UOB Logo

Follow up Questionnaire

Thank you for volunteering to participate in this research.

Instructions: Please read each statement and select a response from the dropdown box which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.


1. I found myself getting upset by quite trivial things

2. I was aware of dryness of my mouth

3. I couldn’t seem to experience any positive feelings at all

4. I experienced breathing difficulty (eg, excessively rapid breathing)

5. I just couldn’t seem to get going

6. I tended to over-react to situations

7. I had a feeling of shakiness (eg, legs going to give way)

8. I found it difficult to relax

9. I found myself in situations that made me so anxious I was most relieved when they ended

10. I felt that I had nothing to look forward to

11. I found myself getting upset rather easily

12. I felt that I was using up a lot of nervous energy

13. I felt sad and depressed

14. I found myself getting upset when I was delayed in any way (eg, lifts, traffic lights, being kept waiting)

15. I had a feeling of faintness

16. I felt that I had lost interest in just about everything

17. I felt that I wasn’t worth much as a person

18. I felt that I was rather touchy

19. I perspired noticeably (eg, hands sweaty) in the absence of high temperatures or physical exertion

20. I felt scared without any good reason

21. I felt that life wasn’t worthwhile

22. I found it hard to wind down

23. I had difficulty swallowing

24. I couldn’t seem to get any enjoyment out of the things I did

25. I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)

26. I felt down-hearted and blue

27. I found that I was very irritable

28. I felt I was close to panic

29. I found it hard to calm down after something upset me

30. I feared that I would be “thrown” by some trivial but unfamiliar task

31. I was unable to become enthusiastic about anything

32. I found it difficult to tolerate interruptions to what I was doing

33. I was in a state of nervous tension

34. I felt I was pretty worthless

35. I was intolerant of anything that kept me from getting on with what I was doing

36. I felt terrified

37. I could see nothing in the future to be hopeful about

38. I felt that life was meaningless

39. I found myself getting agitated

40. I was worried about situations in which I might panic and make a fool of myself

41. I experienced trembling (eg, in the hands)

42. I found it difficult to work up the initiative to do things

Instructions: This section consists of 10 items. Please read each statement carefully. Select the answer that best describes your response.

1	On the whole, I am satisfied with myself

2	At times I think I am no good at all

3	I feel that I have a number of good qualities

4	I am able to do things as well as most other people

5	I feel I do not have as much to be proud of

6	I certainly feel useless at times

7	I feel that I am a person of worth, at least on an equal plane with others

8	I wish I could have more respect for myself

9	All in all, I am inclined to feel that I am a failure

10	I take a positive attitude towards myself

Instructions: Please indicate which stage most applies to you by ticking a box.

The term criterion refers to the minimum amount of physical activity outlined by the World Health Organisation (WHO), which is 30 minutes of moderate exercise 3 times a week, or 20 minutes of vigorous, high-intensity exercise 3 times a week.

Pre-contemplation (no intention of becoming physically active)

Contemplation (thinking about becoming physically active within the next 6 months)

Preparation (making small changes in behaviour but still not meeting a criterion for physical activity)

Action (meeting a criterion for physical activity, but only recently)

Maintenance (meeting a criterion for physical activity for 6 months or longer)

The following questions ask about people in your environment who provide you with help or support.

For the first part, list all the people you know, excluding yourself, whom you can count on for help or support in the manner described. Give the person's initials and their relationship to you (see example below).

For the second part, circle how satisfied you are with the overall support you have. If you have no support for a question, check the words 'No one,' but still rate your level of satisfaction. Do not list more than nine persons per question.

Please answer questions as best you can. All you responses will be kept confidential.

Example:

Who do you know whom you can trust with information that could get you in trouble?

No one 1) T.N. (Brother) 4) T.N. (father) 7)

2)L.M. (friend) 5) L.M. (employer) 8)

3) R.S. (friend) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

Social Support Questionnaire

1. Whom can you really count on to listen to when you need to talk?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

2. Whom could you really count on to help you if a person whom you thought was a good friend insulted you and told you that he/she didn't want to see you again?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

3. Whose lives do you feel you are an important part of?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

4. Whom do you feel would help you if you were married and had just separated from your spouse?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

5. Whom could you really count on to help you out in a crisis situation, even though they would have to go out of their way to do so?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

6. Whom can you talk to frankly, without having to watch what you say?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

7. Who helps you feel that you truly have something positive to contribute to others?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

8. Whom can you really count on to distract you from your worries when you feel stressed?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

9. Whom can you really count on to be dependable when you need help?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

10. Whom could you really count on to help you out if you had just been fired from you job or expelled from your university/school?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

11. With whom can you totally be yourself?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

12. Whom do you feel really appreciates you as a person?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

13. Whom can you really count on to give you useful suggestions that help you to avoid making mistakes?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

14. Whom can you count on to listen openly and uncritically to your innermost feelings?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

15. Who will comfort you when you need it?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

16. Whom do you feel would help if a good friend of yours had been in a car accident and was hospitalised in a serious condition?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

17. Whom can you really count on to help you feel more relaxed when you are under pressure or tense?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

18. Whom do you feel would help if a family member very close to you died?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

19. Who accepts you totally, including both your worst and your best points?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

20. Whom can you really count on to care about you, regardless of what is happening to you?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

21. Whom can you really count on to listen to you when you are very angry at someone else?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

22. Whom can you really count on to tell you, in a thoughtful manner, when you need to improve in some way?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

23. Whom can you really count on to help you feel better when you are feeling generally 'down in the dumps'?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

24. Whom do you feel truly loves you deeply?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

25. Whom can you count on to console you when you are very upset?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

26. Whom can you really count on to support you in major decisions you make?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

27. Whom can you really on to help you feel better when you are very irritable, ready to get angry at almost anything?

No one 1) 4) 7)

2) 5) 8)

3) 6) 9)

How satisfied?

Very satisfied Fairly Satisfied A little satisfied A little dissatisfied Fairly dissatisfied Very dissatisfied

Email address

End of questionnaire. If you are ready to submit your responses, please click the button below.