Stress Impact 5D Name of the Individual *Contact Number *Email AddressDate of Birth *Gender, Education and Occupation Details *1. During the past 1 week - Did you feel easily irritated ? *NoSometimesRegularlyOftenVery Often or Constantly2. During the past 1 week - Did you feel that you can't face it anymore OR No longer feel like doing anything *NoSometimesRegularlyOftenVery Often or Constantly3. During the past 1 week - Did you feel that life is not worthwhile *NoSometimesRegularlyOftenVery Often or Constantly4. During the past 1 week - Did you ever think "if only I was dead" ? *NoSometimesRegularlyOftenVery Often or Constantly5. During the past 1 week - Did you feel unknown fear or become restless / tense ? *NoSometimesRegularlyOftenVery Often or Constantly6. During the past 1 week - Did you feel frightened or anxiety or panic ? *NoSometimesRegularlyOftenVery Often or Constantly7. During the past 1 week - Did you feel pressure or tight feeling in the chest or pain ? *NoSometimesRegularlyOftenVery Often or Constantly8. During the past 1 week - Did you feel shortness of breath or bloating in the stomach ? *NoSometimesRegularlyOftenVery Often or Constantly9. During the past 4 week - I found myself getting angry at people or situations *NoA littleSometimeOften / Most of the timeAlmost All the time or Constantly10. During the past 4 week - When I got angry, I got really mad (Strong or intense level of anger) *NoA littleSometimeOften / Most of the timeAlmost All the time or Constantly11. During the past 4 week - When I got angry, I stayed angry for sometime *NoA littleSometimeOften / Most of the timeAlmost All the time or Constantly12. During the past 4 week - When I got angry, I wanted to hit them *NoA littleSometimeOften / Most of the timeAlmost All the time or Constantly13. During the past 4 week - My anger prevented me from getting along with people to the extent I wanted to get along *NoA littleSometimeOften / Most of the timeAlmost All the time or Constantly4 Dimensional Symptom Questionnaire - Example Items - DISTRESS (out of 8)4 Dimensional Symptom Questionnaire - Example Items - DEPRESSION (out of 8)4 Dimensional Symptom Questionnaire - Example Items - ANXIETY (out of 8)4 Dimensional Symptom Questionnaire - Example Items - SOMATIZATION (out of 8)Dimensions of Anger Reaction DAR 5 - out of 20SubmitPlease do not fill in this field.
