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232

Appendix

233

APPENDIX – 1

PERSONAL DATA SCHEDULE SHEET

{Fill the following information}

Name :

Sex :

Age :

Address :

Cast :

Education :

Family type :

(Joint/Nuclear family) :

Occupation :

Domicile (Rural/Urban) :

234

APPENDIX - 2

P.G.I. SOCIAL SUPPORT QUESTIONNAIRE

Constructed and Standardized by Ritu Nehara, P. Kulhara

S.K. Verma (1988) Department of Psychology

PGIMER, Chandigarh

Instruction:

Read carefully and answer the following question how much you are

agreed to the following questions.

1. If you are fully agreed tick or (right) no (4) as correct answer.

2. If you are agreed maximum tick on no (3) (right) as correct answer.

3. If you are agreed slightly means you tick on no (2) (right) as correct

answer.

4. If you are completely disagreed tick or no (1) as correct answer kindly

answer the following question as soon as possible. Your answer will

be kept secretly.

235

Sl. No. Question

You are agreed to how much of the following question

Fully Maximum Slightly Disagree 01 No one is worried if

anything happens with me

02 Every one respects me

03 People won’t listen carefully

about what I am talking

04 People always help me more

than their capacity

05 If is difficult to get good

friends

06 If would have been better if

may people understood

properly about me

07 That will be better which my

authorities / elders wanted

to ask

08 If I am failed to solve my

problem responsibility any

one will be there at that time

to awake me

09 We help each other while

working

10 I didn’t get any person in my

life whose ideas and my

ideals are matching with

each other

11 People will not cheat me

more

236

12 People will praise me if I do

any good work

13 Incapable thoughts will be

done regarding home/office

work

14 If is very difficult to get

trustable people

15 There are very rare relating

in my life or which I can

faith

16 I feel that I don’t have more

time for fun

17 I feel lonely with my friends

18 People will praise me if I

help them.

237

APPENDIX – 3

DEATH ANXIETY SCALE

BY

UPINDER DHAR

SAVITA MEHTA

AND SANTOSH DHAR (1971)

Instructions:

Here is some statement having a choice or Yes or NO against it. You

have to encircle one of the two choices by putting tick (√ ) mark. Encircle the

choice as per its applicability to you. Your response will be kept fully

confidential.

Sl. No

Statements Yes No

01 I do not like old age. Yes No

02 I am afraid of taking medicine given by quack. Yes No

03 I get panicky on having even mild chest pain. Yes No

04 I get terrified on seeing a criminal being hanged. Yes No

05 I cannot see anybody dying. Yes No

06 I dread suffocating surroundings. Yes No

07 I get nervous on hearing about someone’s

sudden death.

Yes No

08 I realize the importance of destiny seeing an

accident.

Yes No

09 I do not want to die a miserable death. Yes No

10 I get frightened on looking into a well. Yes No

238

APPENDIX - 4

PSYCHOLOGICAL WELL-BEING QUESTIONNAIRE

Constructed and Standardized by

Sudha Bhogale and Jai Prakash (1995)

Given below is a number of questions regarding health, well-being, attitudes and interest. We request you to answer them by writing YES if the answer

is true or mostly true of you and NO if the answer is false or mostly false. There is no right or wrong answers. All the information given by you will be kept

confidential. Please cooperate with us and answer frankly.

Sl. No.

STATEMENTS Yes No

01 On the whole I would say my health is good. Yes No 02 Compared to others of my age and background I am better off Yes No 03 In the past I have received much support when I really need it. Yes No 04 My life often seems empty. Yes No 05 I have recently been getting a feeling of tightness or pressure in

my head. Yes No

06 I feel worthless at time Yes No 07 I have felt pleased about having accomplished sometimes Yes No 08 I have recently felt capable of making decisions about things Yes No 09 Life is better now that I had expected it to be Yes No 10 I have recently though of the possibility that I may kill myself Yes No 11 In my case getting what I want does not depend on my luck Yes No 12 I have recently been getting edgy and bad tempered Yes No 13 I have recently felt that on the whole I am going things well Yes No 14 I have recently feeling in need of good tonic Yes No 15 I feel all alone in the world Yes No 16 I have recently been getting pains in my head Yes No 17 I feel I am a person of worth, at least equal to others Yes No 18 I have felt proud because someone complicated me on some

achievement Yes No

19 I have recently been able to enjoy my normal day to day activities

Yes No

20 These are the best years of my life Yes No 21 What happens to me depends on me head Yes No 22 I am happy/satisfied with the support I have received Yes No 23 I have recently felt constantly under strain Yes No 24 I have recently felt perfectly well and in good health Yes No 25 I have recently been satisfied with the way I have carried out

my task Yes No

26 (In case married) considering everything I would say, in marriage, I am satisfied.

Yes No

27 On the whole, I would say that my life is satisfactory at present Yes No

239

List of Publications

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