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1. What is your age
2. How do you self-identify your gender identity?
A. Male
B. Female
C. Transgender or gender non-binary
D. Prefer to self-describe ______
E. Refuse to answer
3. What is the highest grade or level of schooling you completed?
A. Less than 8 years
B. 8 through 11 years
C. 12 years or completed high school
D. Post high school training other than college
E. Some college
F. College graduate
G. Graduate Degree (e.g., MD, PhD)
4. What is your race?
A. Hispanic
B. White
C. Black or African American
D. American Indian or Alaska Native
E. Asian
F. Native Hawaiian or other Pacific Islander
G. Other, please specify _______________
5. Do you identify yourself as from any low resource communities or marginalized communities?
A. First generation students
B. International students
C. New immigrants
D. LGBTQ +
E. Disabled
F. Low income
G. Race minority
G. Other, please specify: __________________
6. Have you ever been diagnosed with any mental health disorders (e.g., depression, anxiety)?
A. Yes, I have been diagnosed by doctors with ____________
B. No, I have not been officially diagnosed with any mental health disorder
7. Over the last two weeks, how often have you been bothered by any of the following problems?
7. Over the last two weeks, how often have you been bothered by any of the following problems?
Not at all
Several days
More than half the days
Nearly every day
Feeling nervous, anxious or on edge
Not at all
Several days
More than half the days
Nearly every day
Not being able to stop or control worrying
Not at all
Several days
More than half the days
Nearly every day
Little interest or pleasure in doing things
Not at all
Several days
More than half the days
Nearly every day
Feeling down, depressed, or hopeless
Not at all
Several days
More than half the days
Nearly every day
8. Whom have you sought help from?
A. Family
B. Friends
C. Professionals, such as therapists and doctors
D. People with similar experiences
E. Others, please specify ______
F. I have not sought help from anyone
9. What technologies, platforms, or organizations have you used to seek help for mental health concerns?
A. Social media (e.g., Facebook, Twitter, Instagram)
B. Online mental health forums or communities
C. Search engines
D. Mobile applications
E. Teletherapy services
F. Hotlines
G. Services in your local community (e.g., schools, libraries, community centers)
H. Others, please specify ______
I. I haven’t used any of these
10. Can you briefly describe the last or most impressive help-seeking experience (it can be a successful or failed experience)?
11. Please leave your email address for us to contact you for the interview.
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