QUESTIONNAIRE FORM

Ben Cat, 22th March 2024

We are a dedicated group of first year students from D4, majoring in Finance and Accounting in
Vietnamese German University(VGU). We are conducting Academic Writing 3 research with
the topic “The impact of loneliness on students’ health”.

The purposes of this research topic are to deeply explore VGU first year students’ perceptions
of loneliness as a psychological matter, and analyze the impacts of loneliness on their health.

All information collected will be only used for analyzing data of this thesis; therefore, all
information is private and confidential under any circumstances.

It may take nearly 5 minutes to finish the survey. Your cooperation greatly contributes to the
success of this research.

Please join this survey. Thank you!

PART 1: PERSONAL INFORMATION

Direction: Please choose your suitable answer:
1.1. Gender:
● Male
● Female
● Prefer not to say
1.2. Your major:
● Mechanical Engineering (MEN)
● Computer Science and Engineering (CSE)
● Electrical and Computer Engineering (ECE)
● Civil Engineering and Construction Management (BCE)
● Architecture (ARC)
● Finance and Accounting (BFA)
● Business Administration (BBA)

PART 2: THE EFFECT OF LONELINESS ON MENTAL HEALTH

Direction:Please CIRCLE only one number, which is Frequency
equivalent with the degree of frequency that you agree with. 1: Strongly disagree
2: Disagree
3: Neither agree nor disagree
4: Agree
5: Strongly agree

2.1 Loneliness tends to increase my feelings of unease and 1 2 3 4 5

worry.

2.2 When I feel lonely, I often catch myself thinking too 1 2 3 4 5

much and getting stuck on negative thoughts.

2.3 Loneliness often affects my ability to concentrate and 1 2 3 4 5

focus on tasks.

2.4 The experience of loneliness impacts my cognitive 1 2 3 4 5

abilities (problem-solving and critical thinking skills).

2.5 I have noticed a decrease in my overall energy levels 1 2 3 4 5

due to loneliness.

2.6 I don’t have any motivation when I feel lonely. 1 2 3 4 5

2.7 I feel a lack of companionship. 1 2 3 4 5

2.8 I feel unconfident to make new relationships with 1 2 3 4 5

others.

2.9 I often feel left out or excluded from social gatherings 1 2 3 4 5

or activities.

2.10 I frequently experience negative feelings (sadness, 1 2 3 4 5

stress, despair and emptiness).

2.11 Loneliness makes me feel worthlessness and self- 1 2 3 4 5

criticism.

PART 3: THE EFFECT OF LONELINESS ON PHYSICAL HEALTH

Direction:Please CIRCLE only one number, which is Frequency
equivalent with the degree of frequency that you agree with. 1: Strongly disagree
2: Disagree
3: Neutral
4: Agree
5: Strongly agree

3.1 My whole body feels tired due to loneliness. 1 2 3 4 5

3.2 Loneliness makes me feel exhausted. 1 2 3 4 5

3.3 Loneliness has negatively affected my overall well- 1 2 3 4 5

being.

3.4 I’ve thought about seeking professional help and 1 2 3 4 5

therapy.

3.5 Loneliness makes me feel worthlessness and self- 1 2 3 4 5

criticism

3.6 Loneliness often leads me to lack of exercises and 1 2 3 4 5

proper nutrition

3.7 Loneliness often leads me to engage in unhealthy 1 2 3 4 5

behaviors (overreacting, substance abuse, etc).

3.8 My sleep schedule was messed up because of 1 2 3 4 5

loneliness.

3.9 I experience sleep deprivation due to loneliness. 1 2 3 4 5

3.10 I usually consume alcohol. 1 2 3 4 5

3.11 I found alcohol can help me to reduce the feeling of 1 2 3 4 5

loneliness.

3.12 I feel an intense feeling of hopelessness and despair 1 2 3 4 5

3.13 Loneliness increases my risk of experiencing suicidal 1 2 3 4 5

thoughts or behaviors.

THANKS FOR YOUR COOPERATION

 FRAMEWORK
Original:
https://doi.org/10.1016/j.psychres.2020.113514
Sci-hub:
https://sci-hub.3800808.com/https://www.sciencedirect.com/science/article/abs/pii/
S0165178120331759?via%3Dihub

CITATION PARAPHRASED QUESTIONS

2.1 Depression I frequently experience negative
feelings (sadness, stress, despair and
emptiness).
Loneliness makes me feel
worthlessness and self-criticism.
2.2 Anxiety Loneliness tends to increase my
feelings of unease and worry.
When I feel lonely, I often catch
myself thinking too much and getting
stuck on negative thoughts.

2.3 Suicidality I feel an intense feeling of

hopelessness and despair
Loneliness increases my risk of
experiencing suicidal thoughts or
behaviors.

2.4 General Mental Health I have noticed a decrease in my

overall energy levels due to
loneliness.
I don’t have any motivation when I
feel lonely.
2.5 General Health My whole body feels tired due to
loneliness.
Loneliness makes me feel exhausted.
2.6 Well-being Loneliness has negatively affected
my overall well-being.
I’ve thought about seeking
 professional help and therapy.
Loneliness makes me feel
worthlessness and self-criticism.
2.7 Physical Health Loneliness often leads me to lack of
exercises and proper nutrition
Loneliness often leads me to engage
in unhealthy behaviors (overreacting,
substance abuse, etc).

2.8 Sleep My sleep schedule was messed up

because of loneliness.
I experience sleep deprivation due to
loneliness.
2.9 Cognition Loneliness often affects my ability to
concentrate and focus on tasks.
The experience of loneliness impacts
my cognitive abilities (problem-
solving and critical thinking skills).

2.10 Alcohol I usually consume alcohol.

I found alcohol can help me to
reduce the feeling of loneliness.
x Social relationship I feel a lack of companionship.
I feel unconfident to make new
relationships with others.
I often feel left out or excluded from
social gatherings or activities.