1 |
Gender |
Male |
|
Female |
|
2 |
Age |
18-24 years |
|
25-35 years |
|
36-45 years |
|
46-60 years |
|
>60 years |
|
3 |
City (Residence at present) |
|
4 |
Education |
|
5 |
Marital status |
Single |
|
Married |
|
Widow/Widower |
|
6 |
What is your current living status in this period of lockdown? |
Living alone |
|
Living with significant other |
|
7 |
Profession |
|
8 |
Are you working at present in any of the following essential COVID-19 services? |
Healthcare |
|
Police |
|
Sanitization services |
|
Government public administrative services |
|
Banking, electricity, postal department |
|
Other |
|
No, not working |
|
9 |
Do you need to work from home or attend classes online (students) during lockdown period? |
Yes |
|
No |
|
10 |
Medical Illness/Psychiatric illness? If yes, specify |
Yes |
|
No |
|
Specify, if yes |
11 |
Do you use/ consume alcohol/tobacco/cannabis? |
Yes |
|
No |
|
12 |
What is your source of information regarding COVID-19? |
News |
|
Social media |
|
Journals/publications |
|
Friends/relatives/neighbors |
|
Healthcare professionals |
|
Other |
|
13 |
How much time do you spend on average on coronavirus news/statistics? (Watching/Reading/Forwarding/Discussing) |
<1 hour |
|
1-3 hours |
|
4-7 hours |
|
> 7 hours |
|
14 |
Do you personally know anyone who has been infected by the coronavirus? |
Yes |
|
No |
|
15 |
How do you rate your level of risk for contracting (catching) the coronavirus (COVID-19)? |
High |
|
Medium |
|
Low |
|
16 |
How concerned are you that a family member will contract the coronavirus ? |
Extremely concerned |
|
Somewhat concerned |
|
Not concerned at all |
|
|
Rate your agreement from (1)- Strongly disagree to (5) -Strongly agree |
17 |
I am most afraid of COVID-19 |
1 |
2 |
3 |
4 |
5 |
18 |
It makes me uncomfortable to think about COVID-19 |
1 |
2 |
3 |
4 |
5 |
19 |
My hands become clammy when I think about COVID-19 |
1 |
2 |
3 |
4 |
5 |
20 |
I am afraid of losing my life because of COVID-19 |
1 |
2 |
3 |
4 |
5 |
21 |
When watching news and stories about COVID-19 on social media, I become nervous or anxious |
1 |
2 |
3 |
4 |
5 |
22 |
I cannot sleep because I'm worrying about getting COVID-19 |
1 |
2 |
3 |
4 |
5 |
23 |
My heart races or palpitates when I think about getting COVID-19 |
1 |
2 |
3 |
4 |
5 |
|
Rate your agreement from (0)- Did not apply to me at all, (1)- Applied to me to some degree, (2)- Applied to me to a considerable degree, (3)- Applied to me very much |
24 |
I found it hard to wind down |
0 |
1 |
2 |
3 |
25 |
I was aware of dryness of mouth |
0 |
1 |
2 |
3 |
26 |
I couldn't seem to experience any positive feeling at all |
0 |
1 |
2 |
3 |
27 |
I experienced breathing difficulty (especially rapid breathing, breathlessness in the absence of physical exertion) |
0 |
1 |
2 |
3 |
28 |
I found it difficult to work up the initiative to do things |
0 |
1 |
2 |
3 |
29 |
I tended to over-react to situations |
0 |
1 |
2 |
3 |
30 |
I experienced trembling (e.g., in the hands) |
0 |
1 |
2 |
3 |
31 |
I was worried about situations in which I might panic and make a fool of myself |
0 |
1 |
2 |
3 |
32 |
I felt that I was using a lot of nervous energy |
0 |
1 |
2 |
3 |
33 |
I felt that I had nothing to look forward to |
0 |
1 |
2 |
3 |
34 |
I found myself getting agitated |
0 |
1 |
2 |
3 |
35 |
I found it difficult to relax |
0 |
1 |
2 |
3 |
36 |
I felt down-hearted and blue |
0 |
1 |
2 |
3 |
37 |
I felt intolerant of anything that kept me from getting on with what I was doing |
0 |
1 |
2 |
3 |
38 |
I felt I was close to panic |
0 |
1 |
2 |
3 |
39 |
I was unable to become enthusiastic about anything |
0 |
1 |
2 |
3 |
40 |
I felt I wasn't worth much as a person |
0 |
1 |
2 |
3 |
41 |
I felt that I was rather touchy |
0 |
1 |
2 |
3 |
42 |
I was aware of the action of my heart in the absence of physical exertion (sense of heart rate increase, heart missing a beat) |
0 |
1 |
2 |
3 |
43 |
I felt scared without any good reason |
0 |
1 |
2 |
3 |
44 |
I felt that life was meaningless |
0 |
1 |
2 |
3 |
|
Rate your agreement from (1)-Does not describe me, (2)- Does not describe me, (3)- Neutral, (4)- Describes me, (5)- Describes me very well. |
45 |
I look for creative ways to alter difficult situations |
1 |
2 |
3 |
4 |
5 |
46 |
Regardless of what happens to me, I believe I can control my reaction to it |
1 |
2 |
3 |
4 |
5 |
47 |
I believe I can grow in positive ways by dealing with difficult situations |
1 |
2 |
3 |
4 |
5 |
48 |
I actively look for ways to replace the losses I encounter in life |
1 |
2 |
3 |
4 |
5 |