Physical

Indicate how often each of the following effects happens to you either when you are experiencing stress, or post exposure to a significant demand/problem.  Respond to each of the following item using the rating scale.

Never/Don't remember = 1  Once in two to three months = 2   Once in two to three weeks = 3   Once or twice a week = 4   Daily = 5


1. How often do you get tightness around your head (light head ache)*
2. How often does your hands get cold / sweaty*
3. How often do you experience a stiff neck (light neck pain)*
4. How often do you have low back pain*
5. How often do you find difficulty in breathing*
6. How often do get muscle tensions)*
7. How often do you get reeling sensation / giddiness*
8. How often do you tighten your teeth with frustration*
9. How often do you get increased heart beats without physical exercise*
10. How often do you have cramps and pain in your stomach*

Psychological

Never/Don't remember = 1  Once in two to three months = 2   Once in two to three weeks = 3   Once or twice a week = 4   Daily = 5

1. How often do you feel depressed*
2. How often do you experience problems / work overload*
3. How often do you get angry without any reason*
4. How often do you feel difficulty in making decisions (confused state of mind)*
5. How often do you have trouble remembering names and appointments*
6. How often do you feel lonely*
7. How often do you feel anxiety/worry/guilty/ nervousness*
8. How often do you feel as if you cannot change the bad thing in your life (hopelessness)*
9. How often do you experience bad dreams*
10. How often do you feel uncontrolled //suicidal thoughts*

Behavioural

Never/Don't remember = 1  Once in two to three months = 2   Once in two to three weeks = 3   Once or twice a week = 4   Daily = 5

1. How often do you over react to small issues ( bad temperament )*
2. How often do you withdraw from the social gatherings (marriage, ceremonies etc.)*
3. How often do you have arguments with others*
4. How often do you have a sleeping problem (delayed /disturbed sleep)*
5. How often do you shout at others (aggression)*
6. How often do you get tiredness and exhibit weakness in routine activities*
7. How often are you late to work schedules*
8. How often do you face adjustment problems*
9. How often do you give explanations to others for your behaviour*
10. How often do you increase smoking/ alcohol / any substance consumption in case habit*

Self-Concept

Never = 1  Rarely = 2   Often = 3   Always = 4

1. I have a very high degree of confidence in my own abilities*
2. I am comfortable and at ease around my superiors*
3. I am often overly self-conscious or shy when among strangers*
4. Whenever something goes wrong, I tend to blame myself*
5. When I don’t succeed, I tend to let it depress me more than I should*

Behaviour Pattern

Never = 1  Rarely = 2   Often = 3   Always = 4

1. Do you become upset if something is taking too long ?*
2. Do your friends comment upon you that you get irritated easily?*
3. Do you usually prefer to do things when there is competition/target?*
4. Mistakes that you commit are due to little time for thought and planning?*
5. Do you prefer to do things simultaneously; like eating while working/ planning while driving*

Psychological Hardiness

Hardly Ever = 1  Seldom = 2   Sometimes = 3   Usually = 4  Alsmost Always = 5

1. I have a high achievement need and strive hard to be successful.*
2. I am a courageous independent thinker and like to work independently.*
3. I am confident in new situations and seek new experiences. *
4. I am positive and optimistic in meeting challenges. *
5. I work hard and diligently at tasks; finish homework on time. *
6. I love intellectual challenges i.e. enjoy learning new things.*

Anxious Reactivity

Never = 1   Rarely = 2  Often = 3  Always = 4

1. Will you be able to picture the crisis clearly in your mind even a week after it is over?*
2. Do you feel your heart palpitation during crisis ?*
3. Do you notice that you sweat profusely during crisis ?*
4. Do you notice that your hands and fingers are trembling during crisis ?*
5. Do you have difficulty in speaking during crisis ?*

Depression

None of the time = 1   Some of the time = 2    Good part of the time = 3   Most or all of the time = 4

1. I am getting too little or too much sleep*
2. I don’t feel hopeful about the future*
3. I have crying spells or feel like crying*
4. I have thoughts of suicide or death*
5. I feel more interested in being alone *

Life Events

Below are listed events, which occur in the process of living.  Yes or No tick mark each of those events that have

1. Went on a pleasure trip or pilgrimage
2. Wife takes up or gives up a job
3. Change in eating habits
4. Change in social activities
5. Gain of new family member
6. Reduction in number of family functions
7. Birth of a daughter
8. Change in sleeping habits
9. Change in working conditions or transfers
10. Begin or end of schooling of children
11. Change in residence
12. Unfulfilled commitments
13. Trouble with neighbors
14. Getting married or engaged
15. Death of a pet
16. Major purchases or construction of house
17. Break-up with a friend
18. Family conflict
19. Minor violation of law
20. Marriage of daughter or dependent sister
21. Large loan (more than Rs. 1,00.000/-)
22. Lack of son
23. Sexual problems
24. Conflict over dowry (self or spouse)
25. Prophecy of Astrologer (wanted or unwanted
26. Trouble at work with colleagues, superiors or subordinates
27. Illness of a family member
28. Financial loss or problem
29. Son or Daughter leaving home
30. Major personal illness or injury
31. Robbery or theft
32. Death of friend
33. Marital conflict
34. Death of close family member
35. Lack of child (infertility)
36. Marital separation/divorce
37. Extra marital relation of spouse
38. Death of spouse

Overload

Never = 1  Rarely = 2   Often = 3   Always = 4

1. Do you find yourself with insufficient time to complete your work*
2. Do you feel that people around you simply expect too much from you*
3. Do you find your work taking up the time of your leisure hours*
4. Do you have to skip a meal so that you can get work completed*
5. Do you feel that you have too much responsibility*

Frustration

Never = 1  Rarely = 2   Often = 3   Always = 4

1. I get upset when someone in front of me drives slowly*
2. I am uncomfortable standing in long lines*
3. Any arguments upset me*
4. I require a lot of room (space) to live and work in*
5. When I am busy at some task, I hate to be disturbed*

Deprivation

Never = 1  Rarely = 2   Often = 3   Always = 4

1. I dislike repetitive tasks, I would rather work on something different every time*
2. I dislike repetitive tasks, I would rather work on something different every time*
3. I relax best by keeping myself busy*
4. I find it difficult to throw away old clothes, furniture, and other mementos*
5. I get homesick when I am in a new place even for a short time *

Role Stress

Never = 1  Rarely = 2   Often = 3   Always = 4

1. I am not able to satisfy the conflicting demands of various people over me.*
2. My role has recently been reduced in importance.*
3. My workload is too heavy.*
4. I am not clear on the scope and responsibilities of my role (job).*
5. There is not enough interaction between my role and other roles.*
6. I do not get enough people / resources to be effective in my role.*
7. My role does not allow me to have enough time with my family.*
8. I wish there was more consultation between my role and other roles. *
9. The expectations of my seniors conflict with those of my juniors.*
10. I feel stagnant in my role.*
11. I am bothered with the contradictory expectations different people have from my role.*
12. I experience conflict between my values and what I have to do in my role. *

Diet Pattern

Never = 1  Rarely = 2   Often = 3   Always = 4

1. Fixed quantity of Rice / Roti (main dish) in each meal during average days*
2. Dinner (night meal) is as much or more than Lunch*
3. Consumption of seasonal fruits & regular leafy vegetables (more than 100 grams per day)*
4. Consumption of sweets / cool drinks (above 25 grams) (or) coffee / Tea (above 3 cups) per day *
5. Taking evening(4-6pm) snacks (other than deep fried items) as fourth meal*
6. Skipping breakfast /Delaying Lunch during average days*

BMI

1. Weight (in Kg)*
1. Height (in Foot)*