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Q1 What is your age, were you born premature or with any health conditions?
Q2 What is your birth weight? what is your current height and weight?
Q3 What is your ethnic background?
Q4 Which city and which background did you grow up in?
Q5 How many schools have you attended and why?
Q6 Who lived in the home with you where you were raised?
Q7 What is your parents education level?
Q8 How would you classify your relationship with your parents
Q9 What was the income wage rate for the person who raised you?
Q10 Have you ever been abused ( sexually, physically or emotionally).
What challenges have you had to overcome in your life and did they have an impact on you , if so how?
Q12 What physical disabilities do you have?
Q13 What mental health conditions have you been diagnosed with or you feel you may have?
Q14 What grades did you attain in grades K-12?
Q15 Which extra-curricular activities did you participate in?
Q16 What is your highest level of education?
Q17List each job you have ever had and how long you worked there.
Q18 What religion were you raided in ?What religion are you in now?
Q20 How often do you socialize with friends each month?
Q21 Describe your diet and exercise throughout your life?
Q22 How would you describe your personality?
Q23 Were you exposed to asbestos, lead paint ,second hand smoke or poor water quality
growing up?
Q24 Did you go for annual medical, Dental, and vision appointments growing up? When were your last appointments for these?
Q25 Have you experienced or witnessed domestic Violence?
Q26How many and which languages were spoken in your home growing up ?
Q27 Did your parents read to you as a child? What was your access to books and toys
growing up?
Q28 Did your parents use alcohol or drugs while you were growing up?
Q29 Did your mother drink or use drugs while pregnant with you?
Q30 Were you ever neglected or abandoned growing up?
Questionnaire Relevance For A Mental Health Centre
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Questionnaire Relevance for a Mental Health Centre.
Q1 What is your age, were you born premature or with any health conditions?
The information gathered is about the age , and the stage of being born whether premature or normally . Research by Bradbury (2020) shows that there is a link between ageing and depression ,evidence suggests that natural body changes that are associated with one getting older are linked to depression. Children born prematurely have an increased risk of developing mental health conditions including depression, bi-polar disorder and schizophrenia (Nosarti ,2019).
Q2 What is your birth weight? what is your current height and weight?
Low birth weight is a term used to describe babies born below eight ounces or less than five pounds . The questions are relevant because, if a patient was born below this weight, then there are particular mental health conditions that may be linked to it that may begin at childhood extending to adulthood example, ADHD (Attention Deficit Hyperactivity Disorder) (Lim et al.,2018). Weight and height may also contribute to mental health problems example, being overweight or obese may predispose a patient to depression, eating disorders, anxiety and even substance abuse (Kang &Kwack (2020).
Q3 What is your ethnic background?
The question gives an insight to where the patient may have come from. Ethnic minorities often suffer from poor mental health outcomes because of their inaccessibility to quality mental health care, cultural stigma, discrimination and a lack of awareness about mental health (Trinh et al.,2019). So Knowing a patient's ethnic history goes a long way in helping identify what mental health issues a patient may be predisposed to.
Q4 Which city and which background did you grow up in?
The question aims to know if a person grew up in an urban , semi urban or rural setting. Studies show that living in a city can make a person with a family history of mental health develop much faster. Environmental stresses are potential triggers to developing psychiatric conditions such as anxiety, depression and bipolar disorder affecting normal human development (Kirkbride et al.,2018).
Q5 How many schools have you attended and why?
The question seeks to understand if a patient has constantly attended one school or has been moved to different schools maybe due to bad behavior or the family moving. Switching schools in children may be linked to higher psychotic problems in children and other related mental health problems in children later developing into adult hood
