Mental Health Survey

Hare Krishna!Today on the occasion of World Mental Health Day, our scientific and medical teams want to study how spirituality plays a role in the mental and physical well-being.
Please fill the form and participate in the survey and help us study the medical aspects of spirituality!
Section A : Basic Details
Name*
Email*
Age*
Sex*
Occupation
Education*
Relationship Status*
Single
Married
In a causal relationship
In a committed relationship
Divorced
Widowed
Are you practicing Krishna Consciousness/Krishna Bhakti?*
Yes, I am following it
I know about it, but don’t follow 
Neither I know about it nor I follow
Do you chant any mantra? *
Hare Krishna mahamantra 
No
Yes, some other (please specify)
How often do you chant the mantra(s) you mentioned above? *
Daily 
Weekly 
Rarely ever 
Never
Do you consume any of the following? (Select all that apply) *
Alcohol 
Tobacco ((Bidi/Cigarette/Gutka/Other) 
non-vegetarian food (Meat, seafood, eggs) 
Caffeine (Coffee/Tea/Energy drinks/chocolates) 
None of the above
At what time do you wake up? *
Before 4 am 
4-6 am 
8-10 am 
After 10 am 
Varies
Do you read any scripture (e.g., Bhagavad Gita, Srimad Bhagavatam, Caitanya Caritamrta, or any of Srila Prabhupada’s books)? *
No 
Yes (For how many hours, please specify)
Do you consume only Krishna Prasadam? *
Never 
Sometimes 
Mostly 
Always
Section B : Survey Questions
In Past were you suffering from any mental illness?*
I never did
Yes (specify name or tell in brief) 
Presently are you suffering from any mental illness? *
No
Yes (specify name or tell in brief) 
In Past were you suffering from any physical illness?*
No
Yes (specify name or tell in brief) 
Presently are you suffering from any physical illness? *
No
Yes (specify name or tell in brief) 
Have you been clinically diagnosed with your mental/physical illness? *
Not that I know of 
No
Yes (Tell in brief) 
If you are clinically diagnosed, please upload a medical report
Are you currently on any medication? *
Yes (Specify name) 
No
Before coming to Krishna consciousness, how often has your mental health affected your ability to get work done? *
Very often 
Somewhat often 
Rarely 
Never
Before coming to Krishna consciousness, how often has your physical health affected your ability to get work done? *
Very often 
Somewhat often 
Rarely 
Never
Before coming to Krishna consciousness, has your mental health affected your relationships? *
Very often 
Somewhat often 
Rarely 
Never
Before coming to Krishna consciousness, has your physical health affected your relationships? *
Very often 
Somewhat often 
Rarely 
Never
Before coming to Krishna consciousness, how often has your mental health affected your ability to socialize? *
Very often 
Somewhat often 
Rarely 
Never
Before coming to Krishna consciousness, how often has your physical health affected your ability to socialize? *
Very often 
Somewhat often 
Rarely 
Never
Before coming to Krishna consciousness, have you felt particularly low or down for more than 2 weeks in a row? *
Yes
No
How would you rate your mental health before coming to Krishna consciousness? *
Excellent 
Good 
Moderate 
Poor (Reason, if any, please specify)
How would you rate your physical health before coming to Krishna consciousness? *
Excellent 
Good 
Moderate 
Poor (Reason, if any, please specify)
How would you rate your sleep quality before coming to Krishna consciousness? *
Excellent 
Good 
Moderate 
Poor (Reason, if any, please specify)
How would you rate your mental health after coming to Krishna consciousness? *
Excellent 
Good 
Moderate 
Poor (Reason, if any, please specify)
How would you rate your physical health after coming to Krishna consciousness? *
Excellent 
Good 
Moderate 
Poor (Reason, if any, please specify)
After coming to Krishna consciousness, has your mental health improved? *
Significantly improved 
Moderately improved 
Slightly improved 
No improvement 
Worsened my mental health
After coming to Krishna consciousness, has your physical health improved? *
Significantly improved 
Moderately improved 
Slightly improved 
No improvement 
Worsened my mental health
After coming to Krishna consciousness, have you felt particularly low or down for more than 2 weeks in a row? *
Yes
No
After coming to Krishna consciousness, how often has your mental health affected your ability to socialize? *
Very often 
Somewhat often 
Rarely 
Never
After coming to Krishna consciousness, how often has your physical health affected your ability to socialize? *
Very often 
Somewhat often 
Rarely 
Never
After coming to Krishna consciousness, how often has your mental health affected your ability to get work done? *
Very often 
Somewhat often 
Rarely 
Never
After coming to Krishna consciousness, how often has your physical health affected your ability to get work done? *
Very often 
Somewhat often 
Rarely 
Never
How would you rate your sleep quality after coming to Krishna consciousness? 
Excellent 
Good 
Moderate 
Poor (Reason, if any, please specify)
How has coming to Krishna Consciousness changed your relationships? *
No change 
It improved for the better 
It got worse
Any other change you have noticed in your life before and after coming to Krishna consciousness? 
Section C: DASS scale (please fill according to your current situation)
DASS- 21 Scale
I find it hard to wind down*
never
sometimes
often 
almost always
I was aware of dryness of my mouth*
never
sometimes
often 
almost always
I couldn’t seem to experience any positive feeling at all*
never
sometimes
often 
almost always
I experienced breathing difficulty (e.g. excessively rapid breathing in the absence of physical exertion)*
never
sometimes
often 
almost always
I found it difficult to work up the initative to do things*
never
sometimes
often 
almost always
I tended to over - react to situations *
never
sometimes
often 
almost always
I experienced trembling ( eg. in the hands)*
never
sometimes
often 
almost always
I felt that I was using a lot of nervous energy *
never
sometimes
often 
almost always
I was worried about situations in which i might panic and make a fool of myself*
never
sometimes
often 
almost always
I felt I had nothing to look forward to*
never
sometimes
often 
almost always
I found myself getting agitated *
never
sometimes
often 
almost always
I found it difficult to relax*
never
sometimes
often 
almost always
I felt down- hearted and blue*
never
sometimes
often 
almost always
I was intolerant of anything that kept me from getting on with what I was doing *
never
sometimes
often 
almost always
I felt I was close to panic *
never
sometimes
often 
almost always
I felt I wasn’t worth much as a person *
never
sometimes
often 
almost always
I was aware of action of my heart in the absence of physical exertion (e.g. sense if heart rate increase, heart missing a beat)*
never
sometimes
often 
almost always
I felt scared without any good reason*
never
sometimes
often 
almost always
I felt that life was meaningless *
never
sometimes
often 
almost always