Questions | Answer choices | |
---|---|---|
Ft McMurray Demographics Questionnaire | ||
1 | Are you at school right now, while you are taking the survey? | Yes, no |
2 | Are you a student? | Yes, no |
3 | What gender do you identify with? | Female, male, other, prefer not to say |
4 | What is your age in years? | 10 years or less, 11 years, 12 years, 13 years, 14 years, 15 years, 16 years, 17 years, 18 years, 19 years, 20 years or more |
5 | What is your school? | 7, 8, 9, 10, 11, 12, other |
6 | What grade are you in? | Select from a list of all Ft McMurray schools with any classes in grades 7–12 |
7 | What school were you in for grade 6? | Select from a list of all Ft McMurray schools with grade 6 |
Red Deer EMPATHY Demographics Questionnaire | ||
1 | What gender do you identify with? | Female, male |
2 | What is today’s date? | Date selection |
3 | What is your date of birth? | Date selection |
4 | What grade are you in? | 6, 7, 8, 9, 10, 11, 12 |
Ft McMurray Patient Health Questionnaire (PHQ-A, Depression Symptoms) | ||
Over the past 2 weeks, how often have you been bothered by any of the following problems? | ||
1 | Feeling down, depressed, irritable or hopeless | Not at all, Several days, More than half the days, Nearly every day |
2 | Little interest or pleasure in doing things? | Same as above |
3 | Trouble falling or staying asleep, or sleeping too much | Same as above |
4 | Poor appetite, weight loss, or overeating? | Same as above |
5 | Feeling tired, or having little energy? | Same as above |
6 | Feeling bad about yourself-or that you are a failure or that you have let yourself or your family down | Same as above |
7 | Trouble concentrating on things, such as school work, reading or watching television | Same as above |
8 | Moving or speaking so slowly that other people could have noticed. Or the opposite-being so figety or restless that you have been moving around a lot more than usual | Same as above |
9 | Thoughts that you would be better off dead, or of hurting yourself in some way | Same as above |
Questions 10 and 11 asked only if answer to question 9 is not “Not at all” | ||
10 | Has there been a time in the past month when you have had serious thoughts about ending your life? | Yes, no |
11 | Have you ever, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt? | Yes, no |
Red Deer EMPATHY Patient Health Questionnaire (PHQ-A, Depression Symptoms) | ||
Over the past 2 weeks, how often have you been bothered by any of the following problems? | ||
1 | Feeling down, depressed, irritable or hopeless | Not at all, Several days, More than half the days, Nearly every day |
2 | Little interest or pleasure in doing things? | Not at all, Several days, More than half the days, Nearly every day |
3 | Trouble falling or staying asleep, or sleeping too much | Not at all, Several days, More than half the days, Nearly every day |
4 | Poor appetite, weight loss, or overeating? | Not at all, Several days, More than half the days, Nearly every day |
5 | Feeling tired, or having little energy? | Not at all, Several days, More than half the days, Nearly every day |
6 | Feeling bad about yourself-or that you are a failure or that you have let yourself or your family down | Not at all, Several days, More than half the days, Nearly every day |
7 | Trouble concentrating on things, such as school work, reading or watching television | Not at all, Several days, More than half the days, Nearly every day |
8 | Moving or speaking so slowly that other people could have noticed. Or the opposite-being so figety or restless that you have been moving around a lot more than usual | Not at all, Several days, More than half the days, Nearly every day |
9 | Thought of hurting yourself in some way | Not at all, Several days, More than half the days, Nearly every day |
10 | Thoughts that you would be better off dead | Not at all, Several days, More than half the days, Nearly every day |
11 | If you checked off “any problems”, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? | Not difficult at all; Somewhat difficult; Very difficult; Extremely difficult |
Questions 12 and 13 asked only if answer to question 10 is not “Not at all” | Yes, no | |
12 | Has there been a time in the past month when you have had serious thoughts about ending your life? | Yes, no |
13 | Have you ever, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt? | Yes, no |
Hospital Anxiety and Depression Scale (HADS, Anxiety Symptoms) | ||
Tick the box beside the reply that is closest to how you have been feeling in the past week. Don’t take too long over you replies: your immediate is best. | ||
1 | I feel tense or wound up: | Most of the time; A lot of the time; From time to time, occasionally; Not at all |
2 | I get a sort of frightened feeling as if something bad is about to happen: | Very definitely and quite badly; Yes, but not too badly; A little, but it doesn’t worry me; Not at all |
3 | Worrying thoughts go through my mind: | A great deal of the time; A lot of the time; From time to time, but not too often; Only occasionally |
4 | I can sit at ease and feel relaxed: | Definitely; Usually; Not often; Not at all |
5 | I get a sort of frightened feeling like ‘butterflies’ in the stomach: | Not at all; Occasionally; Quite often; Very often |
6 | I feel restless and have to be on the move: | Very much indeed; Quite a lot; Not very much; Not at all |
7 | I get sudden feelings of panic: | Very often indeed; Quite often; Not very often; Not at all |
CRAFFT Questionnaire (Drugs/Alcohol/Tabacco) | ||
During the past 12 months, did you: | ||
1 | Drink any alcohol (more than a few sips)? | Yes, no |
2 | Smoke any marijuana or hashish? | Yes, no |
3 | Use anything else to get high? | Yes, no |
4 | Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs? | Yes, no |
Questions 5–9 asked only if “yes” to one or more of questions 1–3. | ||
5 | Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? | Yes, no |
6 | Do you ever use alcohol or drugs while you are by yourself, or ALONE? | Yes, no |
7 | Do you every FORGET things you did while using alcohol or drugs? | Yes, no |
8 | Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use? | Yes, no |
9 | Have you ever gotten into TROUBLE while you were using alcohol or drugs? | Yes, no |
Tobacco Use Questionnaire | ||
During the past month: | ||
1 | Do you smoke tobacco products? | Yes, no |
2 | Do you use smokeless tobacco products? | Yes, no |
Rosenberg Self-Esteem Scale | ||
1 | On the whole, I am satisfied with myself. | Strongly agree, Agree, Disagree, Strongly disagree |
2 | At times, I think I am no good at all. | Strongly agree, Agree, Disagree, Strongly disagree |
3 | I feel that I have a number of good qualities. | Strongly agree, Agree, Disagree, Strongly disagree |
4 | I am able to do things as well as most other people | Strongly agree, Agree, Disagree, Strongly disagree |
5 | I feel I do not have much to be proud of. | Strongly agree, Agree, Disagree, Strongly disagree |
6 | I certainly feel useless at times. | Strongly agree, Agree, Disagree, Strongly disagree |
7 | I feel that I’m a person of worth, at least on an equal plane with others. | Strongly agree, Agree, Disagree, Strongly disagree |
8 | I wish I could have more respect for myself. | Strongly agree, Agree, Disagree, Strongly disagree |
9 | All in all, I am inclined to feel that I am a failure. | Strongly agree, Agree, Disagree, Strongly disagree |
10 | I take a positive attitude toward myself. | Strongly agree, Agree, Disagree, Strongly disagree |
Kidscreen Questionnaire (Quality of Life) | ||
Thinking about the last week: | ||
1 | Have you physically felt fit and well | Not at all, slightly, moderately, very, |
2 | Have you felt full of energy? | Never, seldom, quite often, very often, |
3 | Have you felt sad? | Never, seldom, quite often, very often, |
4 | Have you felt lonely? | Never, seldom, quite often, very often, |
5 | Have you had enough time for yourself? | Never, seldom, quite often, very often, |
6 | Have you been able to do the things that you want to do in your free time? | Never, seldom, quite often, very often, always |
7 | Have your parent(s) treated you fairly? | Never, seldom, quite often, very often, |
8 | Have you had fun with your friends? | Never, seldom, quite often, very often, |
9 | Have you got on well at school? | Not at all, slightly, moderately, very, |
10 | Have you been able to pay attention? | Never, seldom, quite often, very often, |
11 | In general, how would you say your health is? | Excellent, very good, good, fair, poor |