Emotional mode

Psychological condition of cancer patient relatives' questionnaire

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1. What is your gender?

MaleFemale

2. What is your age?

18-2424-30>30

3. Does anyone from your close family have/had cancer?

(If “Yes”, please answer questions 4 - 7, if “No”, please go to question 8.)

YesNo

4. Please name your relation with the patient.

Mother/FatherBrother/SisterHusband/WifeOne of the grandparentsSon/Daughter

5. Have you felt any symptoms of depression at that time?

(If no, skip the question, if yes, name them (more than one answer is possible)

Trouble concentrating, remembering details, and making decisionsFatigueFeelings of guilt, worthlessness, and helplessnessPessimism and hopelessnessInsomnia, early-morning wakefulness, or sleeping too muchIrritabilityRestlessnessLoss of interest in things once pleasurable, including sexOvereating, or appetite lossAches, pains, headaches, or cramps that won't go awayDigestive problems that don't get better, even with treatmentPersistent sad, anxious, or "empty" feelingsSuicidal thoughts or attempts

6. Did you look for psychological help at that time?

YesNo

7. What had helped you to endure that time?

Professional psychological helpSupport from the family and friendsMeditationReligion

8. Does anyone from your relatives or friends have/had cancer?

(If “Yes”, please answer questions 9 - 12, if “No”, the test is finished.)

YesNo

9. Please name your relation with the patient.

Niece/NephewBrother in law/Sister in lawMother in law/Father in lawAunt/UncleCousinFriend

10. Have you felt any symptoms of depression at that time?

(If no, skip the question, if yes, name them (more than one answer is possible)

Trouble concentrating, remembering details, and making decisionsFatigueFeelings of guilt, worthlessness, and helplessnessPessimism and hopelessnessInsomnia, early-morning wakefulness, or sleeping too muchIrritabilityRestlessnessLoss of interest in things once pleasurable, including sexOvereating, or appetite lossAches, pains, headaches, or cramps that won't go awayDigestive problems that don't get better, even with treatmentPersistent sad, anxious, or "empty" feelingsSuicidal thoughts or attempts

11. Did you look for psychological help at that time?

YesNo

12. What had helped you to endure that time?

Professional psychological helpSupport from the family and friendsMeditationReligion