QUESTIONNAIRE

Researcher-Made Questionnaire on Factors Affecting the Grade 10 Students that resorts to

suicidal tendencies

Name: _____________________________ (optional) Sex: ___________ (required)

Age: ________________ (required) Section: ____________ (required)

Direction: Please check () and rate yourself accordingly using the scale below. Your honesty in
answering the following statements is highly appreciated.

5 4 3 2 1
(alwa (ofte (sometim (rarel (nev
ys) n) es) y) er)
1. I feel being isolated.
2. I think that no one loves me.
3. I feel that I am burden to my family.
4. I lose hope in my life.
5. I feel uneasy in front of the people.
6. I wish I was dead and never wake up the next day.
7. I am collecting stuff that can hurt me physically.
(sample)
8. I experienced being underestimated.
9. I am judge by my physcical appearance.
10. I am affected whenever I see my parents fighting.
11. I am affected when I see some broken families.
12. I experience having financial problems.
13. I receive harsh words from my parents. (sample, “and
the like”)
14. I experience slashing my wrist using blades or any sharp
objects
15. There are times when it comes to my mind overdosing myself
with medicines
16. I am affected whenever I fail in some subjects.
17.I don't like doing some activities in school .
18. I am affected whenever my teacher scolds me.
19. I experienced being bullied at school.
20. I feel hurt whenever my friends say harsh words to me.
21. I feel sad whenever my friends fight me.
22. I experienced failed relationship.
23. I drink alcoholic beverages.
24. I smoke (vape, cigarettes)
25. I experience physical abuse.
26. I experience sexual abuse.