Aasra Survey Questionaire ( Suicide Susceptibility Survey)
Thank you for being honest and earnest in filling up this questionnaire. We appreciate your efforts wholeheartedly and are grateful for your co-operation.
Full Name *
Your answer
City *
Your answer
State *
Your answer
Gender *
male/female
Your answer
Country *
Your answer
Age *
Your answer
1) Are you aware of the growing incidence of Mental illness, Depression and Suicide in your country? *
2) What according to you are the reasons for this malaise? *
(Tick as many factors s you feel appropriate)
Required
3) Have you ever felt depressed or suicidal in the past 2 years? *
4) If yes to either do you believe you suffer from a mental illness?
5) Have you ever attempted suicide in your lifetime? *
6) If Yes, How many Times have you attempted Suicide?
Your answer
7) Was every attempt treated medically ?
8) Was your life the same as before, after the attempt?
9) Did your life change after the attempt?
(Tick whatever appropriate)
10) Has the attempt
Yes
No
been treated with sensitivity and care by your family and friends?
been reported in the Media?
has a case been registered by the local police station?
11) Do you suffer from a mental illness as diagnosed by a Medical Professional? *
12) If yes, what is the diagnosis?
Your answer
13) If Yes. Did the Medical professional take time to explain to you the details about the illness diagnosed ?
14) Would you say that you and your family are well-informed about the illness, medication aspects and the relapses that occur? *
15) What kind of help have you sought for your mental health issues (if any)?
(Tick as many as you feel appropriate)
16) Do you know about Aasra, the suicide prevention crisis hotline providing 24x7 emotional support through it’s helpline service 91-22-27546667/9 ? *
17) Now that you know, would you seek help from this service whenever you feel depressed or suicidal?
18) Would you consider seeking professional help when confronted with a mental health issue? *
19) If No, What are the reasons?
Your answer
20) How did you learn about this psychological first aid service provided by Aasra? *
( Tick one or more as appropriate)
Required
Is there anything else that you would like to confide in us about? Feel free to do so as we ensure complete confidentiality and anonymity, as desired.
Your answer
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