DISTRESS SCREENING

(This distress screening will help you understand which domain is an area of concern to you in specific. It will also provide which domains you are good at.)

This is Distress profile gives which area of stress is of concern to you. Please enter the responses honestly for better results. Please read the questions carefully before selecting your response. The data entered is used for generating your Distress Profile
Name:Name of the participant
Address:
Gender:
Age in years:*
Weight in Kgs*
Height in meters*
Mobile:
E-mail:

Indicate how often do you experience each of the following effects to you either when you are under stress, or post exposure to a significant demand/problem. Please click on the rating button with a number using frequency rating scale.

Rating: Never/ Not Remembered= 1      Once in two/three months = 2          Once in two/three weeks = 3

Once/more a week = 4       Daily = 5

Physical

How often do you get tightness around your head or feel light head ache*
1
2
3
4
5
How often do you experience low back pain or a stiff neck or light neck pain*
1
2
3
4
5
How often do you experience stomach upset, Diarrhoea or Constipation*
1
2
3
4
5
How often do you experience continual episodes of illness, colds, flu etc*
1
2
3
4
5
How often do get muscle discomfort/tightness/cramps*
1
2
3
4
5
How often do you feel physical tiredness/weakness (fatigue) in routine activities*
1
2
3
4
5
How often do you find inability to relax*
1
2
3
4
5
How often do you feel dissatisfied in married life.*
1
2
3
4
5
How often do you get increased heart beats (palpitation) without physical exercise*
1
2
3
4
5
How often do you have a sleeping problem (delayed /disturbed sleep)*
1
2
3
4
5

Psychological

How often do you feel depressed*
1
2
3
4
5
How often do you get angry without proper cause (short temper)*
1
2
3
4
5
How often do you feel irritability / displaying agitation*
1
2
3
4
5
How often do you feel anxiety/worry/guilty*
1
2
3
4
5
How often do you feel uncontrolled /suicidal thoughts*
1
2
3
4
5
How often do you feel problem with attention and concentration at work*
1
2
3
4
5
How often do you feel difficulty in making decisions (confused state of mind)*
1
2
3
4
5
How often do you experience work overload problems in daily life*
1
2
3
4
5
How often do you feel trouble learning new things*
1
2
3
4
5
How often do you have trouble remembering names (forgetfulness)*
1
2
3
4
5

Behavioural

How often do you over react to small issues(impulsive behavior)at home*
1
2
3
4
5
How often do you withdraw from the social gatherings (marriage, ceremonies etc.)*
1
2
3
4
5
How often do you shout (aggression)/ violent acts towards self and/or others at home*
1
2
3
4
5
How often do you have relationship (spouse) conflicts / crying spells*
1
2
3
4
5
How often do you have arguments with others at work*
1
2
3
4
5
How often do you display poor self-care / neglected personal hygiene at work*
1
2
3
4
5
How often are you late to work schedules / avoidance of tasks*
1
2
3
4
5
How often do you have adjustment problems with others / in new environment at work*
1
2
3
4
5
How often do you have changes in appetite - either not eating or eating too much*
1
2
3
4
5
How often do you increase smoking/ alcohol / over the counter (OTC) drugs in case habit*
1
2
3
4
5