Early Life Stress Questionnaire

Early life stress can be profound and have a long lasting effect on a person’s life. So it is important to detect it early. Early life stress questionnaires can be administered on children or adults who seem to behave or reach to situations differently and find an appropriate cure for the same.

Early Life Stress Questionnaire Sample:

Name:                       ____________________

Address:            ____________________

Phone Number:   ____________________

Email id:            ____________________

Q1. Tick the right choice.

a)   I am a student

b)   I am a teenager pursuing studies

c)   I am a teenager and have just started working

d)   I am a teenager and I’m a job seeker

e)   Others

If ‘Others’, please specify __________________________________

Q2. Do you stay with your family?

a)   Yes

b)   No

Q3. Have you experienced any family problems till date?

a)   Yes

b)   No

Q4. If the answer to the above question is ‘Yes’, then tick the right choice describing your family problem

a)   Arguments between parents

b)   Separation among my parents

c)   Fight with or between my siblings

d)   Fight between in-laws and parents

e)   Others ____________________________________________________

Q5. Did you face fights or serious arguments with any of your friends?

a)   Yes

b)   No

Q6. If the answer to the above question is ‘Yes’, did the incident have a lasting impression on you?

a)   Yes

b)   No

c)   For only a brief period of time

Q7. Does your teacher punish students severely for gaining low marks during examination?

a)   Yes

b)   No

Q8. Did you come across any physical violence or incident that has disturbed you profusely?

a)   Yes

b)   No

Q9. If yes, then describe the situation


Category: Stress Questionnaire

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