Mental Health Product Research

EthicnicityWhite BritishWhite IrishAny other white backgroundMixed – White and Black CaribbeanMixed – White and Black AfricanMixed – White and AsianAny other mixed backgroundIndianPakistaniBangladeshiAny other Asian BackgroundCaribbeanAfricanAny other Black backgroundChinese

Have you ever taken part in market research?

YesNo

Do you, or any close family or friends work in any of the following occupations or industries?

Marketing or Market ResearchAdvertising or Public RelationsJournalism or Press (TV, radio, print, online)Healthcare services (private or NHS)CharitiesNone of the above

Have you ever been told by a health professional (doctor or nurse) that you have any of the following conditions: depression, generalised anxiety disorder, eating disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, bipolar disorder, psychosis, a personality disorder or any other condition)?

YesNo

Thinking about the past 6 months up to now, which one of the following statements would you say most closely applies to you?

I think I may have a mental illness or mental health condition but I have not been formally diagnosedI don’t think I have experienced a mental illness or mental health condition but there are times when some emotions (e.g. anxiety, anger, panic, sadness, feeling low) can be quite intense and sometimes stop me from functioning normally day to day.I don’t think I have experienced a mental health problem or get to the point of feeling really distressed. Negative emotions like anger, irritation or sadness pass quite quickly. But I think my mental and emotional well-being could probably be better than it is right now.At the moment, I think I’m mentally and emotionally very healthy. On the whole, I feel positive and optimistic. I cope fairly easily with stress and life’s challenges and have good relationships with others

Are you currently having, or have you ever had, any treatment or using any services for that condition?
CODE ALL THAT APPLY

Currently

Prescription medicationTalking therapy services provided through the NHS or privatelyNon-medical treatments or therapiesOther servicesNo treatment

Previously

Prescription medicationTalking therapy services provided through the NHS or privatelyNon-medical treatments or therapiesOther servicesNo treatment

Would you say ‘anxiety’ is one of the things you suffer from sometimes?

YesNo

Thinking about those times when you don’t feel 100%, which of the following two statements most closely relates to you?

There are specific things I do to try and help myself feel betterWhen I don’t feel 100% I tend to just have to wait for it to pass

On a scale of 1 to 10, where 1 is ‘not at all’ and 10 is ‘very much’ how concerned would you say you are about how you feel at those times?

Which of the following would you be willing to do?

Look up ways to help in books or onlineAsk someone for advice or talk to other people about things you can do to feel better
__________________________________________________

Do you have experience of anyone close to you (friend, partner or family member) ever having a mental health problem (this might be one that has been formally diagnosed and treated with medication or use of a health service or one that hasn’t)?

YesNo

Which of the following apply to you?

I have no childrenI am currently pregnantI have at least one child at home aged under 18I have children who have left home

What is your current working status?

I am working full timeI am working part-timeI am volunteeringI am a student, for example at a secondary school, college or other education institutionI am a carerI am currently on leave long-termI am currently at home looking after my childrenUnemployedRetired

You said you are a carer. Which of the following applies to you?

I look after a parent who is old/ill/has a disabilityI look after my child who is ill/has a disabilityI look after my relative/friend who is ill/has a disabilityI look after my partner who is ill/has a disabilityOther (please specify)None of these

Other

Which of the following would you use to describe yourself?

HeterosexualLesbianGayBisexualTrans*Unsure/QuestioningOtherPrefer not to say

Do any of the following learning difficulties apply to you:

Attention Deficit Hyperactivity Disorder (ADHD)DyslexiaDyspraxiaAutistic spectrum disorders (ASD), e.g. Asperger SyndromeTourette SyndromeOther (please specify)

Do you have any registered disabilities?

YesNo

What type of registered disability do you have?

Visual impairmentHearing impairmentMobility impairmentLearning disabilityDisability due to a chronic physical health conditionDisability due to a chronic mental health conditionOther

Are you a smoker?

No I have never smokedI was – I gave up/have given upYes, less than 5 cigarettes a dayYes, 5 – 10 cigarettes a dayYes, 11 - 20 cigarettes a dayYes, 20+ cigarettes a day

Have you ever had a diagnosis for alcohol or drug dependency?

YesNo

Date and time you'd like to be interviewed?

Alternative date and time, in case first choice is already taken.