Revised April 18, 2005
RESPONDENT’S DEMOGRAPHIC PROFILE
Country
Name
Age
Gender
Occupation
Highest Educational Attainment
Address
Phone Number
Email
Group/Institutional Affiliation
Years of service at present work
QUESTIONNAIRE ON STATUS OF MENTAL HEALTH RESEARCH
(For Professional Associations, Consumer Associations and Family Groups)
Number
Question
1. Demographics
1.1
ID Number
1.2
Type of user group
1.3
Membership
1.4
Focus of group (please tick all that apply)
1.5
Duration of existence
2. Status of mental health research
2.1
In your assessment, how relevant is mental
health research to your group?
2.2
In what ways is your group involved in mental
health research activities? Please tick all that
apply.
Response Categories
Support group
Advocacy group
Research group
<10
10-20
20-100
100-1000
>1000
Psychosis
Dementia
Learning Disability
Depression
Alcohol and drugs
Mental health/issues in general
Social justice of people perceived as having a mental
health problem
Other, please specify
<1 year
1-5 years
5-10 years
>10 years
Very
Moderate
Not at all
Don’t know
None
Occasional consultation or briefing by researchers
Participating (or facilitating participation) as subjects
Involvement in planning/designing mental health research
conducted by others
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Revised April 18, 2005
Involvement in interpretation/dissemination of mental
health research conducted by others
Direct conduct of mental health research
Ethical review of mental health research
Other, please specify
2.3
Has your group ever been involved in
activities aimed at ensuring the
implementation of mental health research
findings?
If yes, how? Please tick all that apply.
Yes
No
Don’t know
2.5
In your view, in what ways could your
association/group be involved in mental health
research activities? Please tick all that apply.
Mental Health Research priority setting
Mental Health Research planning
As subjects
Implementation of mental health research finding
Dissemination of mental health research findings
Fund raising
Direct conduct of mental health research
Ethical review of mental health research proposals
Other, please specify
2.6
Based on your experience and knowledge, are
there any policies, programmes, advocacy
movements, or practices that have resulted
from the evidence of mental health research
findings done in your country?
If yes, please give one important example
Yes
No
Don’t know
Based on your experience and knowledge, is
there any established research evidence that
should have influenced policy, programme,
advocacy or practice but has not done so?
2.9
If yes, please give one important example
3. Role of media
3.1
In your experience and to your knowledge, 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).
Yes
No
Don’t know
2.4
2.7
2.8
4. Mental Health Research Priorities
4.1
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 for 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.
Advocacy
Lobbying policy makers
Raising funds for implementation
Any other, please specify
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
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Revised April 18, 2005
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
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!
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