20 Mental Health Survey Questions for Questionnaire + Sample Template

Mental Health Survey Template designed by QuestionPro consists of questions and examples that help evaluate a person’s overall mental health. This sample survey template consists of questions that help 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. This questionnaire example consists of demographic questions, these questions can be customized and used to suit the needs of a researcher.



   
 
 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.


Please provide us with the following information.

 
   
 
1. What is your gender?
 
Male
 
Female
 
   
 
4. What is the highest level of education you have attained?
 
Primary school
 
Some high school
 
High school diploma or GED
 
Some college
 
2 year college degree
 
4 year college degree
 
Graduate level degree
 
Other
 
   
 
5. What is your marital status?
 
Married
 
Widowed
 
Divorced
 
Separated
 
Single never married
 
   
 
6. Are you disabled?
 
Yes
 
No
 
   
 
7. Please mark your annual gross income?
 
0 to $10,000
 
$10,001 to $25,000
 
$25,001 to $50,000
 
$50,001 to $100,000
 
$100,001 to $250,000
 
$250,001 +
 
I prefer not to answer
 
   
 
8. Which of the following group of race best describes you?
 
White
 
Black or African American
 
American Indian
 
Asian
 
Hispanic or Latino
 
Two or more races
 
   
 
9. Overall how would you rate your mental health?
 
Excellent
 
Somewhat good
 
Average
 
Somewhat poor
 
Poor
 
Not sure
 
   
 
10. Is there a history of mental disorder in your family?
 
Yes
 
No
 
   
 
11. If "Yes", please select which family member has/had a history of mental illness.
 
Mother
 
Father
 
Brother 
 
Sister
 
Grandfather
 
Grandmother
 
Other
 
 
   
 
12. Have you ever been diagnosed with a mental disorder before?
 
Yes
 
No
 
   
 
13. Have you ever been committed?
 
Yes
 
No
 
   
 
14. Are you currently taking any medication?
 
Yes
 
No
 
   
 
15. Have you felt particularly low or down for more than 2 weeks in a row?
 
Yes 
 
No
 
   
 
16. Are you habituated to drugs and alcohol?
 
Yes to both 
 
Only  to Drugs 
 
Only  to Alcohol 
 
I am not habituated to either
 
   
 
17. When did you last get your mental health examination done?
 
Less than 6 months ago
 
6 months ago 
 
A year ago 
 
More than a year ago
 
   
 
18. Was any of the female member in your household physically abused?
 
Yes 
 
No
 
   
 
19. How knowledgeable are you about mental health related issues? 
 
Very Knowledgeable 
 
Knowledgeable
 
Neutral 
 
Not Knowledgeable
 
Not Knowledgeable at all
 
   
 
20. Have you seen a therapist in the recent past?
 
Yes 
 
No
 

Why conduct 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 a 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 survey:

  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: This survey consists of questions that help 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 the first-hand information from respondents.

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