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Do you feel sad most of the time?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE 2
 
STRONGLY DISAGREE 1
 
Unsure
 
Other
 

 
 
 
Do you want to be alone most of the time?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE 2
 
STRONGLY DISAGREE 1
 
Unsure

 
 
 
You want to sleep most of the time?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE 2
 
STRONGLY DISAGREE 1
 
Unsure

 
 
 
You have made excuses not see family and friends?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE 2
 
STRONGLY DISAGREE 1
 
Unsure

 
 
 
You believe you cannot do anything right, and when you do you believe it is not done right?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE STRONGLY 2
 
DISAGREE 1
 
Unsure 0

 
 
You have started to wear all dark colors?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE STRONGLY 2
 
DISAGREE 1
 
Unsure 0

 
 
 
Do have a change within your eating habits eating more/less?
 
 
STRONGLY AGREE 5
 
AGREE 4
 
NEUTRAL 3
 
DISAGREE STRONGLY 2
 
DISAGREE 1
 
Unsure 0

 
 
 
Do you believe that communication with a support system is a good idea?
 
Yes
 
No

 
 
 
Do you feel that multimedia (TV, Movies, Songs, Video’s) influences your decision about seeking treatment?
 
Yes
 
No

 
 
 
Did peer pressure influence your decisions on seeking treatment?
 
Yes
 
No

 
PERSONAL AND OTHER INFLUENCES.
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