RESPONDENT’S DEMOGRAPHIC PROFILE Country Name

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Revised April 18, 2005
RESPONDENT’S DEMOGRAPHIC PROFILE
Country
Name
Age
Gender
Occupation
Highest Educational Attainment
Postal Address
Phone Number
Email
Group/Institutional Affiliation
Years of service at present work
QUESTIONNAIRE ON STATUS OF MENTAL HEALTH RESEARCH
(For Ministry Officials, Insurance Executives, etc)
Number
Question
Response Categories
1. Personal
1.1
ID number
1.2
How old are you?
1.3
Are you male or female?
What is your current work designation
(e.g. Director, Manager, President,
etc)
1.5
Which organization/department do
you represent?
2. Status of Mental Health Research
2.1
In what ways is your group involved
in mental health research activities?
Please tick all that apply
Years
Female
Male
1.4
None
Occasional consultation or briefing by researchers
Participating (or facilitating participation) as subjects
Involvement in planning/designing research conducted by
others
Involvement in interpretation/dissemination of research
conducted by others
Direct conduct of research
Using research product/findings
Participation in ethical review boards
Other, please specify
2.2
Has your group ever been involved in
activities aimed at ensuring the use of
mental health research findings?
Yes
No
Don’t know
2.3
If yes, how? Tick all that apply.
Advocacy
Lobbying policy makers
Raising funds for implementation
Implementation
Any other, please specify
1
2.4
Revised April 18, 2005
Mental Health Research priority setting
Mental Health Research planning
Implementation of mental health research findings
Dissemination of mental health research findings
Fund raising
Direct conduct of mental health research
Ethical review of mental health research proposals
Funding
Any other, please specify
In your view, in what ways could your
association/group be involved in
mental health research activities?
Please tick all that apply
3. Mental Health Research Resources
3.1
Is your institution involved in the
training of personnel for research in
mental health (including
sponsorships)?
3.2
Does your institution have any policy
on mental health research?
3.3
Does your institution have a mental
health evaluation/research unit?
3.4
Does your institution have any ongoing collaboration on mental health
research (national or international)?
3.5
3.6
3.7
3.8
In the past five years, has your
organization supported any research
activity?
If yes, in what way? List up to three
different kinds of support
Do you know of any research
literature (journals, conference
abstracts, documents, etc) reporting
mental health issues in your country?
If yes, please give the names of up to
five that you are aware of.
4. Mental Health Research Impact
4.1
Based on your experience and
knowledge, do you know of any
policy, programme, advocacy
movement, or practice that has
resulted from the evidence of research
findings obtained in your country?
4.2
If yes, please give one important
example
4.3
4.4
Based on your experience and
knowledge, do you know of any
established mental health research
evidence that should have influenced
policy, programme, advocacy or
practice but that has not done so?
If yes, please give one example of
such evidence
No
Only short courses (i.e. lasting for less than one year)
Only degree programmes, e.g.BA, MSc, PhD
Both short courses and degree programmes
No
Yes
No
Yes
No
Yes, only with other national body/organization
Yes, with international body/organization
Yes, with both national and international bodies/organizations
No
Yes
1.
2.
3.
No
Yes
1.
2.
3.
4.
5.
No
Yes
No
Yes
2
Revised April 18, 2005
5. Role of Media
5.1
In your personal experience and
judgment, are the media in your
country involved in any of the
following activities in the area of
mental health research? (Please tick
all that apply)
6. Mental Health Research Priorities
6.1
Over the next five years, what, in your
opinion, are the most important
mental health research priorities in
your country? Please indicate your top
three in each of the following
categories of research priorities:
(1 = First priority, 2 = Second
priority, 3 = Third priority).
Please do not mark more than one
choice with the same rank.
Dissemination of results
Advocacy for implementation
Popularization of research culture
No activity at all
Displaying basic information or news about general
health services delivered
Sensationalizing mental illness in a negative way
Emphasizing a medical (as opposed to psychosocial) model of
mental illness
Type of Mental Health Research
Epidemiological studies of burden and risk factors
Clinical Trials
Social science research e.g. illness beliefs, measurement
Health systems research e.g. services evaluation, policy and
economic studies
Basic sciences research, including genetics and neuroimaging
Mental Health Issues
Psychoses
Depression/Anxiety
Substance use
Childhood disorders
Dementia
Epilepsy
Personality
Learning disabilities
Eating disorders
Suicide
Other, please specify
Specific Populations
Women
Children and Adolescents
Poor
Refugees
Minorities
Elderly persons
Persons exposed to Violence/Trauma
Prisoners
Disabled persons
Other, please specify
Criteria for Prioritizing
Burden of disease in the population
Availability of funds
Personal interest
Policy maker request
Social justice/equity
Commissioned by external agency
Other, please specify
3
Revised April 18, 2005
Please refer other researchers or stakeholders in your country who are also involve in mental health
research and practice:
Name
Mailing Address
Phone/Fax/Mobile
Email
Kindly attach your CV if possible.
THANK YOU FOR YOUR VALUABLE TIME AND CONTRIBUTION!
4
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