亲爱的各位住客，请认真填写下列心理评估问卷，跟大家顺利解除隔离有关。Dear guests,, in order to provide you with better medical and health care, we need you to fill in the psychological questionnaire. Please choose according to the recent actual situation, thank you for your cooperation!
2021-04-22 18:38:27
人人秀问卷
姓名 name：
房号：
对医学观察的态度 Attitudes towards medical observation
1、完全理解 Fully understand
2、部分理解 Part understand
3、不理解 Don't understand
自伤自杀风险 Risk of self-injury and suicide
无明显自杀自伤风险 No obvious risk of suicide and self-harm
有自杀自伤观念 have the idea of suicide and self-harm
有自杀自伤企图 Attempt to commit suicide
有自杀自伤行为 Have committed suicide and self-harm
2-1 入睡困难 Difficulty falling asleep
0、无 no
1、轻度 Mild
2、中度 Moderate
3、重度 Severe
4、极重度 Extremely Severe
2-2 睡眠维持困难 Difficulty maintaining sleep
0、无 no
1、轻度 Mild
2、中度 Moderate
3、重度 Severe
4、极重度 Extremely Severe
2-3 早醒 Wake up early
0、无 None
1、轻度 Mild
2、中度 Moderate
3、重度 Severe
4、极重度 Extremely Severe
2-4 对您目前的睡眠模式满意/不满意程度如何? How satisfied/dissatisfied with y
0、非常满意 Very satisfied
1、满意 Satisfied
2、不太满意 Not too satisfied
3、不满意 Dissatisfied
4、很不满意 Very dissatisfied
2-5 您认为您的失眠在多大程度上影响了你的日常功能 To what extent does your insomn
0、无 None
1、轻度 Mild
2、中度 Moderate
3、重度 Severe
4、极重度 Extremely Severe
2-6 你的失眠问题影响了你的生活质量，你觉得在别人眼中你的失眠情况如何? Your insomnia problem
0、无 None
1、轻度 Mild
2、中度 Moderate
3、重度 Severe
4、极重度 Extremely Severe
2-7 您对目前的睡眠问题的担心/痛苦程度如何?满意/不满意程度如何? How worried/painful are
0、无 None
1、轻度 Mild
2、中度 Moderate
3、重度 Severe
4、极重度 Extremely Severe
3-1做事时没有兴趣或乐趣 No interest or pleasure in doing things
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-2 感到心情低落、沮丧或绝望 Feeling down, depressed, or hopeless
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-3 入睡困难、易醒或睡眠过多 Difficulty falling asleep, waking up easi
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-4 感到疲倦或没有精力 Feel tired or lack energy
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-5 食欲不振或吃得过多 Loss of appetite or overeating
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-6 觉得自己很糟或自己很失败，或让自己或家人失望 Feeling bad or failing, or disa
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-7 做事情难以专注、例如读报纸或看电视 Difficulty in doing things, such as
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
Acts or speaks slowly to the point where others have noticed
0、完全没有 Not at all
1、几天时间 few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
3-9 有不如死掉的想法，或以某种方式伤害自己的念头 Thoughts that it’s better to d
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-1 感到紧张、焦虑或快要崩溃 Feeling nervous, anxious or about to col
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-2 不能停止或控制担忧 Can't stop or control worry
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-3 过多的担忧各种各样的事情 worry about all kinds of things too much
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-4 很难放松下来 Hard to relax
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-5 不安得难以静坐 Feel uneasy and have difficulty sitting still
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-6 变得容易气恼或易怒 Become irritable or irritable easily
0、完全没有 Not at all
1、几天时间 a few days
2、一半以上时间 more than half of the time
3、几乎每天 almost every day
4-7 感到似乎要发生不好的事情而担心受怕 Feeling that something bad is about
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