The purpose of this research project is to determine if there is a correlation between income, level of education, or race on one’s level of depression. By completing this survey you acknowledge that you are participating voluntarily, that you are at least 18 years of age, and that you can quit the survey at any time. Furthermore, you provide consent to the researcher to use your responses as data for the research project. Thank you for participating in this study.
Please respond to the questions below to the best of your knowledge
Part 1: Demographic Information
1. What age group do you fit into?
(a) 18-25
(b) 26-39
(c) 40-55
(d) 56-70
(e) 71or above
2. What is your gender?
(a)Male
(b)Female
(c)Other
3. How would you categorize your race?
(a)Caucasian
(b)African American
(c)Hispanic
(d)Other
4. Are you:
(a) Married
(b) Divorced
(c) Widowed
(d) Single
5. Do you have children?
(a) Yes
(b) No
6. What is your yearlyindividual
income?
(a)0-29,999
(b)30,000-60,999
(c)70,000 or above
7. What is your yearly FAMILY income?
(a)0-29,999
(b)30,000-60,999
(c)70,000 or above
8. What is your highest level of education
achieved?
(a)Less than High School
(b)High school Diploma or GED
(c)Associates Degree
(d)Bachelors Degree
(e)Degree beyond a Bachelors Degree
9. On average, how many hours do you
work a week?
(a) More than 40 hours per week
(b) 40 hours per week
(c) Less than 40 hours per week
(d) I do not work
Part II: Religious Views
10.On average, in a typical month, how often do you attend religious services?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
11.On average, in a typical month, how often do you pray/meditate alone?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
12.On average, in a typical month, how often do you read/study religious texts alone?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
13.On average, in a typical month, how often do you volunteer for a religious organization (e.g. working in a soup
kitchen)?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
14.On average, in a typical month, how often do you attend wear jewelry with a religious message (e.g. a cross)?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
15.On average, in a typical month, how often do you attend informal meetings (e.g. dinner parties) with other
individuals who share your religious persuasion?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
16.On average, in a typical month, how often do you get together with others outside of formal religious services to
pray/meditate?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
17.On average, in a typical month, how often do you get together with others outside of formal religious services to
study religious texts?
a.0
b.1-2
c.3-4
d.5-6
e.More than 6
A. Scoring Table for each Question:
Range of Scores for Each Questiona. 0 = 0 point
b. 1-2 = 1 point
c. 3-4 = 2 point
d. 5-6 = 3 point
e. More than 6 = 4 point
B. Total Range Possible for Entire Survey = 0 – 32 points
(8 questions x 4 points maximum possible for each
question)
C. Total Scoring Table for the Survey
Range of Scores / Level of Religiosity0
1-8
9-16
17-24
25-32 / No religiosity
Low
Moderate
High
Very High