Impacts of COVID-19 on Canadians - Your mental health
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Mental health impacts (MH)
- Behaviours and health impacts (BH)
- Labour market impacts (LM)
- Indigenous identity (IS)
- Sociodemographic characteristics (PG)
- Demographic questions 1 (DEM1)
- Demographic questions (DEM)
- Sign-up (UCE)
Mental health impacts (MH)
Mental health impacts (MH) - Question identifier:MH_R05
The following questions are about your experience during the COVID-19 pandemic.
Mental health impacts (MH) - Question identifier:MH_Q05
In general, how would you describe your mental health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Mental health impacts (MH) - Question identifier:MH_Q10
Compared to before physical distancing began, how would you say your mental health is now?
- 1: Much better now
- 2: Somewhat better now
- 3: About the same
- 4: Somewhat worse now
- 5: Much worse now
Mental health impacts (MH) - Question identifier:MH_Q15A
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious or on edge
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15B
Over the last 2 weeks, how often have you been bothered by the following problems?
Not being able to stop or control worrying
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15C
Over the last 2 weeks, how often have you been bothered by the following problems?
Worrying too much about different things
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15D
Over the last 2 weeks, how often have you been bothered by the following problems?
Trouble relaxing
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15E
Over the last 2 weeks, how often have you been bothered by the following problems?
Being so restless that it is hard to sit still
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15F
Over the last 2 weeks, how often have you been bothered by the following problems?
Becoming easily annoyed or irritable
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q15G
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling afraid as if something awful might happen
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health impacts (MH) - Question identifier:MH_Q20
Thinking about the amount of stress in your life, how would you describe most of your days?
- 1: Not at all stressful
- 2: Not very stressful
- 3: A bit stressful
- 4: Quite a bit stressful
- 5: Extremely stressful
Behaviours and health impacts (BH)
Behaviours and health impacts (BH) - Question identifier:BH_Q60A
In the last week, how often did you do each of the following activities?
Went shopping at the grocery store or drugstore
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and health impacts (BH) - Question identifier:BH_Q60B
In the last week, how often did you do each of the following activities?
Used a delivery service for groceries or for a drugstore
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and health impacts (BH) - Question identifier:BH_Q60C
In the last week, how often did you do each of the following activities?
Used a food delivery service for prepared food
- 1: Daily or more
- 2: 4 or 5 times
- 3: 1 to 3 times
- 4: Never
Behaviours and health impacts (BH) - Question identifier:BH_Q55A
How concerned are you about each of the following impacts of COVID-19?
My own health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55B
How concerned are you about each of the following impacts of COVID-19?
Member of the household's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55C
How concerned are you about each of the following impacts of COVID-19?
Vulnerable people's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55D
How concerned are you about each of the following impacts of COVID-19?
Canadian population's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55E
How concerned are you about each of the following impacts of COVID-19?
World population's health
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55F
How concerned are you about each of the following impacts of COVID-19?
Overloading the health system
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55G
How concerned are you about each of the following impacts of COVID-19?
Civil disorder
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55H
How concerned are you about each of the following impacts of COVID-19?
Maintaining social ties
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55I
How concerned are you about each of the following impacts of COVID-19?
Ability to cooperate and support one another during the crisis
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55J
How concerned are you about each of the following impacts of COVID-19?
Ability to cooperate and support one another after the crisis
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55K
How concerned are you about each of the following impacts of COVID-19?
Family stress from confinement
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Behaviours and health impacts (BH) - Question identifier:BH_Q55L
How concerned are you about each of the following impacts of COVID-19?
Violence in your home
- 1: Not at all
- 2: Somewhat
- 3: Very
- 4: Extremely
Labour market impacts (LM)
Labour market impacts (LM) - Question identifier:LM_Q30
To what extent do you agree or disagree with the following statement?
I might lose my main job or main self-employment income source in the next four weeks.
- 1: Strongly agree
- 2: Agree
- 3: Neither agree nor disagree
- 4: Disagree
- 5: Strongly disagree
- 6: I have lost my job or business within the last 4 weeks
- 7: I did not work at a job or business in the last 4 weeks
Labour market impacts (LM) - Question identifier:LM_Q40
Which of the following best describes the impact of COVID-19 on your ability to meet financial obligations or essential needs, such as rent or mortgage payments, utilities and groceries?
- 1: Major impact
- 2: Moderate impact
- 3: Minor impact
- 4: No impact
- 5: Too soon to tell
Indigenous identity (IS)
Indigenous identity (IS) - Question identifier:IS_Q01
Are you First Nations, Métis or Inuk (Inuit)?
- 1: No
- 2: Yes, First Nations
- 3: Yes, Métis
- 4: Yes, Inuk (Inuit)
Sociodemographic characteristics (PG)
Sociodemographic characteristics (PG) - Question identifier:PG_Q05
The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.
Are you:
- 01: White
- 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
- 03: Chinese
- 04: Black
- 05: Filipino
- 06: Arab
- 07: Latin American
- 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
- 09: West Asian (e.g., Iranian, Afghan)
- 10: Korean
- 11: Japanese
- 12: Other
Demographic questions 1 (DEM1)
Demographic questions 1 (DEM1) - Question identifier:DEM1_Q30A
Where were you born?
- 1: Born in Canada
- 2: Born outside Canada
Demographic questions 1 (DEM1) - Question identifier:DEM1_Q30B
Are you a Canadian citizen?
- 1: Yes, a Canadian citizen by birth
- 2: Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
- 3: No, not a Canadian citizen
Demographic questions 1 (DEM1) - Question identifier:DEM1_Q30C
Are you a landed immigrant or permanent resident?
- 1: No
- 2: Yes
Demographic questions 1 (DEM1) - Question identifier:DEM1_Q35
In what year did you first become a landed immigrant or a permanent resident?
Min = 0; Max = 9999
Demographic questions (DEM)
Demographic questions (DEM) - Question identifier:DEM_Q05
What is your age?
Min = 0; Max = 999
Demographic questions (DEM) - Question identifier:DEM_Q10
What is your gender?
- 1: Male
- 2: Female
- 3: Or please specify
Demographic questions (DEM) - Question identifier:DEM_Q15
To determine which geographic region you live in, please provide your postal code.
Long Answer Length = 6
Sign-up (UCE)
Sign-up (UCE) - Question identifier:UCE_R05
Would you like to sign-up for future surveys?
Statistics Canada is planning a series of surveys about important social topics. These surveys will be sent out every month or two and will ask about a wide variety of issues such as COVID-19, fake news, digital technologies, health, education and justice.
By participating in this survey series, you will be able to share your opinions and thoughts on these issues and compare your ideas with those of other Canadians.
Sign-up (UCE) - Question identifier:UCE_Q01
Would you like to sign-up for future surveys?
- 1: Yes
- 2: No
Sign-up (UCE) - Question identifier:UCE_Q05B
Please provide the following information so we can email or text you to participate in this survey series.
Email address
Long Answer Length = 80
Sign-up (UCE) - Question identifier:UCE_Q05C
Please provide the following information so we can email or text you to participate in this survey series.
Cellular number
Long Answer Length = 10
Sign-up (UCE) - Question identifier:UCE_R10
Thank you for signing up. We will contact you soon.
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