QUESTIONNAIRES

These questionnaires are all self-assessment tools. Their goal is to assist you in identifying relevant bio-psycho-socio-spiritual concerns and health-risk factors. Several were developed personally, whereas others have been scientifically and professionally validated (i.e., as being reliable, reproducible, sensitive and specific) for various mental and physical disorders, illnesses and risk factors. Please feel free to make use of them. Upon completion of each questionnaire, the individual is given the opportunity to submit an e-mail address to receive a copy for their records, together with the scoring or interpretation where applicable.

 

We do not interact with those who complete the forms unless we are asked specifically to do so.

As such, participating in these Questionnaires and surveys does not imply or constitute any doctor-patient relationship.

 

The information is confidential and no identifying information is required to complete them.

 

There is no charge to use them. If you would like to contribute towards the running costs of this service, click here.

 

Health- & Life Orientation Questionnaire [English & Afrikaans]: Addresses life and relational challenges relevant to spiritual, mental and physical health. These were developed this for our practice. We have found them very helpful to identify themes of relational breakdown or distress.

Physical, Mental & Spiritual Health Questionnaire: This assesses markers of faith and religion as well as relevant negative beliefs regarding the individual's relationship with God. It also assesses various aspects of stress, anxiety and depression. This was the questionnaire we used for the Be in Health study. 

The Mental Health Questionnaire is a shortened version that excludes the faith and religious components of the previous questionnaire. If focuses on stress, anxiety and depression in particular.

Beck's Hopelessness Questionnaire: This questionnaire evaluates the individual's future expectations. When it is high (i.e., elevated hopelessness) it corresponds to poor outcomes for health - especially for cancer.

Life Event & Relational Distress Scale: This questionnaire assesses residual feelings of distress (unrelated to anxiety or fear), following an exceptional event or loss. As such, it differs from e.g., Post-Traumatic Stress assessments in that it considers the pain, frustration, offense, anger and resentments that may persist following a distressing or traumatic event, rather than the stress and anxiety. 

Self-Assessment of Spiritual Health Questionnaire: This questionnaire addresses phenomena associated with spiritual interference or psychic fragmentation (dissociation). We have found it very helpful to distinguish primarily physical, psychological or spiritual issues as the cause. It is not diagnostic, but it facilitates reflection, dialogue and appropriate intervention by a multidisciplinary team.

Dissociative Experiences Scale: This is a well-known screening tool for dissociative conditions. For our detailed discussion on Dissociative Disorders in Psychiatry and Medicine - [Click Here]

Operation Styles: This is based on the last of the three sets 1 Corinthians 12:46: "variety of operations". The Questionnaire is a modified version of the Christway Counseling Questionnaire designed to identify the 7 gifts outlined in Romans 12:3-8. The questions are randomised between the gifts, so avoid looking for a pattern. At the end, a score is generated and allocated using the terminology of Romans 12:3-8: Prophet; Servant; Teacher; Exhorter; Giver; Ruler; Mercy.