Effects of Mood Disorder on Youth Mental Health
What is your gender?
Female
Male
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Have any of your family had Mood Disorders?
Yes
No
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Do you think your parents have a happy relationship?
Yes
No
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Do your parents live together?
Yes
No
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Do your direct family have anger issues?
Yes
No
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Has there been a death in the family that they have not recovered from?
Yes
No
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Does your family struggle financially?
Yes
No
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Do you get angry easily?
Yes
No
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Do you experience dramatic mood changes throughout the day?
Yes
No
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How well do you get along with your family?
Well
Not Well
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Do you feel insecure, hopelessness or sadness which does not go away?
Yes
No
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Do you constantly get lazy?
Yes
No
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How many siblings do you have?
1
2
More?
Other:
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Has there been any event recently that has affected you greatly?
Yes
No
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