Participant detail

Thank you for the interest in the study. Please answer the following questions so that we can contact you to talk to you about the study, and to help us to work out whether you can take part.

Please contact YouthOnlineStudy@cardiff.ac.uk for more information about the study. If you live in Scotland, you can also contact the study team at the University of Glasgow at sphsu-phrf@glasgow.ac.uk. If at any point you feel you need support relating to your mental health, please talk to someone you trust (e.g. a parent or carer), a counsellor or therapist (if you are seeing someone), or your family doctor (GP). The contacts at the end of the form might also be helpful.

You could get the help of someone you trust, such as a parent, guardian or professional (e.g. a teacher or counsellor) to fill out this form, or they could fill it on your behalf with your permission.

Who is filling in this form?

Young person

Parent/guardian

Professional (e.g. teacher, counsellor)

Your details (or young person, if form filled by parent/guardian or professional):

Name:

Email address:

Contact number:

Email address of parent/guardian or professional (if form filled in with/by them):

Phone number of parent/guardian or professional (if form filled in with/by them):

Please indicate preference about how you are contacted:

Email

Text

Phone

Other (please state)

Please state other preference for how you are contacted:

What is the best time to contact you?

Morning

Afternoon

Evening

I am aged between 13 and 19 years old:

Yes

No

If yes, I am…:

Under 16 years old

16 years old or older

I have access to mobile or wifi internet, and I have a valid email address:

Yes

No

I am fluent in English:

Yes

No

Where do you live?

Wales

Scotland

Now we are going to ask you about your mood and feelings. These questions are about how you may have been feeling or acting the past two weeks. If the sentence was not true about you in the past two weeks, choose ‘Not true’. If it was only sometimes true, choose ‘Sometimes’. If it was true most of the time choose ‘True’. The terms ‘family’ or ‘parent’ in the following questions also refer to carers or guardians.

1. I felt miserable or unhappy:

Not true

Sometimes

True

2. I didn't enjoy anything at all:

Not true

Sometimes

True

3. I was less hungry than usual:

Not true

Sometimes

True

4. I ate more than usual:

Not true

Sometimes

True

5. I felt so tired I just sat around and did nothing:

Not true

Sometimes

True

6. I was moving and walking more slowly than usual:

Not true

Sometimes

True

7. I was very restless:

Not true

Sometimes

True

8. I felt I was no good any more:

Not true

Sometimes

True

9. I blamed myself for things that were not my fault:

Not true

Sometimes

True

10. It was hard for me to make up my mind:

Not true

Sometimes

True

11. I felt grumpy and cross with my parents:

Not true

Sometimes

True

12. I felt like talking less than usual:

Not true

Sometimes

True

13. I was talking more slowly than usual:

Not true

Sometimes

True

14. I cried a lot:

Not true

Sometimes

True

15. I thought there was nothing good for me in the future:

Not true

Sometimes

True

16. I thought that life was not worth living:

Not true

Sometimes

True

17. I thought about death or dying:

Not true

Sometimes

True

18. I thought my family would be better off without me:

Not true

Sometimes

True

19. I thought about killing myself:

Not true

Sometimes

True

20. I did not want to see my friends:

Not true

Sometimes

True

21. I found it hard to think properly or concentrate:

Not true

Sometimes

True

22. I thought that bad things would happen to me:

Not true

Sometimes

True

23. I hated myself:

Not true

Sometimes

True

24. I thought I was a bad person:

Not true

Sometimes

True

25. I thought I looked ugly:

Not true

Sometimes

True

26. I worried about aches and pains:

Not true

Sometimes

True

27. I felt lonely:

Not true

Sometimes

True

28. I thought nobody loved me:

Not true

Sometimes

True

29. I did not have any fun at school or college:

Not true

Sometimes

True

30. I thought I could never be as good as other people:

Not true

Sometimes

True

31. I did everything wrong:

Not true

Sometimes

True

32. I did not sleep as well as I usually sleep:

Not true

Sometimes

True

33. I slept a lot more than usual:

Not true

Sometimes

True

34. I was not as happy as usual, even when I was praised or rewarded:

Not true

Sometimes

True

Please complete these final questions

I understand the information given to me about the study 'Digital support for young people with their mood and well-being' and what I need to do to take part:

Yes

No

I agree that a researcher can contact me to check that it would be appropriate for me to take part in the study (confirm my eligibility):

Yes

No

I understand that all information I give in this questionnaire will be kept confidential (private) and will only be seen by researchers and people whose job it is to check the work of researchers:

Yes

No

I understand the research team might contact my GP if they have a serious concern (e.g. if I describe thoughts of harming myself):

Yes

No

Please write the name of your GP (family doctor) surgery and address here:

Eligibility form - Ffurflen gymryd rhan (CRF01)