None Have you been feeling constantly under strain? Not at all Occasionally Quite often Very often None Have you been getting edgy and bad-tempered? Not at all Occasionally Quite often Very often None Have you been getting scared or panicky for no good reason? Not at all Occasionally Quite often Very often None Have you found everything getting on top of you? Not at all Occasionally Quite often Very often None Are you feeling nervous and strung-up all the time? Not at all Occasionally Quite often Very often None Have you been managing to keep yourself busy and occupied? More than usual Same as usual Less than usual Much less than usual None Have you been taking longer in doing the things you do? More than usual Same as usual Less than usual Much less than usual None Have you felt on the whole you were doing things well? All the time Most of the time Sometimes Rarely or never None Are you satisfied with the way you've carried out your tasks? Very satisfied Somewhat satisfied Slightly dissatisfied Very dissatisfied None Have you felt that you are playing a useful part in the work you do? Definitely To some extent Not much Not at all None Have you felt capable of making decisions about things? All the time Most of the time Sometimes Rarely or never None I have been able to enjoy my normal day-to-day activities. Completely Somewhat Slightly Not at all None I have been thinking of myself as a worthless person. Not at all Occasionally Often Nearly always None Have you felt that life is entirely hopeless? Not at all Occasionally Often Nearly always None Have you felt that life isn't worth living? Not at all Occasionally Often Nearly always None I have thought of the possibility of harming yourself or ending your life. Not at all Occasionally Often Nearly always None Have you found at times you couldn't do anything because you were nervous? Not at all Occasionally Often Nearly always None Have you found yourself wishing you were dead and away from it all? Not at all Occasionally Often Nearly always None Have you found that the idea of taking your own life kept coming into your mind? Not at all Occasionally Often Nearly always None Time's up
