PERSONALI IDENTITY

1. Name
: ................................................
..............................
2. Age
: ................................................
..............................
3. Sex
:M/F
4. Address
: ................................................
..............................
5. Occupation
: ................................................
..............................
6. Education
: ................................................
..............................
7. Marital Status
: Married / Not Married / Divorced
8. Number of children
: ...............................................
..............................
9. The duration of Caring families
: ................................. year
10. Relationships with Patients
: ..............................................
...............................
11. Social activities
: ...............................................
.................................
12. Special note
: ...............................................
..................................
FAMILY EXPENSES QUESTIONNAIRES
Charging Instructions :
1. Please fill out the following questions by ticking the appropriate answer
to that you experienced.
2. Answer with:
NE if you've never experienced
SE if you sometimes - sometimes experience
EX if you are experiencing
AE if you always experience

No

Statement

1.

I'm a long way on a regular basis to check

my family who have a mental disorder.

2.

I spent the money to a family member

having a mental disorder.

NE

SE

EX

AE

No

Statement

3.

I work hard to care for family members who

have mental disorders.

4.

I was busy caring for family members who

have mental disorders.
I'm sick of taking care of family members
who have mental disorders.

5.

6.

I was disturbed because of caring for family

members who have mental disorders.

7.

My time was wasted because of caring for

family members who have mental disorders.

8.

I lost work time due to caring for family

members who have mental disorders.

9.

My free time is reduced because of caring

for family members who have mental
disorders.

10.

My little rest for family members caring for

mentally ill.

11.

I attend social activities despite having to

care for family members who have mental
disorders.

12.

My life plan is still running despite having to

care for family members who have mental
disorders.

13.

I do not get help to care for family members

who have mental disorders.

14.

I do not have a friend to share the problem

of caring for family members who are
experiencing mental disorders.

NE

SE

EX

AE

No

Statement

15.

I was angry that family members caring for

mentally ill.

16.

I am desperate for a family member with

mental disorders.

17.

I shy away from any family members who

have mental disorders.

18.

I'm sad because there are family members

who have mental disorders

19.

I worry because there are family members

who have mental disorders.

20.

I'm insulted because a family member is

mentally ill.

21.

I'm tired of caring for family members who

have mental disorders.

22.

I got scared because a family member is

mentally ill.

23.

I was wrong because a family member is

mentally ill.

24.

I feel depressed because a family member is

mentally ill.

25.

I am confused because there are family

members who have mental disorders.

26.

I get the ease in obtaining information about

mental disorders.

27.

I know what to do on the family members

who have mental disorders.

NE

SE

EX

AE

No

Statement

28.

I provide my own room for families who have a

mental disorder.

29.

I do not think there was my family who have

a mental disorder.

30

I do not think there was my family who have

a mental disorder.

NE

SE

EX

AE