Beck Depression Indicator & Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) & Academic Environment

Gender? *

Male

Female

Age?
*

How many hours do you sleep per day? *

Sadness

*

0: I do not feel sad.

1: I feel sad.

2: I am sad all the time and I can't snap out of it.

3: I am so sad or unhappy that I can't stand it.

Pessimism

*

0: I am not discouraged about my future.

1: I feel more discouraged about my future than I used to.

2: I do not expect things to work out for me.

3: I feel my future is hopeless and will only get worse.

Sense of Failure

*

0: I do not feel like a failure.

1: I feel I have failed more than the average person.

2: As I look back, I see a lot of failures.

3: I feel I am a complete failure as a person.

Loss of Pleasure

*

0: I get as much satisfaction out of things as I used to.

1: I don't enjoy things as much as I used to.

2: I get very little pleasure from the things I used to enjoy.

3: I can't get any pleasure from the things I used to enjoy.

Guilt

*

0: I don't feel particularly guilty.

1: I feel guilty over many things I have done or should have done.

2: I feel guilty most of the time.

3: I feel guilty all of the time.

Punishment Feelings

*

0: I don't feel I am being punished.

1: I feel I may be punished.

2: I expect to be punished.

3: I feel I am being punished.

Self-Dislike

*

0: I feel the same about myself as ever.

1: I have lost confidence in myself.

2: I am disappointed in myself.

3: I dislike myself.

Self-Criticism

*

0: I don't criticize or blame myself more than usual.

1: I am more critical of myself than I used to be.

2: I criticize myself for all my faults.

3: I blame myself for everything bad that happens.

Suicidal Thoughts or Wishes

*

0: I don't have any thoughts of killing myself.

1: I have thoughts of killing myself, but I would not carry them out.

2: I would like to kill myself.

3: I would kill myself if I had the chance.

Crying

*

0: I don't cry any more than I used to.

1: I cry more than I used to.

2: I cry over every little thing.

3: I feel like crying, but I can't.

Agitation

*

0: I am no more restless or wound up than usual.

1: I feel more restless or wound up than usual.

2: I am so restless or agitated it's hard to stay still.

3: I am so restless or agitated that I have to keep moving or doing something.

Loss of Interest

*

0: I have not lost interest in other people or activities.

1: I am less interested in other people or things than before.

2: I have lost most of my interest in other people or things.

3: It's hard to get interested in anything.

Indecisiveness

*

0: I make decisions about as well as ever.

1: I find it more difficult to make decisions than usual.

2: I have much greater difficulty in making decisions than I used to.

3: I have trouble making any decisions.

Worthlessness

*

0: I do not feel I am worthless.

1: I don't consider myself as worthwhile and useful as I used to.

2: I feel more worthless as compared to others.

3: I feel utterly worthless.

Loss of Energy

*

0: I have as much energy as ever.

1: I have less energy than I used to have.

2: I don't have enough energy to do very much.

3: I don't have enough energy to do anything.

Sleep Changes

*

0: I have not experienced any change in my sleeping pattern.

1: I sleep somewhat more OR less than usual.

2: I sleep a lot more OR a lot less than usual.

3: I sleep most of the day OR I wake up 1-2 hours early and can't get back to sleep.

Irritability

*

0: I am no more irritable than usual.

1: I am more irritable than usual.

2: I am much more irritable than usual.

3: I am irritable all the time.

Appetite Changes

*

0: I have not experienced any change in my appetite.

1: My appetite is somewhat less OR greater than usual.

2: My appetite is much less OR greater than usual.

3: I have no appetite at all OR I want to eat all the time.

Concentration Difficulty *

0: I can concentrate as well as ever.

1: I can't concentrate as well as usual.

2: It's hard to keep my mind on anything for very long.

3: I find I can't concentrate on anything.

Tiredness or Fatigue

*

0: I am no more tired or fatigued than usual.

1: I get more tired or fatigued more easily than usual.

2: I am too tired or fatigued to do a lot of the things I used to do.

3: I am too tired or fatigued to do most of the things I used to do.

Repeated, disturbing, and unwanted memories of the stressful experience? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Repeated, disturbing dreams of the stressful experience? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Feeling very upset when something reminded you of the stressful experience? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Having strong physical reactions when something reminded you of the stressful experience (e.g., heart pounding, trouble breathing, sweating)? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Avoiding memories, thoughts, or feelings related to the stressful experience? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Avoiding external reminders of the stressful experience (e.g., people, places, conversations, activities, objects, or situations)? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Trouble remembering important parts of the stressful experience? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Having strong negative beliefs about yourself, other people, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous”)? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Blaming yourself or someone else for the stressful experience or what happened after it? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Having strong negative feelings such as fear, horror, anger, guilt, or shame? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Loss of interest in activities that you used to enjoy? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Feeling distant or cut off from other people? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Trouble experiencing positive feelings (e.g., being unable to feel happiness or have loving feelings for people close to you)? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Irritable behavior, angry outbursts, or acting aggressively? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Taking too many risks or doing things that could cause you harm? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Being “super-alert” or watchful or on guard? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Feeling jumpy or easily startled? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Having difficulty concentrating? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Trouble falling or staying asleep? *

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Do you feel stressed about your academic workload?

*

Yes

No

Do you feel overwhelmed by the number of assignments and exams you have to complete?

*

Yes

No

Do you feel like you have someone to talk to when you’re feeling down or stressed?

*

Yes

No

Do you find that your sleep quality affect your life?

*

Yes

No

Do you engage in physical activity (e.g., walking, exercise, sports)?

*

Yes

No

How would you rate your overall quality of life in the past 3 months on a scale of 0 to 5?

*

Very poor

Poor

Fair

Good

Very Good

Excellent

When you're feeling Sad, what do you usually do to cope with those feelings?

*

Talk to a friend or family member

Exercise

Watch TV or play games or use Mobile

Nothing

Others

Do you have regular or frequent feelings of worry about your health, future, or everyday events, even when everything seems fine?

*

Yes

No

Does your childhood experience make you happy? *

Yes

No

Do you wish to go back to your childhood again? *

Yes

No

Do you have any plans to study abroad? *

Yes

No

Do you have any future plan? *

Yes

No

Thank you for your support. Would you like to share any suggestions, advice, or even your favorite things? (Optional)