Name (optional):__________________ . Age: __________________.

Gender : ___________________ . Class: _________________.

Relationship status: _______________. Address: _____________________.

1-What is occupation of your parents?

Answer:

2- What is estimated income of your guardian?

a) < Rs.20,000 b) < Rs. 50,000 c) < Rs.100,000 d) Above

3-How many siblings do you have?

a) Brothers b) Sisters

4- Are you: a) hostelite b) day-scholar

5- Are you satisfied with administration of your institute?

a) Yes b) No c) Reason:________________________

6- What are your Hobbies?

a)Reading-Writing b) Entertainment c) others : ____________________

7- What games do you play when you are at leisure?

a)E-gaming b)Cricket-Football c) others: ____________________

8- Number of supplementary exam attempts? (If any)

a)1st year b) 2nd year c)3rd year d) None

9- Do you share your issues with Family members?

a) Yes b) No
10- Do they help to sort out your Problems?

a) Yes b) No

11- Did you visit any Psychiatrist before?

a) Yes b) No

12- Is there any history of mental disorders in your Family?

a) Yes b) No c) If Yes then what is it ___________

13- Do you like to hurt yourself by cutting or pinching skin?

a) Yes c) No
b) If yes, then how would you prefer to do it ___________________________________

14- Do you Smoke or do any other drug Abuse?

a) Yes b) No c) Name ________________

15- Do you get ideation about ending your life?

a) Yes b) No

16- Did you ever witness any sort of disturbing event like RTA/murder/natural disasters?
If yes, then share few words about your experience.

Answer:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
___________________________________________

17- What do you think is the cause of your Depression?

Answer:________________________________________________________________________________________
_______________________________________________________________________________________________
________________________________________________________

18- What was your number of ETEA attempts?