7.4.

Data Collection Instruments (English version)

Questionnaire Identification Data

001 Questionnaire Identification Number______________
002 woreda: ______________
003 High school______________
004 Date of data collections: ______/____/___________
005 Time of Start data collections: _________:___________
006 Time of End: _________:__________
007 Checked by Supervisor _________________ ______________ ____________

INSTRUCTION: The questionnaire has five parts. It will take about 20-30 minutes to fillout
the quetionnaire. Please try to respond to all questions. Thank you very much for your
patience.

No Questions Answer
SECTION I: SOCIO DEMOGRAPHIC INFORMATION

SDQ-101 What is your age? ________________

SDQ-102 What is your sex? 1.Male
2. Female
SDQ-103 With whom do you live now? 1. With one parent
2. With two parents
3. with Family
4. Others
SDQ-104 In What grade/class are you?
1. 9th
2. 10th
3. 11th
4. 12th
SDQ-105 Have you family history of suicide? 1. Yes
2. No

SDQ-106 Have you family history of suicide? 1. Yes

2. No
 SECTION II: CLINCAL FACTORS

Factors to assess depression, anxiety and stress

Please read each statement and circle only one response from 0, 1, 2 or 3 which indicates how much
the statement applied to you over the past week. There is no right or wrong answers. Do not spend
too much time on any statement.

The rating scale is as follows:

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

S. No QUESTIONS Rating

DASS-201 0 1 2 3
I found it hard to wind down
DASS-202 0 1 2 3
I was aware of dryness of my mouth
DASS-203 0 1 2 3
I couldn't seem to experience any positive feeling at all
DASS-204 0 1 2 3
I experienced breathing difficulty (e.g., excessively rapid
breathing, breathlessness in the absence of physical
exertion)
DASS-205 0 1 2 3
I found it difficult to work up the initiative to do things
DASS-206 0 1 2 3
I tended to over-react to situations
DASS-207 0 1 2 3
I experienced trembling (e.g., in the hands)
DASS-208 0 1 2 3
I felt that I was using a lot of nervous energy
DASS-209 0 1 2 3
I was worried about situations in which I might panic and
make a fool of myself
DASS-210 0 1 2 3
I felt that I had nothing to look forward to
DASS-211 0 1 2 3
I found myself getting agitated
DASS-212 0 1 2 3
I found it difficult to relax
DASS-213 0 1 2 3
I felt down-hearted and blue
DASS-214 0 1 2 3
I was intolerant of anything that kept me from getting on
with what I was doing
DASS-215 0 1 2 3
I felt I was close to panic
DASS-216 0 1 2 3
I was unable to become enthusiastic about anything
DASS-217 0 1 2 3
I felt I wasn't worth much as a person
DASS-218 0 1 2 3
I felt that I was rather touchy
DASS-219 0 1 2 3
I was aware of the action of my heart in the absence of
physical exertion (e.g., a sense of heart rate increase, heart
missing a beat)
DASS-220 0 1 2 3
I felt scared without any good reason
DASS-221 0 1 2 3
I felt that life was meaningless

S.NO QUESTIONS Alternative

response
SECTION III;SUBSTANCE RELATED FACTORS Please circle one
Response for each
SRQ-301 In your life, which of the following substance Have you
ever used(for non-medical use only)
1.Alcohol 1. yes
2. No
2.Cigarette 1. yes
2. No
3. Khat 1. yes
2. No
4. Others, specify ……………………………….
SRQ-302 In the past 3 months, how often have you used the 0 Never
substances you mentioned? (for non-medical use only) 1 Once or twice
2 Monthly
3 Weekly
4 Daily or almost
daily

1 Alcohol 0 Never
1 Once or twice
2 Monthly
3 Weekly
4 Daily or almost
daily
2 Cigarette 0 Never
1 Once or twice
2 Monthly
3 Weekly
4 Daily or almost
daily
3 khat 0 Never
1 Once or twice
2 Monthly
3 Weekly
 4 Daily or almost
daily
4. Others, specify ……………………. 0 Never
1 Once or twice
2 Monthly
3 Weekly
4 Daily or almost
daily

.
S.NO QUESTIONS Response
SECTION IV; PSYCHOSOCIAL FACTORS Please circle only one
response
PSQ.401 How many people are so close to you that you can Count A. None
on them if you have serious personal problems (choose
one option)? B.1 or 2
C.3-5
D. More than 5
PSQ.402 How much concern do people show in what you are A. No concern and
doing (choose one option)? interest
B. Little concern and
interest
C. Uncertain
D. some
E. a lot
PSQ.403 How easy is it for you to get practical help from friends A. Very difficult
or dorm-mates’ if you need it (choose one option)?
B. Difficult
C. Possible
D. Easy
E. Very easy
The next 5 questions ask about your experiences at school and at home.
PSQ_404 During the past 30 days, on how many days did you miss A= 0 days
classes or school without permission?
B= 1or 2 days
C=3 to 5 days
 D=6 to 9 days
E=10 or more
PSQ.405 During the past 30 days, how often were most of the A. Never
students in your school kind and helpful? B. Rarely
C. Sometimes
D. Most of the time
E. Always

PSQ.40 How often did your parents or guardians understand and A. Never
Responds to your problems and worries? B. Rarely
6
C. Sometimes
D. Most of the time
E. Always

PSQ.40 How often did your parents or guardians check to see if A. Never
your homework was done? B. Rarely
7
C. Sometimes
D. Most of the time
E. Always

PSQ.40 During the past 30 days, how often did your parents or A. Never
guardians checks what you are doing with your free B. Rarely
8
time? C. Sometimes
D. Most of the time
E. Always

The next question asks about physical attacks. A Physical attack occurs when one or more people hit
or strike someone, or when one or more people hurt another person with a weapon (such as a stick,
knife, or gun). It is not a physical attack when two students of about the same strength or power
choose to fight each other.

PSQ.40 4. During the past 12 months, how many times were you A. 0 times
physically attacked at school? B. 1 time
9
C. 2 or 3 times
D. 4 or 5 times
E. 6 or 7 times
F. 8 or 9 times
G. 10 or 11 times
H.12 or more times

The next question asks about physical fights. A Physical fight occurs when two students of about the
same strength or power choose to fight each other.
PSQ.41 During the past 12 months, how many times were you in A. 0 times
a physical fight on school property? B. 1 time
0
C. 2 or 3 times
D. 4 or 5 times
E. 6 or 7 times
F. 8 or 9 times
G. 10 or 11 times
H. 12 or more times

The next 3 questions ask about bullying. Bullying occurs when one or more students or other people
about your age say or do hurtful or mean things. Bullying can occur when someone teases, threatens,
ignores, spreads rumors about, calls someone a bad name, makes sexual remarks, or hits, shoves, or
hurts another person over and over again. It is not bullying when two people of about the same
strength or power argue or fight or tease each other in a friendly way

SEQ.41 During the past 12-months, were you bullied on school A. Yes
property? B. No
1

Cyber bullying: is a form of bullying using social media and other forms of online communication.
Cyber bullying may happen on Instagram, Twitter, Snap chat, and Facebook, and other social media
platforms or through texting and email.

PSQ.41 During the past 12 months, were you cyber bullied? A. Yes
B. No
2

Sexual violence: is Being forced to do sexual things that

you do not want to do is called sexual violence. Sexual
violence may include being kissed or touched, being
spied on when you are not fully dressed, being shown
someone’s private parts, pulling at your clothes to expose
your Underwear or body, making sexual comments or
 gestures, and being physically or verbally forced to have
sexual intercourse. Sexual violence may occur in person
or on social media or the internet.

PSQ.41 Have you ever been physically or verbally forced to A. Yes

have sexual intercourse when you did not want to? B. No
3

SECTION V; SUICIDAL BEHAVIOR QUESTIONNIER

The following questionnaire consists of 4 items. Please read each item carefully and then
circle only one alternative choice in each group. Be sure that you do not choose more than
one statement for any item.

SBQ- Have you ever thought about or kill yourself? 1= never

5O1
2= it was just a brief passing thought
3a= I have had a plan at least once to kill
myself but did not try to do it
3b= I have had a plan at least once to kill
myself and really wanted to die.
4a= I have attempted to kill myself but
did not want to die.
4b= I have attempted to kill myself and
really hoped to die.
SBQ- How often have you thought about killing 1= never
502 yourself in the past year?
2= rarely(1 times)
3= sometimes(2 times)
4= often(3-4 times)
5= very often(5 or more times)
SBQ- Have you ever told someone that you were going 1= no
503 to commit suicide, or that you might do it?
2a= yes, at one time, but did not really
want to die.
 2b= yes, at one time, and really wanted
to do it.
3a= yes, more than once, but did not
want to do it.
3b= yes, more than once, and really want
to do it.
SBQ- How likely is it you will attempt suicide someday? 0= never
504
1= no chance at all
2= rather unlikely
3= unlikely
4= likely
5= rather likely
6= very likely
Extra quetions
6. If you attempted suicide in your life time, did A. I did not attempt suicide in my life
any attempt result in an injury, poisoning, or time
overdose that had to be treated by a doctor or B. Yes
nurse? C. No

7. If you have ever lifetime suicidal ideation or A. I have never thought or attempted
attempts, what was the reason? suicide in my life
B. conflict with parent
C. relationship breakup
D. academic failure

8. If you attempted suicide in your life time, what A. I did not attempt suicide in my life
method did you use for the most recent attempt? B. I cut myself
C. I swallowed or injected drugs or
something poisonous
D. I burnt myself
E. I tried to hang or suffocate myself
F. I used some other method
7.7. Data Collection Questionnaire Afan Oromo Version

Seensa: Gaaffiwwan armaan gadii kutaa Shan qaba. Yaada gaaffiwwan kana deebistanii
fixuuf /xumuruuf daqiqaa 20-30 isinitti fudhata. Hanga danda’ametti gaaffiwwan hunda
deebistanii xumuruuf yaala. Tasgabboftanii gaafiwwan kanaaf deebi kennuu keessaniif
galatooma
Kutaa 1. Hawwassumma fi Dimograafii
Lakk. Gaaffiwwan Deebii
Koodii
HD101 Umriin kee Meeqa? ………….
HD-102 Saalli Kee Maali? 1. Dhiira
2. Dhalaa/Dubartti
HD - 103 Yeroo amma kana Eenyu wajjin Jiraatta 1. Abbaa fi haadha kiyya Wajjin
2. Abbaa/ haadha kiyya Wajjin
3. Fira Wajjin
4. Kan Biraa( Ibsi) ………
HD-104 Kutaa Meeqa Baratta? 1. 9ffaa
2. 10ffaa
3. 11ffaa
4. 12ffaa
HD-105 Maatii keessan keessatti namni of 1. Eyyen
Ajjeesuuf Yaali godhe ykn off ajjessee ni 2. Hin jiru
jira?
HD-106 Hiriyaa keessan keessa namni of 1.Eyyen
Ajjeesuuf Yaali godhe ykn off ajjessee ni 2.Hin jiru
jira?

Kutaa II: Sababawwan xinsamuu Hawaasaa

Warshaalee mukaa’uu, yaaddoo fi dhiphina
Maaloo Gaaffiin tokkon tokkon erga dubbistanii booda lakk 0, 1, 2, 3 kessa tokko filachun
iiratti akka martanii fi lakkoofsi kunis hamam takka isin ibsuu akka danda’u torban darbe
keessattii. Deebiin sirrii fi sirrii hin taane hin jiru. Ibsa kamirrattiyyuu yeroo baayyee hin
dabarsin.

Iskeeliin qubannaa akka armaan gadiiti:

0 walumaa galatti na hin ibsuu
1 yeroo muraasa na ibsa’a
2 yeroo caala na ibsa’a
3 yeroo baay’ee na ibsa’a dha.

Lakk. Gaaffiwwan Deebii /

Koodii
SXH-201 Of tasgabeessun dhadhabee 0 1 2 3
SXH-202 Gogiinsa afaan koo irratti hubadheen ture 0 1 2 3
 SXH-203 Miira gaariin tokko illeen natti hin 0 1 2 3
dhagahamnee
SXH-204 Sababa tokko malee, hargansuu/Hafuura 0 1 2 3
Baafachun na rakkise ture (fkn, hargansuu
ariifachiisaa, hargansuu dhabuu qaama
keessatti)
SXH-205 kakka’umsa qu’aachu/hojii jalqbuf na 0 1 2 3
rakkisee ykn natti ulfaatee ture (waa cufafu
kakka’umsan dhabee)
SXH-206 Waa cufafu arrifachun ture (jarjaraan ture 0 1 2 3
SXH-207 Nin holladhee/raafamee (fkn, harkki na 0 1 2 3
hollatee /raafamee)
SXH-208 Humna ol yaddawuu akkaan jirutti natti 0 1 2 3
dhagahame
SXH-209 Waan ifduraa nanasisu fi gowwomsu 0 1 2 3
danda’ufiin dhiphadhe
SXH-210 Akkan waan gara fuuldurarraa abdii takka hin 0 1 2 3
qabne natti dhagahame(abdii kutannatu natti
dhagahame)
SXH-211 Salphumatti dallanuun firatti arkee 0 1 2 3

SXH-212 Buhaaruu na rakkise 0 1 2 3

SXH-213 qalbii cabu fii gadda natti dhagahame 0 1 2 3
SXH-214 Ani waan hojjechu jiruraa kan na dhorku 0 1 2 3
kamiyyuf obsaan dhabe.(waa cufafu obsaan
dhabee)
SXH-215 Akka nama rifatuuf dhiyatee natti 0 1 2 3
dhagahame(rifatu rifatu natti dhagahame)
SXH-216 Waa’ee waan kamiifuu fedhii hin qabu 0 1 2 3
ture(waan duraan nagamachisu cufaf,
gamachuu dhabutu natii dhagahame)
SXH-217 Ani akka nama tokkootti gatii akka hin 0 1 2 3
qabne natti dhagahame(nama faydaa hin
qabnee tahu natii dhagahame)
SXH-218 sababa tokko malee, miira onnee dabaluu, 0 1 2 3
onnee rukuttaa dhabuu kkf, gochaa onnee
kootti nan hubadha ture,
SXH-219 nama salphumatti Humna ol aruu tahutu 0 1 2 3
natti dhagahame
SXH-220 Sababa tokko malee sodaatu natti 0 1 2 3
dhagahame
SXH-221 Jireenyi akka hiikka hin qabne natti 0 1 2 3
dhagahame.

Kutaa III Gaafii Arraddan Walqabatu

SAW Jireenya kee keessatti Araddawwan Debii codii
301 keessaa kaam fayyadamtee beekta?
1. Alkoolii 1. Eyyen
 2. lakkii
2. Sigaaraa/ Tamboo 1.Eyyen
2.lakkii
3. Jimaa 1. Eyyen
2. lakkii
4. Kan biraa (Ibsi/caqasi) 1.Eyyen
2.lakkii
SAW Araddawwan Jireenya kee keessatti Debii codii
302 Fayyadamte keessaa Baatii / ji’a sadeen
darban kana keessatti yeroo meeqa’a
fayyadamte?
1.Alkoolii 0. Gonkuma
1.yeroo tokko
ykn lama
2. Ji’a ji’aan
3.torbaan
torbanin
4. yeroo mara
2.Sigaaraa/ Tamboo 0. Gonkuma
1.yeroo tokko
ykn lama
2. Ji’a ji’aan
3.torbaan
torbanin
4. yeroo mara
3.Jimaa 0. Gonkuma
1.yeroo tokko
ykn lama
2. Ji’a ji’aan
3.torbaan
torbanin
4. yeroo cufa
4.Kan biraa (Ibsi/caqasi) 0. Gonkuma
1.yeroo tokko
ykn lama
2. Ji’a ji’aan
3.torbaan
torbanin
4. yeroo mara

Kutaa IV: Gaafii waa’ee hawaasaa fi xin sammuu ilalatuu

Gaaffiwwan armaan gadii haala walitti dhuffenya hawaasa nannoo kee wajjin qabdu
muuxannoo dhuunfa kee ilaalatta. Deebii tokko irratti marsi.
Lakk Gargaarssa Hawaasa illalchisa Deebii
HHN Namoota meeqatu sitti dhiyaata kan ati isaan A. Homaayyuu
401 irratti lakkaa’uu dandeessu yoo rakkoo B. 1 ykn 2
 dhuunfaa cimaa si qabaatte? C. 3-5
D. 5 ol
HHN Namoonni waan ati hojjettu keessatti A. Dantaa fi fedhii hin qaban
402 hammam quuqama agarsiisuu? B. Dantaa fi fedhii xiqqoo
C. Kan hin mirkanoofne
D. Muraasa
E. baayyee

HHN- Gargaarsa sirrii hiriyaa ykn barattota irraa A. baayyee Ulfaata dha
403 argachuun hangam sii salphaadha yoo kan B. Ulfaata dha
barbaaddu ta’e? C. G/Galeessaa
D. Salphaadha
E. Bayyee salphaadha

HHN- Ji’a/Baatii darbe keessatti, yeroo meeqa A. Hafe hin beeku

404 haayyama malee barumssa irraa hafte? B. Guyyaa 1 ykn 2
C. Guyyaa 3-5
D. Guyyaa 6-9
E. Guyyaa 10 ol
HHN - Ji’a/Baatii darbe keessatti, hammam takkaa A. Gonkumaa
405 barattotni mana barumsa kee gargaarsa fi B. Dabre dabree yeroo tokko
arjoomina siif qaban agarsiisan? C. Yeroo tokko tokko
D. Yeroo Baayyee
E. Yeroo mara’a
HHN- Ji’a/Baatii darbe keessatti, maatiin kee ykn A.Gonkumaa
406 eegdu kee hangam rakkoo fi yaaddo kee B.Dabre dabree yeroo tokko
Hubatan? C.Yeroo tokko tokko
D.Yeroo Baayyee
E.Yeroo mara’a
HHN- Ji’a/Baati darbe keessatti, maatiin kee ykn A.Gonkumaa
407 eegdu kee akka hojiin manaa kee A. Dabre dabree yeroo tokko
hojjetame ilaaluuf hangam si sakatta’u? B. Yeroo tokko tokko
C. Yeroo Baayyee
D. Yeroo mara’a
HHN - Reebicha/miidha qama jachun; fkn, yeroo A. Gonkumaa/yeroo 0
408 namoonni tokko ykn isaa ol nama rukutan, B. Yeroo tokko
yookiin yeroo nama biraa miidhan C. Yeroo 2 ykn 3
meeshaan (fkn, kan akka ulee, albee, D. Yeroo 4 ykn 5
yookiin mancaa). Barattotni lama cimina fi E. Yeroo 6 ykn 7
humna walqixa qaban yoo wal reeban, F. Yeroo 8 ykn 9
rebicha hin jedhamu. G. Yeroo 10 ykn 11
H. Yeroo 12 ol
Ji’oota 12n darban keessatti, yeroo meeqa
reebichii qaama si dhaqabe?
HHN- Walreebu jechun; fkn, yeroo barattoonni A. Gonkuma/yeroo 0
409 lama cimina fi humna walqixa qaban yoo B. Yeroo tokko
wal loluuf filatani waltuman waltumu C. Yeroo 2 ykn 3
jedhama D. Yeroo 4 ykn 5
E. Yeroo 6 ykn 7
Ji’oota 12n darban keessatti, yeroo meeqa F. Yeroo 8 ykn 9
 barattota wajjin mana barumsa keessatti G. Yeroo 10 ykn 11
wal reebdee/waltumtee? H. Yeroo 12 ol
HHN - Bullying jachun; fkn, yeroo namni oduu A. Eeyyen
410 maqaa baleesii wa’ee nama facaasu, maqaa B. lakki
gadheen nama waamu, yookiin wan nama
miidhuu irra deddeebi’ee rawatudha.
Yeroo namoonni lama waa’ee cimina ykn
humna wal fakkaataa irratti wal morman
ykn wal lolan ykn wal barsiisan, bully hin
ja’amu.

Ji’ota 12 darban kessati, bullyingin

barattotaan sira gahe ni beeka?
HHN - Sayberbullying(Cyberbullying) jachun,
411 gosa bully toora marsarii tiin godhamu,
fkn, Fesibuukii, twitarii, instagramii kkf
guba irratti dha, fkn Arabsamuu, maqaa
baleessu,ykn Qaaneffamu kkf.

Ji’aota 12 darban kessati, toora Marsarii irratti

cyberbullyin sira gahe ni beeka?
HHN – Halelaa walqunaamtti(Sexual violence)
413 jechuun namni tokko fedhii isaa malee
dirqiin dhungatamuu, tuqamuu , qaama
qullaa taate dhakatanii si ilaalu , qaama
saala offi dirqiin kaanif agarsisu ykn
ilaalu , paantii namaa gototanii qaamni
saala isaa akka muldhatu gochuu, jecha
walqunamtii dubbachuu, ykn agarsisuu ,
afaani fi gochaan walqunnamti akka
raawwatan dirqisisuu?

Sexual violenciin Qaaman ykn jechaan

dhiibba siratti godhamee ni beeka? A. Eeyyen
B. Lakki

Kutaa V: Amaloota lubu off bAlleesuu

AOA - Jireenya kee keessatti, waa’ee off Ajjeesu 1. Gonkuma
501 Yaadde ykn yalltee ni Beekta? 2. Yaada yadoo gababaa
3a Yeroo tokko karoorsen
ture Garuu hin raawwanne
3b.Yeroo tokko
karoorsen ture akkasumas
dhugumatti du’uun
barbaadde.
4a. off ajeessuuf yaalen
ture Garuu du’uu hin
barbaanne.
4b. off ajeessuuf yaalen
 ture dhugadhan
du’udhaf barbaada.

AOA - Ji’a 12 darbe keessatti waa’ee of ajjeesuu 1. Gonkuma

502 hangam yaaddee beekta? 2. yeroo tokko
3. Yeroo tokko tokko
( yeroo 2)
4. Yeroo 3-4
5. Yeroo bayee ( yeroo 5
ol)
AOA - Akka of Ajjeestu fi of Ajjeessu akka dandeessu 1.lakki
503 namatti himtee ne beekta? 2a.eyyeen, yeroo tokko,
garuu dhugumatti du’uu hin
barbaadnee.
2b. eeyyee, yeroo tokko, fi
dhugumatti du’uun
barbaadee
3a. eyyee, yeroo tokko ol,
garuu du’uun hin barbaanne.
3b. eyyee, yeroo tokko ol, fi
dhugumatti du’uun
barbaada.

AOA - Hamam takka Gara fuulduratti guyya tokko of 0. Gonkuma

504 Ajjeesuu dandeessa? 1.carraa hin qabu
2. ta’uu hin danda’u
3. hin beekamu
4. ta’uu danda’a
5. carraa ta’uu isaa cala
6. Bayee carraa ta’uu isaa
cala.
7.10. Amharic Version Questionnaire
የጥያቄዉ መለያ ቁጥር-----------

የተቐም ስም--------------------

መጥይቁ የታሞላበት ቀን----//----//-----

የመረጃ ሰብሳቢዉ ሥም ና ፊርማ------------------------------

ክፍል አንድ

መመሪያ፡ መጠይቁ አምስት ክፍሎች አሉት። መጠይቁን ለማጠናቀቅ ከ 20-30 ደቂቃዎች ይወስዳል።

እባክዎ ለሁሉም ጥያቄዎች ምላሽ ለመስጠት ይሞክሩ። ለትዕግስትዎ በጣም እናመሰግናለን።

ክፍል I፡ ማህበራዊ እና ሥነ-ህዝባዊ ጉዳዮችን የሚመለከቱ ጥያቄዎች

ተ.ቁ ጥያቄዎች መልስ ኮድ
SDQ- ዕድሜህዎ ስንት ነው? ………….
101
SDQ- የእርስዎ ፆታ ምንድን ነው? 1. ወንድ
102 2. ሴት
 SDQ- የስንተኛ ክፍል ተማሪ ኖት? 1. 9 ኛ
103 2. 10 ኛ
3. 11 ኛ
4. 12 ኛ

SDQ-104 አሁን ከማን ጋር ነው የሚኖሩት? 1. ከሁለት ወላጆች ጋር

2. ከአንድ ወላጅ ጋር
3. ከዘመድ ጋር
4. ሌሎች
SDQ-105 ራስን የመግደል ሙከራ የቤተሰብ ታሪክ 1. አዎ
አለህዎት? 2. አይ/አይደለም
SDQ-106 ራስን የመግደል ሙከራ ገደኛ ታሪክ አለህዎት? 1. አዎ
2. አይ/አይደለም

ክፍል II: የስነ-ልቦና መጥይቆች

እባክዎን እያንዳንዱን መግለጫ ያንብቡ እና ቁጥር 0, 1, 2 ወይም 3 ያክብቡ ይህም መግለጫው ባለፈው

ሳምንት ለእርስዎ ምን ያህል እንደሚገልፅ ያመለክታል፡፡ ትክክለኛ ወይም የተሳሳቱ መልሶች የሉም።

በማንኛውም መግለጫ ላይ ብዙ ጊዜ አያጠፉ።

የደረጃ አሰጣጡ ሚዛኑ እንደሚከተለው ነው፤

0 ጨርሶ አይመለከተኝም

1 የተወሰነ ጊዜ

2 በይበልጥ

3 በአብዛኛው ግዜ.
ተ.ቁ ጥያቄዎች መልስ
SXH-201 እራሴን ማረጋጋት ከብዶኝ ነበር። 0 1 2
3
SXH-202 የአፌን መድረቅ እገነዘብ ነበር። 0 1 2
3
SXH-203 ምንም አይነት አዎንታዊ ስሜት የሚሰማኝ 0 1 2
አይመስለኝም ነበር። 3
SXH-204 ያለምንም ምክንያት የመተንፈስ ችግር አጋጥሞኛል 0 1 2
(ለምሳሌ፣ ከመጠን በላይ ፈጣን መተንፈስ፣ ትንፋሽ 3
ማጠር)
SXH-205 ነገሮችን ለመስራት መነሳሳት ከብዶኝ ነበር (ተነሳሽነት 0 1 2
አልነበረኝም)። 3

SXH-206 ለሁኔታዎች ከመጠን በላይ ምላሽ የመስጠት ዝንባሌ 0 1 2

 ነበረኝ (ለሁኔታዎች ችኩል ነበረኩኝ)፡፡ 3
SXH-207 መንቀጥቀጥ አጋጥሞኛል (ለምሳሌ፣ እጆቼ) 0 1 2
3
SXH-208 ከፍተኛ የመጨነቅ ስሜት ተሰማኝ። 0 1 2
3
SXH-209 ሊያስደነግጠኝ እና እራሴን ሊያሞኘኝ በሚችል 0 1 2
ቅዠቶዎች ተጨንቄ ነበር። 3
SXH-210 ምንም ተስፋ የምአደርግበት ነገር እንደሌለ ተሰማኝ 0 1 2
(ተስፋቢስነት ተሰማኝ)፡፡ 3
SXH-211 በቀላሉ ቁጣ ቁጣ እንደሚለኝ ኣየሁት፡፡ 0 1 2
3
SXH-212 ዘና ለማለት ከብዶኝ ነበር፡፡ 0 1 2
3
SXH-213 የቅስም መሰበር እና የሃዘን ስሜት ተሰማኝ። 0 1 2
3
SXH-214 የምሠራውን ሥራ እንዳላከናውን የሚከለክለኝን 0 1 2
ማንኛውንም ነገር አልታገሥም ነበር ( ለሁኔታዎች 3
ትግስት አልነበረኝም)፡፡
SXH-215 ለድንጋጤ የቀረብኩኝ ይሃል ተሰማኝ። 0 1 2
3
SXH-216 ስለ ምንም ነገር መጓጓት አልቻልኩም(ምንም ነገር 0 1 2
ሊያስደስተኝ አልቻለም) 3
SXH-217 እንደ ሰው ዋጋ እንደሌለኝ ተሰማኝ (ዋጋቢስነት 0 1 2
ተሰማኝ)፡፡ 3
SXH-218 በቀላሉ ተናዳጅ እንደሆንኩ ተሰማኝ። 0 1 2
3
SXH-219 ያለምንም ምክንያት በድንገት የልቤን ተግባር እገነዘብ 0 1 2
ነበር (ለምሳሌ፡ የልብ ትርታ መጨመር/በኃይል 3
መምታት፣ የልብ ምት መሳት)
SXH-220 ያለ በቂ ምክንያት ፍርሃት ተሰማኝ። 0 1 2
3
SXH-221 ሕይወት ትርጉም የለሽ እንደሆነ ይሰማኝ ነበር። 0 1 2
3

ክፍል III ከደባል ሱስ ጋረ የተያያዘ

SAW በህይወት ዘመንዎ ከሚከተሉት ሱስ ሊያስከትሉ ከሚችሉ እጽ ምላሽ
301 ውስጥ የትኛውን ተጠቅምዎ ያውቃሉ(ለህክምና ላልሆነ ለየአንድ አንዱ ጥያቄ በአንድ
አገልግሎት ብቻ) ምላሽ ላይ ብቻ ያክብቡ

1.አልኮል 1.አዎ
2.አይ/ አይደለም
2.ሲጋራ 1.አዎ
2.አይ/ አይደለም
3.ጫት 1.አዎ
2.አይ/ አይደለም
 4.ሌሎች፣ ይግለጹ 1.አዎ
2.አይ/ አይደለም
SAW በህይወት ዘመንዎ ከተጠቀሙት ሱስ ሊያስከትሉ ከሚችሉ ምላሽ
302 እጽ ውስጥ ባለፉት ሶስት ወራት ምን ያህል ግዜ ተጠቅመዋል
(ለህክምና ላልሆነ አገልግሎት ብቻ)

5. አልኮል 0.በፉጹም
1.አንዴ ወይም ሁለቴ
2.በወር አንዴ
3.በሳምንት አንዴ
4.በየቀኑ
6. ሲጋራ 0.በፉጹም
1.አንዴ ወይም ሁለቴ
2.በወር አንዴ
3.በሳምንት አንዴ
4.በየቀኑ
7. ጫት 0.በፉጹም
1.አንዴ ወይም ሁለቴ
2.በወር አንዴ
3.በሳምንት አንዴ
4.በየቀኑ
8. .ሌሎች፣ ይግለጹ 0.በፉጹም
1.አንዴ ወይም ሁለቴ
2.በወር አንዴ
3.በሳምንት አንዴ
4.በየቀኑ

ክፍል IV: - የስነ-ልቦናዊ እና የማህበራዊ ድጋፍን የሚመለከት መጠይቅ

የሚከተሉት ጥያቄዎች ማህበራዊ ግንኙነቶችዎን እንዴት እንደሚለማመዱ ይጠይቃሉ። ጥያቄው ስለ

እርስዎ የቅርብ ግላዊ ተሞክሮ ነው፣ አንድ ምላሽ ብቻ ያክብቡ::

ተ.ቁ መጠይቅ የመልስ አማራጭ
HHN ምን ያህል ሰዎች ለእርስዎ በጣም ቅርብ ስለሆኑ ከባድ ሀ.የለም
401 የግል ችግሮች ካጋጠምዎ ከጎንዎ ሊሆኑ ይችላሉ (አንድ ለ.1 ወይም 2 A.
አማራጭ ይምረጡ)? ሐ.3-5
መ.ከ 5 በላይ
HHN ሰዎች እርስዎ በሚስሩት ነገር ላይ ምን ያህል ሀ. . አይ አያሳስባቸውም
402 ያሳስቧቸዋል(አንድ አማራጭ ይምረጡ)? ለ. ትንሽ
ሐ. እርግጠኛ አይደለሁም
መ. አንዳንድ
ሠ. በጣም ብዙ
HHN- ከጓደኞችዎ እርዳታ ማግኘት ቢፈለጉ ምን ያህል ቀላል ሀ. በጣም አስቸጋሪ
403 ነው (አንድ አማራጭ ይምረጡ)? ለ. አስቸጋሪ
ሐ. መካከለኛ
መ. ቀላል
ሠ. በጣም ቀላል

HHN- ባለፉት 30 ቀናት ውስጥ፣ ያለፈቃድ ከትምህርት ሀ. 0 ቀናት

404 ቤትዎ ስንት ቀን ቀሩ? ለ. 1 ወይም 2 ቀናት F.
ሐ. ከ 3 እስከ 5 ቀናት
መ. ከ 6 እስከ 9 ቀናት
ሠ. 10 ወይም ከዚያ በላይ
HHN – ባለፉት 30 ቀናት ውስጥ፣ በትምህርት ቤትዎ ውስጥ ሀ. በጭራሽ
405 ያሉ ተማሪዎች ምን ያህል ጊዜ ለእርስዎ ደግ እና አጋዥ ለ. አልፎ አልፎ አንዴ E.
ነበሩ? ሐ. አንዳንድ ጊዜ
መ. ብዙ ጊዜ
ሠ. ሁልጊዜ
HHN- ባለፉት 30 ቀናት ውስጥ፣ ወላጆችዎ ወይም አሳዳጊዎ ሀ. በጭራሽ
406 የእርስዎን ችግሮች እና ጭንቀቶች ምን ያህል ጊዜ ለ. አልፎ አልፎ አንዴ F.
ተረድተዋል? ሐ. አንዳንድ ጊዜ
መ. ብዙ ጊዜ
ሠ.ሁልጊዜ
HHN- ባለፉት 30 ቀናት ውስጥ፣ ወላጆችዎ ወይም አሳዳጊዎ ሀ. በጭራሽ
407 የቤት ስራውዎ መሰራቱን ምን ያህል ጊዜ አረጋግጠዋል? ለ. አልፎ አልፎ አንዴ G.
ሐ. አንዳንድ ጊዜ
መ. ብዙ ጊዜ
ሠ. ሁልጊዜ
408 ባለፉት 30 ቀናት ውስጥ፣ ወላጆችዎ ወይም አሳዳጊዎ ሀ. በጭራሽ
ምን ያህል በትርፍ ጊዜዎ ምን እየሰሩ እንደሆነ በትክክል ለ. አልፎ አልፎ አንዴ
ያውቃሉ? ሐ. አንዳንድ ጊዜ
መ. ብዙ ጊዜ
ሠ. ሁልጊዜ
HHN – መደብደብ ወይም አካላዊ ድብደባ; ማለት አንድ ወይም
409 ብዙ ሰዎች አንድን ሰው ሲመቱ ወይም አንድ ወይም I.
ብዙ ሰዎች ሌላውን ሰው በመሳሪያ (እንደ ዱላ፣ ቢላዋ
ወይም ዲንጋይ የመሳሰሉ) ሲጎዱ ነው። ተመሳሳይ
ጥንካሬ ወይም ሃይል ያላቸው ሁለት ተማሪዎች
እርስበርስ ሲደባደቡ መደብደብ አይባልም፡፡
እናም.
ሀ. 0 ጊዜ
ባለፉት 12 ወራት ውስጥ ስንት ጊዜ መደብደብ
ለ. 1 ጊዜ
ደርሶብህዎታል?
ሐ. 2 ወይም 3 ጊዜ
መ. 4 ወይም 5 ጊዜ
ሠ. 6 ወይም 7 ጊዜ
ረ. 8 ወይም 9 ጊዜ
ሸ. 10 ወይም 11 ጊዜ
HHN - ድብድብ ወይም አካላዊ ፍልሚያ ማለት የሚከሰተው
410 ተመሳሳይ ጥንካሬ ወይም ጉልበት ያላቸው ሁለት C.
ተማሪዎች ሲደባደቡ ነው።

እናም.
አ. 0 ጊዜ
ባለፉት 12 ወራት ውስጥ በትምህርት ቤት ውስጥ B. 1 ጊዜ
ስንት ጊዜ ተደባድብዋል? C. 2 ወይም 3 ጊዜ
መ. 4 ወይም 5 ጊዜ
E. 6 ወይም 7 ጊዜ
F. 8 ወይም 9 ጊዜ
G. 10 ወይም 11 ጊዜ
ሸ 12 ወይም ከዚያ በላይ ጊዜ
HHN – ቡሊንግ(bullying) ማለት አንድ ሰው ሌላ ሰው ላይ A.
411 ሲያሾፍ፣ ሲያንቐሽሽ፡ የውሸት ወሬ ሲያሰራጭ፣
የአንድን ሰው ስም ሲያጠፋ፤ በመጥፎ ስም ሲጠራ፣
ጾታዊ አስተያየት ሲሰጥ፤ ደጋግሞ ሰውን ሚጎዳ ነገር
ማድረግ እና ማዋርድ ናቸው። ሁለት ተመሳሳይ ጥንካሬ
ወይም ጉልበት ያላቸው ሰዎች ሲጨቃጨቁ ወይም
ሲጣሉ ወይም ሲሳለቁ ቡሊ አይደለም፡፡
እናም.
.
አ. አዎ
ባለፉት 12 ወራት ውስጥ በትምህርት ቤት ውስጥ
ለ. አይ
ወይም በትምርት ቤትዎ ተማሪዎች ቡሊንግ(bully)
ደርስዎቦታል?

HHN – ሳይበር-ቡሊ(cyberbullying)፡-ማለት በማህበራዊ

412 ሚዲያን እንደ ኢንስታግራም፣ ትዊተር፣ ስናፕ ቻት እና
ፌስቡክ እና ሌሎች የማህበራዊ ሚዲያ መድረኮች
ወይም በጽሁፍ መልእክት እና ኢሜል በመጠቀም
የሚፈጸም የቡሊ(bully) አይነት ነው።

እናም.
ሀ. አዎ
ለ. አይ
ባለፉት 12 ወራት ውስጥ የሳይበር-ቡሊ ደርስዎቦታል?

HHN – ወሲባዊ ጥቃት፡ ማለት በአካል ወይም በማህበራዊ

413 ሚዲያ ወይም በይነመረብ ላይ A.
የማትፈልጋቸውን ወሲባዊ ድርጊቶች እንድትፈጽም
መስገደድ ወሲባዊ ጥቃት ይባላል። ወሲባዊ ጥቃት
መሳም ወይም መንካት፣ ሙሉ ልብስ ሳትለብሱ
መሰለል፣ የአንድን ሰው የግል ክፍል መታየት፣ የውስጥ
ሱሪዎን ወይም ሰውነቶን ለማጋለጥ ልብስዎን መጎተት፣
የወሲብ አስተያየት ወይም ምልክቶችን መስጠት፣ እና
በአካልም ሆነ በቃላት እንዲያደርጉ መስገደድ ሊያካትት
ይችላል።
 እናም.

ባለፉት 12 ወራት፤ በአካልም ሆነ በቃል ወሲባዊ ጥቃት

ደርስዎቦት ያውቃል? ሀ. አዎ
ለ. አይ

ክፍል V; ህይወትን የማጥፋት ባህሪ

የሚከተለው መጠይቅ 4 ነገሮችን ያካትታል። እባክዎን እያንዳንዱን ንጥብ በጥንቃቄ ያንብቡ እና

በእያንዳንዱ ቡድን ውስጥ አንድ አማራጭ ብቻ ያክብቡ። ለማንኛውም ንጥብ ከአንድ በላይ መግለጫ

አለመምረጥዎን ያረጋግጡ።
AOA - በህይወት ዘመነዎ፤ ህይወትዎን ለማጥፋት አስበው ወይም 1=በጭራሽ
501 ሞክረው ያውቃሉ? 2= አጭር ማለፊያ ሃሳብ
ነበር።
3 ሀ= ራሴን ለማጥፋት
ቢያንስ አንድ ጊዜ እቅድ
ነበረኝ ግን ላደርገው
አልሞከርኩም
3 ለ= ራሴን ለማጥፋት
ቢያንስ አንድ ጊዜ እቅድ
ነበረኝ እና በእውነት መሞት
እፈልግ ነበር።
4 ሀ= ራሴን ለማጥፋት
ሞክሬ ነበር ግን መሞትን ግን
አልፈለኩም።
4 ለ= ራሴን ለመግደል
ሞክሬ ነበር እናም በእውነት
ለመሞት ተስፋ አድርጌ
ነበር።

AOA – ባለፈው 12 ወራት፤ ህይወትዎን ስለማጥፋት ምን ያህል ጊዜ 1= በጭራሽ

502 አስበዋል? 2= አንዴ (1 ጊዜ) 6.
3= አልፎ አልፎ (2 ጊዜ)
4= ብዙ ጊዜ (3-4 ጊዜ)
5= በጣም ብዙ ጊዜ (5
ወይም ከዚያ በላይ ጊዜ)

AOA – ህይወትዎን ልታጠፉ እንደሆነ ወይም ልታደርጉ 1= አይ

503 እንደምትችሉ ለአንድ ሰው ነግረው ያውቃሉ? 2a= አዎ፣ በአንድ ወቅት፣
ግን በእውነት መሞትን
 አልፈለኩም።
2b= አዎ፣ በአንድ ጊዜ፣ እና
በእውነት ማድረግ ፈልጌ
ነበር።
3a= አዎ፣ ከአንድ ጊዜ
በላይ፣ ግን ማድረግ
አልፈለኩም።
3b= አዎ፣ ከአንድ ጊዜ
በላይ፣ እና በእርግጥ ማድረግ
እፈልጋለሁ።
AOA – አንድ ቀን ህይወትዎን ለማጥፋት የመሞከር እድሉ ምን ያህል 0= በጭራሽ
504 ነው? 1=ምንም እድል የለም።
2= ሊሆን አይችልም
3= አይታወቅም
4= ሊሆን ይችላል
5= ይልቅ አይቀርም
6= በጣም አይቀርም
6. በህይወት ዘመንህ ራስን ለማጥፋት ከሞከርክ በዶክተር ሀ.በህይወቴ ራሴን
ወይም ነርስ መታከም የነበረበት ጉዳት፣ መመረዝ ወይም ለማጥፋት አልሞከርኩም
ከመጠን በላይ መውሰድን ያስከተለ ሙከራ አለ? ለ. አዎ
ሐ. አይ

7. የራስን ሕይወት የማጥፋት ሐሳብ ወይም ሙከራ ሀ. በህይወቴ አስቤም ሆነ

ካጋጠመህ ምክንያቱ ምን ነበር? ራስን የመግደል ሙከራ
አድርጌ አላውቅም
ለ. ከወላጅ ጋር ግጭት
ሐ. ግንኙነት መፍረስ
መ. የትምህርት ውድቀት

8. በህይወትዎ ውስጥ ራስን ማጥፋትን ከሞከሩ, ለቅርብ ጊዜ ሀ. በህይወቴ የራሴን

ሙከራ ምን አይነት ዘዴ ተጠቅመዋል? ሕይወት ለማጥፋት
አልሞከርኩም
ለ. ራሴን ቆርጫለሁ
ሐ. አደንዛዥ ዕፅን ወይም
መርዝ የሆነ ነገር ዋጥቻለሁ
ወይም ተወጋሁ
መ. ራሴን አቃጠልኩ።
ሠ. ራሴን ለመስቀል ወይም
ለማፈን ሞከርኩ።
F. ሌላ ዘዴ ተጠቀምኩ