How Our Mental Health Questionnaire Can Help You

Congratulations on deciding to take our free Adult Grief and Loss test.

Please note: this questionnaire was developed by Sullivan + Associates Clinical Psychology to provide a general overview of how much a particular problem or mental health issue impacts you. It is not meant to be diagnostic or replace a formal mental health assessment by a health care practitioner (i.e. Psychologist, Psychiatrist, etc.). However, feel free to use it as a starting point towards learning about improving a particular problem or mental health issue. If you choose to pursue psychotherapy/counselling or discuss your mental health with your Physician or Nurse Practitioner, sharing your results from this questionnaire would provide valuable information.

Benefits of Taking our Mental Health Questionnaire

  • Easy to Do – It’s a rating scale-style questionnaire. Just click on the selection that best describes you.
  • Confidential – Your responses and results are 100% confidential.
  • Direction – Suggests helpful next steps, such as suggestions for resources and services based on your responses.
  • Cost-Effective – It’s free to use as many times as you want.
  • Quick to Use – It takes approximately 5-10 minutes to complete the test.
  • Immediate Results – You will receive your results immediately upon completing the test.
  • Free Report – If you enter your email address, you will receive a copy of your results. If you choose to provide your email address, your responses and results will remain 100% confidential.
  • Anonymous – You don’t need to provide any identifying information to complete the test.

Adult Grief and Loss Questionnaire

Answer each question, then click submit to see your results.

Adult Grief and Loss Mini-Questionnaire
I feel guilty about what I could have done differently.
My daily routine has been disrupted significantly.
I have a plan for harming myself and/or someone else**
I experience confusion or disbelief that the loss really happened.
I want to hurt myself and/or someone else
I have withdrawn from social activities or relationships.
I feel hopeless about my future or numb
I feel tense or restless physically.
I cry when thinking about the person I lost.
I engage in behaviors to feel closer to the deceased (e.g., talking to them, keeping belongings nearby).
I think that life would be better without me in it

Section

You endorsed thoughts/feelings of hopelessness, suicidality, homicidality, and/or self-harm. Please note that you are not alone and that there is help available. For your safety/the safety of others, consider accessing the following resources if you are at imminent risk of harm to yourself or someone else:

  1. Call Crisis Response Services. (They offer mobile crisis response, crisis support residence, and 24/7 telephone services to both youth and adults who are experiencing a mental health crisis) locally at 807-346-8282 or toll-free at 1-888-269-3100.
  2. Go to the Emergency Department at your local hospital or health centre.
  3. Call 911.

For more information on self-harm and preventing suicide:
https://ontario.cmha.ca/documents/preventing-suicide/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244874/
http://sioutreach.org

Do you wish to end the questionnaire here and contact crisis response?
The questionnaire is over. Please contact crisis response.
I find myself constantly thinking about the person I lost.
I avoid places, people, or situations that remind me of the person I lost.
I feel significant anger or sadness related to the loss.
I have trouble sleeping (falling asleep, staying asleep, or sleeping too much).

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