Adolescent Mental Health Survey Template

School & EducationQuestionnaire

Adolescent Mental Health Survey Template

A rapid mental health assessment tool for middle and high school students, covering 7 core dimensions: emotional state, academic stress, parent-child communication, peer relationships, internet dependency, help-seeking willingness, and home-school support.

Generation Prompt

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Design a mental health survey for secondary school students, with a total of 8 questions covering emotional state, academic stress, parent-child communication, peer relationships, internet dependency, help-seeking willingness, and home-school support. The question types should include single-choice, multiple-choice, Likert scale (1-5), NPS (0-10), and one open-ended question. Question 1 measures recent mood (scale). Question 2 assesses sources of academic stress (multiple choice). Question 3 asks about the frequency of parent-child communication (single choice). Question 4 measures trust in peers (single choice). Question 5 measures internet dependency (scale). Question 6 is an NPS on help-seeking willingness. Question 7 evaluates perceived home-school support (single choice). Question 8 is an open-ended question (describe the issue that troubles you most). The wording should be conversational, appropriate for secondary school students, and avoid sensitive language. Suggested sample size: no fewer than 50 students per class, using stratified sampling.

Sample questions

  1. 1Scale

    In the past two weeks, how often did you feel calm and relaxed?

    1 - Almost always (every day)2 - Often (multiple times per week)3 - Sometimes (a few times per week)4 - Rarely (once a week or less)5 - Almost never (not at all)
  2. 2Multiple choice

    Which of the following factors contribute most to your academic stress? (Select all that apply)

    Too much homeworkPressure from exam rankingsHigh expectations from parentsStrict self-expectationsDifficulty of coursework
  3. 3Single choice

    How often do you talk about personal concerns with your parents or guardians?

    Every daySeveral times a weekOnce a weekRarelyNever on my own initiative
  4. 4Single choice

    When you face difficulties, do you feel that you have classmates or friends who genuinely listen to you?

    AlwaysOftenSometimesRarelyNot at all
  5. 5Scale

    Please rate your level of dependence on your phone or the internet (1 = not dependent, 5 = extremely dependent).

    1 - Not dependent at all2 - Slightly dependent3 - Moderately dependent4 - Quite dependent5 - Severely dependent
  6. 6NPS

    If you were experiencing psychological distress, how willing would you be to proactively seek help from a teacher, counselor, or professional? (0 = not willing at all, 10 = extremely willing)

    0-3 (Low willingness)4-6 (Moderate)7-10 (High willingness)
  7. 7Single choice

    Do you feel that your school or family provides sufficient psychological support and care for you?

    Very sufficientSufficientAverageInsufficientNot at all
  8. 8Open text

    Recently, what is the one thing that troubles you most or for which you wish to receive help? (Please describe in detail; responses are anonymous.)