Questionnaire Form

Have you ever felt depressed?	Yes No Unsure
Have you ever felt suicidal?	Yes No Unsure
If you did tell someone, who did you tell?
If you did not tell anyone, please explain why you did not?
When you felt suicidal, did you tell someone about how you felt?	Yes No
Has anyone ever criticized you for feeling depressed?	Yes No
If yes, who?	Parent Friend Other
Were you concerned about telling someone how you felt because you were afraid of what might happen to you if you did?	Yes No
How old are you?
Do you attend school?	Yes No
Have you attended counseling sessions with a therapist?	Yes No
Do you use the internet?	Yes No
Do you feel safe talking about your feelings to school personnel (teachers, counselors, principals, etc) ?	Yes No
If not, what would make you feel safe?
If you were ever to feel depressed or suicidal again, what do you think might help you tell someone about what you were going through?
What else would you like to tell us that may help us understand why children and adolescents don't always seek out help when they are feeling badly?