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Pandemic Stress Questionnaire
Pandemic Stress Questionnaire
EIB10103
NAME ID NO
Pandemic Stress
Biodata
Instruction: Please fill in the blanks provided or tick (/) the most appropriate answer.
1. Age: __________
2. Gender: Male ( ) Female ( )
3. Course: ME ( ) BTPD ( ) IF ( ) IB ( ) M( ) ACC ( )
4. Sem / Year: _____ / ______
5. Race: Malay ( ) Chinese ( ) India ( ) Others : ______________
Instruction: Please tick (/) the most appropriate answer. You are ADVISED to tick (/) more
than one answer.
6. Have you or someone you know ever had any experience being infected by Covid-19?
biha
( ) Family/Relative
( ) Friends
( ) Neighborhood
( ) Self
( ) Never experience
Other: __________________________________________________
9. Please rate your concerns about other family members getting Covid-19. fit
( ) Don’t have family member
( ) Very worried
( ) Not very worried
( ) Not worried at all
( ) Don’t know
Other: _________________________________________________
10. Have you or someone you know ever suffered from the following criteria? aida
( ) Stress
( ) Anxiety
( ) Panic Attacks
( ) Depression
( ) Sleep Disorders e.g. Insomnia
Other: __________________________________________________
11. What are the psychological disorders during the Covid-19 pandemic that affected
individuals? aien
( ) Emotional distress
( ) Mood swings
( ) Irritability
( ) Insomnia
( ) Post-traumatic stress
Other: _________________________________________________
12. What are the stressful factors that can increase stress, anxiety and depressions that you
have experienced? aida
( ) Economic difficulties
( ) Lack of health insurance
( ) Curfew and limitation of freedom
( ) The possibility of losing jobs
( ) Changes in daily care habits and social relationship
Other: ________________________________________________
13. How stressed you feel on a daily basis during the pandemic? ienas
( ) Not stressed at all
( ) Average
( ) Stress
( ) Most stressed
Other: _________________________________________________
Instruction: Please tick (/) the most appropriate answers. You are ADVISED to tick (/) more
14. What are the change of behavior that effected someone that you noticed? -ienas
( ) Difficulty of communicate
( ) Change sleep pattern
( ) Hard to rest and relax
( ) Avoid social interaction
Other: __________________________________________________________________
15. What are the group of people to be associated with higher level of anxiety and
depression? – aien
( ) Women
( ) Younger individuals
( ) Those living in rural areas
( ) Those with lower socioeconomic
( ) Those at higher-risk of Covid-19 infection
Other: __________________________________________________________________
Other: ____________________________________________________
18. What kind of neurological and mental complication that affect the citizens ?
( ) delirium
( ) agitation
( ) stroke
( ) Trauma
( ) depression
( ) bipolar disorder
Other: __________________________________________________________________
19. What kind of emotional effect to the mother after dumping the baby?
( ) Frustrated for throwing the baby
( ) Baby blues
( ) Hopeless no future for them
( ) Feel sinful
( ) Feel regrets
( ) Sad and useless
Other: ____________________________________________________________
20. What are the positive emotions that you may serve as a coping resource against stress?
biha
( ) Daily relationship
( ) Social gathering
( ) Get and provide warm, comforting, social support by video phone or text
( ) Create new routine and keep practicing health behaviors
Other: _______________________________________________________________
23. What are the things you have done to take care of your mental health during the Covid-19
pandemic? aida
( ) Talk to friends or family through phone
( ) Taking breaks from the news or social media
( ) Meditate or other mindfulness practices
( ) Exercise
( ) Participate in creative activities or hobby
Other: ____________________________________________________