Student mental health check-in survey questions in this example
1. What is your age?
The answer should be a single choice:
- Under 18
- 18-24
- 25-34
- 35-44
- 45 or older
2. What is your gender?
The answer should be a single choice:
- Male
- Female
- Other
- Prefer not to say
3. What is your current level of education?
The answer should be a single choice:
- High school
- Undergraduate
- Graduate
4. How often have you felt overwhelmed in the past month?
The answer should be a single choice:
- Never
- Rarely
- Sometimes
- Often
- Always
5. Have you experienced any of the following in the past month? (Select all that apply)
The answer should be a single choice:
- Persistent sadness or hopelessness
- Anxiety or excessive worry
- Panic attacks
- Suicidal thoughts
- None of the above
6. On a scale of 1-10, how would you rate your overall mental health in the past month?
The answer should be a single choice:
- 1 (very poor)
- 2
- 3
- 4
- 5 (average)
- 6
- 7
- 8
- 9
- 10 (excellent)
7. Which of the following have you used to cope with stress or negative feelings in the past month? (Select all that apply)
The answer should be a multiple choice:
- Exercise
- Talking to a friend or family member
- Meditation or mindfulness practices
- Watching TV or movies
- Substance use (alcohol, drugs)
- None of the above
8. How effective have your coping strategies been in managing stress or negative feelings?
The answer should be a single choice:
- Not effective at all
- Somewhat effective
- Moderately effective
- Very effective
- Extremely effective
9. Have you sought help for mental health issues in the past?
The answer should be a single choice:
- Yes
- No
10. If you answered yes to question 9, what resources did you use? (Select all that apply)
The answer should be a multiple choice:
- Therapy or counseling services
- Medication prescribed by a doctor
- Support groups
- Online resources or self-help materials
- None of the above
- N/A
11. If you answered no to question 9, what barriers have prevented you from seeking help? (Select all that apply)
The answer should be a multiple choice:
- Stigma or shame
- Lack of access to resources
- Financial barriers
- Lack of time
- Belief that the issue will resolve on its own
- N/A