SAMPLE QUESTIONNAIRE

PART I: Consent
This study is conducted on behalf of a research proposal in the partial fulfilment of the
Requirements for Medical Students. The study is about the level and effects of anxiety and
depression among Medical Students. Your participation will immensely contribute to our
study. All Your responses are completely anonymous and confidentiality.
port
PART A: Demographic profile
Code: MD-1 Date:
Age:
18-25 [ ] 26-33[ ] 34-41] 42 & above [ ]
Gender: Male[ ] Female[ ]
Nationality: Indian [ ] Thai [ ] Nepalis [ ] Nigerians [ ] others [ ]
Directions: Below are the items to evaluate the challenges in foreign education. Please
choose the option based on whether the said item is a challenging in foreign education for
you personally.
PART B: This Questionnaire was adapted from "GENERALIZED ANXIETY DISORDER" (GAD-7
ANXIETY QUESTIONNAIRE). Drs. Robert et al.'
https://adaa.org/sites/default/files/GAD-7 Anxietv-updated 0.pdf
Instructions: Tick in the appropriate boxes given below of your choice from scale of 1-5.
1. Never 2. Rarely 3. Sometimes 4. Often 5. Always

Question 5 4 3 2 1
Feeling nervous,
anxious or on edge.
Not being able to stop
or control worrying
Worrying too much
about different things.
Becoming easily
annoyed or irritable
Being so restless that it
is hard to sit still.
Feeling afraid as if
something awful might
happen.
Trouble relaxing.
PART C: This Questionnaire was adapted from "QUESTION PRO DEPRESSION
QUESTIONNAIRE". Adi bhatt
https://www.questionpro.com/blog/depression-questionnaire/Instructions: Tick in the
appropriate boxes given below of your choice from scale of 1-5.
1.Completely disagree 2. Somewhat disagree 3, Neutral 4, Somewhat agree
5.CompletelyAgree

Questions 5 4 3 2 1
All the tasks you have
performed, are taking much
more time than usual.
You are facing a lack of
concentration.

You feel, you have no future

You are facing problems
with making decisions

You have lost interest in all

things that were important
to you once upon a time.
You feel, your life is sad, as
there is no joy in your
anymore.
You have been feeling guilty
for everything you do.
You have been very irritated
and angry recently.

You have been feeling very

fatigued.
You are feeling that
everything you have done
has been a failure.

You are having lack of sleep

You are having suicidal
thoughts.

You have lost or gained

weight without any diet
programs.

You are having loss of

appetite.

You are having trust issue

with everyone around you,
You are having trouble in all
your relationships (home as
well as professional)