PROBLEM TO BE SOLVED: To provide a stress sensitivity evaluation form in which the presence or absence of various problems and stress sensitivity faced by a subject are holistically and comprehensively evaluated, and can be discovered at a non-illness stage of a mild depression or before emergence a depression state.SOLUTION: A stress sensitivity evaluation form is configured as follows: in a question column 10, multiple questionnaires classified into a first category A about a human body, a second category B about the psychological or behavioral matter of a human, a third category C about the sociality of the human and a fourth category D about the existence of the human are described in a sentence these questionnaires are to ask living activities of a subject, and have contents in which conditions of the subject can be answered in a range of good or bad state in an answer column 20, a set 23 comprising multiple options for selecting and answering a degree of feeling to be good or bad of the subjects own conditions to each questionnaire of the question column 10 is provided and the multiple options included in each set 23 are arranged in a line in a sequential order from a good state to a bad state or in a sequential order from the bad state to the good state, and the scoring different to each other is given to each option according to the arrangement order.COPYRIGHT: (C)2015,JPO&INPIT【課題】被験者が抱える様々な問題の有無やストレス感受性を全人的・包括的に評価し、軽度のうつ又はうつ状態出現前の未病段階で発見することができるストレス感受性評価用紙を提供する。【解決手段】質問欄10には、人間の身体に関する第1の範疇A、人間の心理又は行動に関する第2の範疇B、人間の社会性に関する第3の範疇C、人間の実存に関する第4の範疇Dに分類される複数の質問事項を文章で表記し、これら質問事項は、いずれも被験者の生活行動を問うものであり、被験者の状態を良好ないし不良の範囲内で回答することができる内容とし、回答欄20には、質問欄10の各質問事項に対して、被験者が自らの状態を良好ないし不良と感じる程度を選択して回答するための複数の選択肢からなるセット23を設け、各セット23に含まれる複数の選択肢は、良好ないし不良に至る順番又は不良から良好に至る順番で一列に並び、各選択肢には、その並び順に応じて互いに異なる配点を与えた構成としてある。【選択図】図1
