Academic Depression Survey Questionnaire

Instructions: Please read each statement carefully and indicate how much each statement applied to
you over the past week. Use the following scale:

0 - Did not apply to me at all

1 - Applied to me to some degree, or some of the time

2 - Applied to me to a considerable degree, or a good part of the time

3 - Applied to me very much, or most of the time

*Demographic Information:*

1. Age: ________

2. Gender: [ ] Male [ ] Female

3. Academic Level:

1. Over the past week, I found it difficult to work up the initiative to complete my academic tasks.

-0 1 2 3

2. I felt that I was lacking in academic accomplishment.

-0 1 2 3

3. Over the past week, I felt downhearted and blue about my academic performance.

-0 1 2 3

4. I found it hard to motivate myself academically over the past week.

-0 1 2 3
5. Over the past week, I felt that I had nothing to look forward to in my academic life.

-0 1 2 3

6. I felt that I was not doing well in my academic studies over the past week.

-0 1 2 3

7. Over the past week, I felt that I was not achieving academic success despite my efforts.

-0 1 2 3

8. I felt unhappy about my academic performance over the past week.

-0 1 2 3

9. Over the past week, I felt that I was not making progress in my academic goals.

-0 1 2 3

10. I found it difficult to concentrate on my academic tasks over the past week.

-0 1 2 3

*Additional Questions:*

11. Have you sought any form of support or counseling for academic-related stress or depression in the
past year?

- [ ] Yes

- [ ] No

12. How would you rate your overall satisfaction with your academic life currently?

- [ ] Very satisfied

- [ ] Satisfied

- [ ] Neutral

- [ ] Dissatisfied

- [ ] Very dissatisfied
13. In your opinion, what are the main factors contributing to academic stress or depression among
students?

14. Do you feel comfortable discussing academic-related stress or depression with someone you trust?

- [ ] Yes

- [ ] No

15. Is there anything else you would like to share about your experiences with academic stress or
depression?