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Mental & Emotional Well-being Questionnaire
Purpose:
market research and service design only. This questionnaire is not a diagnostic or clinical assessment.
Before you begin:
This survey explores mental and emotional well-being experiences to inform the design of BEE4, an early-intervention well-being app. Your responses are anonymous and used only for research and product development.
If any question brings up difficult feelings, please pause and seek support.
Please only complete the survey if you are 18 years or over.
By completing this questionnaire, I understand that my responses will be anonymously used for research, reporting, or awareness purposes.
*
By completing this questionnaire, I understand that my responses will be anonymously used for research, reporting, or awareness purposes.
Agree
Personal Details
Age Range
*
Age Range
18-24
25-34
35-44
45-54
55-64
65+
Gender
*
Gender
A
Male
B
Female
C
Non-binary
D
Other
E
Prefer not to say
Postcode
*
Employment
Employment status
*
Employment status
A
Employed full time
B
Employed part-time
C
Self-employed
D
Student
E
Unemployed
F
Unable to work
G
Retired
Employment sector (if applicable)
Overall Emotional Well-being
Have you experienced any of the following in the past 12 months? (Select all that apply)
*
Have you experienced any of the following in the past 12 months? (Select all that apply)
Bereavement
Relationship breakdown
Serious illness (self or close other)
Caring responsibilities increased
Job loss or role change
None of the above
How would you rate your current mental well-being at present?
*
1 - extremely low; 10 - very positive
How would you rate your current mental well-being at present?
1
2
3
4
5
6
7
8
9
10
Have you ever felt that your mental or emotional well-being was affected?
*
Have you ever felt that your mental or emotional well-being was affected?
A
Yes
B
No
C
Maybe
D
Prefer not to say
Over the past 4 weeks, how often have you felt:
Scale:
1
-Never /
2
-Rarely /
3
-Sometimes /
4-
Often /
5
-Always
Stressed
*
Stressed
1
2
3
4
5
Anxious
*
Anxious
1
2
3
4
5
Low mood
*
Low mood
1
2
3
4
5
Overwhelmed
*
Overwhelmed
1
2
3
4
5
Calm and relaxed
*
Calm and relaxed
1
2
3
4
5
Which factors do you feel contributed to this? (Select all that apply)
*
Which factors do you feel contributed to this? (Select all that apply)
Bereavement or loss
Caring responsibilities
Eating concerns
Financial pressure
Family or relationship issues
Life change or uncertainty
Physical health problems
Social isolation or loneliness
Social media and world news exposure
Sleep issues
Stress / burnout
Work-related stress
Other
When experiencing low well-being, which statement best resonates with you?
*
Recognising and Expressing
How confident are you in recognising your feelings?
*
How confident are you in recognising your feelings?
A
Very confident
B
Confident
C
Neutral
D
Uncertain
E
Very uncertain
How easy do you find it to share or express your emotions with others?
*
How easy do you find it to share or express your emotions with others?
A
Very difficult
B
Difficult
C
Neutral
D
Easy
E
Very easy
Which approaches do you take when processing difficult emotions? (Select all that apply)
*
Which approaches do you take when processing difficult emotions? (Select all that apply)
Reflect internally
Talk with friends and family
Exercise or physical activity
Creative outlets (e.g. art, music, writing, journalling etc.)
Professional support (counselling, therapy sessions, visit to GP)
Digital tools or apps
Avoidance and/or distraction
Other
Seeking support
Do you feel you know where to go for support if needed?
*
Do you feel you know where to go for support if needed?
A
Yes
B
No
C
Unsure
What has prevented you from seeking support in the past? (Select all that apply)
*
What has prevented you from seeking support in the past? (Select all that apply)
Did not feel that my problem was serious enough
Was unsure of where to go or what to do
Cost or access barriers
Fear of judgement or stigma
Long waiting times
Previous negative experiences
Prefer to manage alone
Nothing has stopped me
Which of the following would you consider helpful?
*
Which of the following would you consider helpful?
Speaking with friends or family
Visiting GP / doctor
Seeking a therapist / counsellor
Calling a helpline
EAP / Workplace or education support
Self help resources
None
Other
Have you used any mental health or wellbeing apps or online tools before?
*
Have you used any mental health or wellbeing apps or online tools before?
A
Yes
B
No
If yes, what did you find helpful?
If yes, what did you find unhelpful or limiting?
How comfortable would you feel using an app that checks in on your emotional well-being?
*
How comfortable would you feel using an app that checks in on your emotional well-being?
A
Very comfortable
B
Comfortable
C
Neutral
D
Uncomfortable
E
Very uncomfortable
Which features would you find most helpful? (Select all that apply)
*
Which features would you find most helpful? (Select all that apply)
Daily emotional check-ins
Guided reflection or grounding exercises
Structured chat support
Human support when needed
Mood tracking over time
Signposting to services
Other
Do you feel informed about mental health and well-being?
*
Do you feel informed about mental health and well-being?
A
Not at all
B
Slightly
C
Moderately
D
Very
E
Extremely
Which topics would you like more information about? (Select all that apply)
Which topics would you like more information about? (Select all that apply)
Managing stress
Anxiety
Depression
Burnout
Trauma
Relationships
Workplace wellbeing
Self-care techniques
Other
What does feeling emotionally supported mean to you?
Is there anything you wish existed to support your mental or emotional well-being?
Optional follow up
Would you like to be contacted about future mental health initiatives or resources?
*
Would you like to be contacted about future mental health initiatives or resources?
Yes
No
Support Disclaimer
If completing this form has brought up difficult feelings, please consider reaching out to a trusted person or a mental health professional.
UK support: Samaritans
– 116 123
Emergency:
Call 999 if you are in immediate danger.
Hub of hope
-
https://hubofhope.co.uk/
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