University of Perpetual Help System Laguna – JONELTA

Basic Education Department - Senior High School

SURVEY QUESTIONNAIRE

To the Respondent,
We are currently conducting our research entitled; “Effects of Parenting Style to
Teenagers’ Mental Health” as a partial fulfillment of our course requirements for the
subject Practical Research 2 at University of Perpetual Help System Laguna. In light of
this, we are humbly requesting for your time and effort to go over this questionnaire as
your responses will be very much helpful in achieving the purpose of our research. Rest
assured that the information you will provide will be kept confidential and will be used
for research purposes only. Thank you!

Tricia L. Restrivera
Researcher / Group Leader

Name of the Respondent: (Optional)

Age:
Part I. Direction: Put a check mark (/) in the blank corresponding your answer.
Gender: Male Female
Daily Allowance:
Php 50.00 and below Php 151.00- Php 200.00
Php 51.00- Php 100.00 Php 201.00 and above
Php 101.00- Php 150.00
General Weighted Average (GWA) of 1st semester of A.Y. 2018-2019:
80% and below 86%- 90% 96%-100%
81 %- 85% 91%- 95%
Birth Order:
Youngest Child Eldest Child
Middle Child Only Child

Part II. Parenting Styles

Direction: Below are statements to measure different parenting styles that you have
witnessed/experienced from your parents while growing as a teenager in terms of
authoritarian, authoritative, permissive, and uninvolved. Kindly put a check mark (/) in
the column corresponding your choice. Use the following as your guide.

Numerical
Categorical Response
Rating
4 Strongly Agree (SA)
3 Agree (A)
2 Disagree (D)
1 Strongly Disagree (SD)
 University of Perpetual Help System Laguna – JONELTA
Basic Education Department - Senior High School

Indicators SA A D SD
(4) (3) (2) (1)
1. Whenever my parents told me to do something, they
expected me to do it immediately without any objections.
2. As I was growing up, I knew what my parents expected
from me in the family and they insisted that I conform to
those expectations simply out of respect for their authority.
3. Even if their children didn't agree with them, my parents
felt that it was for our own good if we were forced to
conform to what they thought were right.
4. My parents have always felt that more force should be
used by parents in order to get their children to behave the
way they are supposed to.
5. As I was growing up, my parents did not allow me to
question any decision they make.
6. While I was growing up, my parents felt that in a well-run
home the children should have their way in the family as
often as the parents do.
7. As I was growing up, once family policy has been
established, my parents discussed the reasoning behind the
policy with us.
8. As I was growing up, my parents directed the activities
and decisions of the children in the family through reasoning
and discipline.
9. My parents have always encouraged verbal give-and-take
whenever I have felt that family rules and restrictions were
unreasonable.
10. As I was growing up, my parents consistently gave me
direction and guidance in rational and objective ways.
11. As I was growing up, my parents did not feel that I
needed to obey rules and regulations of behavior simply
because someone in authority had established them.
12. My parents have always felt that what children need is to
be free to make up their own minds and to do what they want
to do, even if this does not agree with what their parents
might want.
13. As I was growing up, my parents seldom gave me
expectations and guidelines for my behavior.
14. As I was growing up, my parents allowed me to decide
most things for myself without a lot of direction from them.
15. Most of the time, my parents did what I wanted when
making family decisions.
16. My parents did not bother to ask me if I needed some
help.
17. My parents did not view themselves as responsible for
directing and guiding my behavior as I was growing up.
18. My parents do not even care, even if I come home late at
night.
19. My parents do not care for me at all.
20. My parents do not have time for me to talk nor bond with
me.
 University of Perpetual Help System Laguna – JONELTA
Basic Education Department - Senior High School
Part III. Mental Health
Direction: Below are statements to measure your mental health in terms of your self-
esteem, emotional well-being, social well-being, and psychological well-being. Kindly
put a check mark (/) in the column corresponding your choice. Use the following as your
guide.
Numerical Numerical Categorical Verbal
Verbal Description
Rating Range Response Interpretation
Strongly Agree Very High/ The respondent experienced the
4 3.26-4.00
(SA) Very Stable indicator 76-100% of the time.
The respondent experienced the
3 2.51-3.25 Agree (A) High/Stable
indicator 51-75% of the time.
The respondent experienced the
2 1.76-2.50 Disagree (D) Low/Unstable
indicator 26-50% of the time.
Strongly Very Low/ The respondent experienced the
1 1.00-1.75
Disagree (SD) Unstable indicator 1-25% of the time.

INDICATORS SA A D SD
(4) (3) (2) (1)
A. Self-Esteem
1. I am satisfied with myself completely.
2. I feel that I have a number of good qualities.
3. I am able to do things just as other people.
4. I feel that I'm a person of worth, at least on an
equal plane with others.
5. I have a positive attitude toward myself.
B. Emotional Well-being
6. Emotions play an important part in my life.
7. I find it easy to express my feelings.
8. I can easily sense when my anger is getting the best
of me.
s9. I find it easy to describe my feelings.
10. I am able to stand apart from my thoughts and
feelings.
C. Social Well-being
11. Most days I feel a sense of accomplishment from
what I do.
12. I feel I am free to decide for myself and how to
live my life.
13. I generally feel that what I do in my life is
valuable and worthwhile.
14. There are lots of things I feel I am good at.
15. I am always optimistic about my future.
D. Psychological Well-being
16. I am not afraid to voice my opinions, even when
they are in opposition to the opinion of the most.
17. Most people see me as loving and affectionate.
18. I think it is important to have new experiences
that challenge how you think about yourself and the
 University of Perpetual Help System Laguna – JONELTA
Basic Education Department - Senior High School
world.
19. In general, I feel confident and positive about
myself.
20. I have a sense of direction and purpose in my life.

Thank you very much!