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Instruction: Please indicate the extent to which you agree with each statement.

Choose the
response that best describes your experience. (1)Strongly Disagree (2) Disagree (3) Agree (4)
Strongly Agree
(5) Strongly Disagree

Note; There are no right or wrong answers. All information is anonymous and will be kept

confidential at all times.


(PARTICIPANT INFORMATION)
Age: ___________
Gender: Male ( ) Female ( )
Marital Status: Married ( ) Single ( ) Divorced ( ) Separated ( ) Widow/Widower ( )
Number of children if any: _____________
Religious affiliation: Christian ( ) Muslim ( ) Traditional ( )
Ethnic Group: Igbo ( ) Hausa ( ) Yoruba ( ) others specify: ____________

ITEMS:

I feel downhearted and blue


ITEMS:

1. I feel that I'm a person of worth, at least on an equal plane with others.
2. I feel that I have a number of good qualities.
3. I am inclined to feel that I am a failure.
4. I am able to do things as well as most other people.
5. I do not have much to be proud of.

6. I take a positive attitude toward myself.


7. On the whole, I am satisfied with myself.
8. I certainly feel useless at times.
9. I wish I had more respect for myself.
10. At times I think I am no good at all.

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