Stress Self-Assessment Survey - StellaPsychologist

Stress Self-Assessment Survey

Instructions: Please read each statement carefully and select the response that best describes your experience over the past month. Choose the number that corresponds to how often each statement applies to you:

Never
Rarely (Once or twice)
Sometimes (A few times a month)
Often (Once or twice a week)

Always (Almost every day)

Name

Phone

I have trouble sleeping due to racing thoughts or worries.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I feel irritable, anxious, or on edge.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I have difficulty concentrating or staying focused on tasks.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I experience physical symptoms such as headaches, muscle tension, or stomach issues related to stress

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I feel overwhelmed by responsibilities or tasks.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I have withdrawn socially or lost interest in activities I used to enjoy.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I find it difficult to relax or unwind.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I have experienced changes in appetite (eating more or less than usual).

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I worry excessively about future events or outcomes.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None

I feel emotionally drained or exhausted.

1. Never

2. Rarely (Once or twice)

3. Sometimes (A few times a month)

4. Often (Once or twice a week)

5. Always (Almost every day)

None