General questions (1 cup = 8 oz of liquid)
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∙ Year in school? (Freshman, Sophomore, Junior, Senior, Fifth Year or “Super Senior”)
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∙ Sex (Male, Female)
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∙ Have you been diagnosed with anxiety or depression? (Anxiety, Depression, Both, Never)
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∙ What is your current GPA? (<2.0, 2.0-2.4, 2.5-2.9, 3.0-3.4, 3.5-4.0)
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∙ How much caffeine do you consume per day? (None, 1, 2, 3, 4, 5, 6, >6 cups)
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∙ How many times a week do you consume caffeine? (Never, 1, 2, 3, 4, 5, 6 times/week, Daily)
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∙ What source of caffeine do you utilize most often? (Coffee, Tea, Soda, Other)
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∙ For what reason do you most often consume caffeine? (Studying/Homework, To stay awake in class, For pleasure or enjoyment, e.g., You like the taste of coffee or tea, Other)
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Patient Health Questionnaire-9 (PHQ-9)
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Over the past 2 weeks, how often have you been bothered by any of the following problems? (Not at all, Several days, More than half the days, or Nearly every day)
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∙ Little interest or pleasure in doing things
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∙ Feeling down, depressed, or hopeless
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∙ Trouble falling or staying asleep, or sleeping too much
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∙ Feeling tired or having little energy
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∙ Poor appetite or overeating
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∙ Feeling bad about yourself, or that you are a failure or have let yourself or your family down
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∙ Trouble concentrating on things, such as reading the newspaper or watching television
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∙ Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
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∙ Thoughts that you would be better off dead, or of hurting yourself in some way
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Generalized Anxiety Disorder-7 (GAD-7)
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Over the past 2 weeks, how often have you been bothered by any of the following problems? (Not at all, Several days, More than half the days or Nearly every day)
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∙ Feeling nervous, anxious, or on edge
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∙ Not being able to stop or control worrying
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∙ Worrying too much about different things
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∙ Trouble relaxing
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∙ Being so restless that it’s hard to sit still
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∙ Becoming easily annoyed or irritable
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∙ Feeling afraid as if something awful might happen
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