ASSESSMENT OF PSYCHOLOGICAL RISK DURING THE COVID-19 PANDEMIC
This questionnaire is designed to assess the risk of anxiety disorders during the pandemic of the new coronavirus infection COVID-19. This survey is conducted on a voluntary basis in compliance with the complete anonymity of the respondent.
Age *
Gender *
Civil status *
Level of education *
Profession *
Ethnic group / nationality *
Have you contracted COVID-19? *
Has anyone in your family contracted COVID-19? *
(For medical professionals only) Experience in a medical institution during the period of COVID 19?
Clear selection
(For medical professionals only) Experience in the red zone?
Clear selection
Have you had any mental disorders, including anxiety disorders, before the COVID-19 pandemic? (e.g. panic attacks, anxiety disorder, depression) *
If you had a mental disorder before the COVID-19 pandemic, please indicate which
Measurement of the state of psychological risk at the time of the Coronavirus Pandemic emergency
The scale is composed of 20 items, each defining a range of discomfort and uneasiness states, psychological and physical, related to the emergency situation caused by the Covid-19 Pandemic (for example the risk of falling ill, of losing loved ones, interpersonal distancing, change of daily routine, isolation and having to stay at home, limitations of freedom and movement, loss of one’s job, etc.)
Time required for task: 5-10 minutes
Main objective: to verify the presence and the intensity of psychological risk in the emergency of the Covid-19 Pandemic
Population: elderly, adults, young and adolescents
Score: for each of the 20 items, identify the value which you think best corresponds to you from 0 to 4 according to the following scale:
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Check 0 if you have not experienced a symptom
1 if the symptom has caused some / slight anxiety
2 if the symptom has definitely caused anxiety
3 if the symptom has bothered significantly
4 if the symptom has been extremely worried
1. Worries about coronavirus (for example, very negative thoughts about the future, fear that things might get worse) occupy my mind for most of the day *
Not at all
Extremely worried
2. I do not feel any interest or pleasure in things that used to be important to me *
Not at all
Extremely worried
3. I feel more irritable and angry, I wake up too early in the morning, even if I would like to sleep more *
None
Extremely worried
4. I feel afraid of people *
Not at all
Extremely worried
5. I fear I might be abandoned and I fear loneliness *
Not at all
Extremely worried
6. In this period I have had difficulties in swallowing, I suffer from stomach aches, I feel that my stomach is full, I feel sick *
Not at all
Extremely worried
7. I have difficulty concentrating and a short memory in the daytime *
Not at all
Extremely worried
8. I have experiences of dimming eyesight, hot flushes and cold shivers, weakness, and itchy skin (heavy or lighter itch) *
Not at all
Extremely worried
9. I feel muscle pain, stiffness, cramps, the tone of my voice is lower *
Not at all
Extremely worried
10. Having to stay at home does not give me a sense of protection against the risk of contagion by Coronavirus *
Not at all
Extremely worried
11. I have heart palpitations, chest pains, sensations of falling *
Not at all
Extremely worried
12. I am experiencing very low energy and sleeping a lot. I can’t get out of bed *
Not at all
Extremely worried
13. I suffer from insomnia, have difficulties falling asleep, I feel tired when I wake up and have bad dreams *
Not at all
Extremely worried
If you experience sleep disorders, please specify the nature of these disorders
14. I feel tense, tired, my hands shake, I have difficulty relaxing *
Not at all
Extremely worried
15. I get easily moved and I frequently cry *
Not at all
Extremely worried
16. I am pale, when I speak I have sweating problems, vertigo, headache; I go to the toilet more often than usual *
Not at all
Extremely worried
17. I sometimes feel pressure or weight on my chest, difficulty breathing, short breath, a sensation of lack of breath *
Not at all
Extremely worried
18. I have feelings of guilt and feel overwhelmed with responsibilities towards my family and other people who depend on me *
Not at all
Extremely worried
19. My sexual desire has diminished *
Not at all
Extremely worried
20. I am overwhelmed by the thought that I might get infected by Coronavirus *
Not at all
Extremely worried
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