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Dear Participant,

This research is a PhD thesis based at Hacettepe University Public Health Department. Our aim is to evaluate the mental health status and quality of life and to identify important factors affecting them and to examine the related items scientifically.

The information collected during this work process will NEVER be shared and will be kept confidential.

Your personal information will only be used for research purposes. If the work data is used in any broadcast and report, your information will not be used in this publication.

Your identification information is not included in the data collection form.

The accuracy of the information you provide is important in terms of the nature of the investigation. Thank you for your participation and your sincere responses.

You are not obliged to answer any questions you do not feel comfortable answering.

Mohamed Saleh Sryh PhD student

Hacettepe University Public Health Department

DEMOGRAPHIC AND SOCIO-ECONOMIC SURVEY:- 1. What is the year of your birth?

……….

2. Mark your gender:- (1) Male.

(2) Female.

3. What is your level of education?

(1) Not educated.

(2) Only literate, did not finish any school.

(3) Primary school (completed sixth grade).

(4) Elementary school graduate.

(5) Secondary school graduate.

(6) Graduated from college.

(7) University graduate.

(8) Completed master's or doctor's degree.

4. What is your marital status?

(1) Married (2) Single (3) Widow

(4) Separated / divorced (5) Other ………

5. How do define your family type?

(1) Nuclear family (Two parents and children).

(2) Single parent family.

(3) Extended family (contains grandparents or grandsons).

(4) Polygamous family.

(5) Other ……….

6. How many persons in your family (including parents)?

……… Persons.

7. Are you enrolled in a regular work?

(1) Enrolled.

(2) Not regularly enrolled.

(3) Partly enrolled.

(4) Not enrolled at all.

8. What kind of job do you work for or are you still working for?

(1) Employer (Any type of company manager).

(2) Highly educated self-employed (such as lawyers, physicians).

(3) Small tradesmen - Craftsmen (shopkeepers, small industry tradesmen, market tradesmen)

(4) Employees without regular work (such as drivers, hawkers, etc.)

(5) High educated wage earner (such as Doctor, Engineer, Architect, Judge, Prosecutor, etc.)

(6) Office worker (Government Officer, Teacher, Police, Nurse, etc.).

(7) Industrial worker.

(8) Assigned at National Center.

(9) Unemployed (There is no job that has earned income for at least 6 months).

(10) Other (Please mention) ……….

9. How much is your monthly income?

………. LD

10. Do you receive any kind of financial support?

(1) Yes (please explain) ………..

(2) No.

11. Do you have any kind of social support (friends or family members that provide help in need)?

(1) Yes (Please explain) …………..

(2) No.

12. What kind of residency are you staying at?

Private accommodation (1) Rented house.

(2) Shared rented house.

(3) Hosted with relatives.

(4) Granted house.

Informal accommodation (5) School.

(6) Public building.

(7) Deserted resort.

(8) Tent, Caravan.

(9) Others (please mention) ………..

13. What is your place of origin?

………

14. What is the cause of displacement?

(1) General violence.

(2) Security issues.

(3) Economic issues.

(4) Others (please mention) ………

15. Did you have any experience;

(1) Lost someone of your nuclear family (2) Lost a relative

(3) Sexual harassment (4) Physical violence (5) Destruction of the house

(6) Others (please mention) ………

16. Please indicate what you consider to be the most hurtful or terrifying events you have experienced. Please specify where and when these events occurred.

………

17. How much does this event affect your mental health? (now) please indicate 1 2 3 4 5 6 7 8 9 10

None Too much

18. How long have you been in displacement?

……….. Years and ………. Months.

19. Did you change place of displacement?

(1) Yes (please explain) City ………….. Duration ………

City ………….. Duration ………

City ………….. Duration …………...

(2) No.

20. Are all your family members living together now being? (nuclear family) (1) Yes.

(2) No. (who is not?...) HEALTH CONDITION SURVEY:-

21. Have you ever used cigarettes?

(1) Yes

(2) No (skip to question 31) 22. If yes, are you still using it?

(1) Yes

(2) No (skip to question 31)

23. How soon after you wake up do you smoke your first cigarette?

(1) Within 5 minutes (2) 6 to 30 minutes (3) 31 to 60 minutes (4) After 60 minutes

24. Do you find it difficult to refrain from smoking in places where it is forbidden (e.g., in church, at the library, in the cinema)?

(1) No (2) Yes

25. Which cigarette would you hate most to give up?

(1) The first one in the morning (2) Any other

26. How many cigarettes per day do you smoke?

(1) 10 or less (2) 11 to 20 (3) 21 to 30 (4) 31 or more

27. Do you smoke more frequently during the first hours after waking than during the rest of the day?

(1) No (2) Yes

28. Do you smoke when you are so ill that you are in bed most of the day?

(1) No (2) Yes

29. Do you drink alcoholic beverages?

(1) Yes

(2) No (skip to question 33) 30. If you drink alcoholic beverages:

How much? (Bag of Bokha a week) How long? (... Years)

31. Do you have any kind of physical special need?

(1) Yes (Please mention) ……….

(2) No.

32. Do you have any kind of chronic disease that has been diagnosed by a doctor?

(1) Yes (Please fill in the table below) (2) No.

No Name of disease Date of

diagnosis

Regular treatment (Yes/No)

Complications (Yes/No) 1 Diabetes

2 Hypertension 3 Hyperlipidemia

4 Chronic respiratory disease 5 Chronic heart disease 6 Mental illness 7 Chronic liver disease 8 Chronic kidney disease 9 Others (please mention)

……….

33. While in displacement, have you ever visited a doctor?

(1) Yes. (How many times did you visit the doctor ………….) (2) No.

34. When was the last time you visited the doctor?

(1) Last week.

(2) Last month.

(3) Last 6 months.

(4) Last year.

35. What kind of health facility did you go to?

(1) Public.

(2) Private.

36. What was your level of satisfaction regarding the health service during your doctor visit?

(1) I was very satisfied.

(2) I was satisfied a little.

(3) I was not satisfied.

(4) I am not sure.

37. Did you experience any kind of difficulties during your doctor’s visit?

(1) Yes.

(2) No.

38. If yes, what type of difficulties did you experience?

(1) Transportation problems.

(2) Getting an appointment.

(3) No doctors in the area.

(4) Security issues.

(5) Once arrived at the office, had to wait too long to see the doctor.

(6) Not able to pay for the visit.

(7) Discrimination problem.

(8) Not able to pay for the medications.

(9) Others (please mention) ……….

39. Do you have any important problem affecting your mental health?

(1) Yes (would you share with us?...) (2) No

DASS Name:

Date:

Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

The rating scale is as follows:

0 Did not apply to me at all

1 Applied to me to some degree, or some of the time

2 Applied to me to a considerable degree, or a good part of time 3 Applied to me very much, or most of the time

1 I found myself getting upset by quite trivial things 0 1 2 3

2 I was aware of dryness of my mouth 0 1 2 3

3 I couldn't seem to experience any positive feeling at all 0 1 2 3 4 I experienced breathing difficulty (eg, excessively rapid breathing,

breathlessness in the absence of physical exertion)

0 1 2 3

5 I just couldn't seem to get going 0 1 2 3

6 I tended to over-react to situations 0 1 2 3

7 I had a feeling of shakiness (eg, legs going to give way) 0 1 2 3

8 I found it difficult to relax 0 1 2 3

9 I found myself in situations that made me so anxious I was most relieved when they ended

0 1 2 3

10 I felt that I had nothing to look forward to 0 1 2 3

11 I found myself getting upset rather easily 0 1 2 3

12 I felt that I was using a lot of nervous energy 0 1 2 3

13 I felt sad and depressed 0 1 2 3

14 I found myself getting impatient when I was delayed in any way (eg, lifts, traffic lights, being kept waiting)

0 1 2 3

15 I had a feeling of faintness 0 1 2 3

16 I felt that I had lost interest in just about everything 0 1 2 3

17 I felt I wasn't worth much as a person 0 1 2 3

18 I felt that I was rather touchy 0 1 2 3

19 I perspired noticeably (eg, hands sweaty) in the absence of high temperatures or physical exertion

0 1 2 3

20 I felt scared without any good reason 0 1 2 3

21 I felt that life wasn't worthwhile 0 1 2 3

Reminder of rating scale:

0 Did not apply to me at all

1 Applied to me to some degree, or some of the time

2 Applied to me to a considerable degree, or a good part of time 3 Applied to me very much, or most of the time

22 I found it hard to wind down 0 1 2 3

23 I had difficulty in swallowing 0 1 2 3

24 I couldn't seem to get any enjoyment out of the things I did 0 1 2 3

25 I was aware of the action of my heart in the absence of physical exertion (eg, sense of heart rate increase, heart missing a beat)

0 1 2 3

26 I felt down-hearted and blue 0 1 2 3

27 I found that I was very irritable 0 1 2 3

28 I felt I was close to panic 0 1 2 3

29 I found it hard to calm down after something upset me 0 1 2 3

30 I feared that I would be "thrown" by some trivial but unfamiliar task

0 1 2 3

31 I was unable to become enthusiastic about anything 0 1 2 3

32 I found it difficult to tolerate interruptions to what I was doing 0 1 2 3

33 I was in a state of nervous tension 0 1 2 3

34 I felt I was pretty worthless 0 1 2 3

35 I was intolerant of anything that kept me from getting on with what I was doing

0 1 2 3

36 I felt terrified 0 1 2 3

37 I could see nothing in the future to be hopeful about 0 1 2 3

38 I felt that life was meaningless 0 1 2 3

39 I found myself getting agitated 0 1 2 3

40 I was worried about situations in which I might panic and make a fool of myself

0 1 2 3

41 I experienced trembling (eg, in the hands) 0 1 2 3

42 I found it difficult to work up the initiative to do things 0 1 2 3

Appendix B: Data Collection Form (Arabic)