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Mothers Self Assessment Survey

The Mothers Self Assessment Survey is a tool used by healthcare professionals to help assess the mental health and well-being of mothers. It is a brief, self-report measure that covers a range of topics related to mental health, including anxiety, depression, stress, and overall wellbeing.

Time to complete

1 minute

Eligibility

Any mother who has recently given birth (within the past 12 months) is eligible to fill out this survey.

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Questions for Mothers Self Assessment Survey

1.

How often have you felt down, depressed, or hopeless in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
2.

How often have you felt nervous, anxious, or on edge in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
3.

How often have you felt like everything was an effort in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
4.

How often have you felt overwhelmed or unable to cope in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
5.

How often have you felt good about yourself or that you are worth something in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
6.

How often have you felt happy in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
7.

How often have you felt satisfied with your life in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
8.

How often have you felt that your life has meaning and purpose in the past two weeks?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always

Similar Ideas

  • Newborn Survey
  • Infant Survey
  • Toddler Survey
  • Parent Self Assessment Survey
  • Child Self Assessment Survey

Here are some FAQs and additional information
on Mothers Self Assessment Survey

What is the purpose of the Mother's Self-Assessment Survey?

The survey is designed to collect information about the needs of mothers and their families.

Who is eligible to participate in the survey?

The survey is open to all mothers who have a child under the age of 18.

How long will the survey take to complete?

The survey should take no more than 10 minutes to complete.

How will the survey be used?

The survey will be used to understand the needs of mothers and their families. The survey will be used to identify areas where mothers need support and make recommendations to improve services and programs.

How will my personal information be used?

Your personal information will be used for research purposes only. Your name and contact information will not be used for any other purpose.

Will my survey responses be confidential?

Yes. Your survey responses will be confidential.

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