PNWGrief | Anonymous Survey

Our team invites you to share your perspective during these unprecedented times.

Your candid and anonymous responses are very important to our team. Your input will help us continue to develop relevant grief education and support resources. Estimated completion time less than 5 minutes.

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* 1. Where are you located? (US Regions)

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* 2. How would you describe your community?

Urban

Suburban

Rural

Other (please specify)

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* 3. How would you describe your current state?

I am sheltering in place, practicing full social isolation, and rarely or never leave the house unless it is an emergency

I am sheltering in place and actively practicing social distancing (i.e. only going out in public to meet basic needs, like grocery shopping)

I have reduced my interactions with other people, but still leave the house regularly for work and other purposes

I have not changed my pre-pandemic patterns of socializing with others, spending time in public, attending gatherings, etc.

Other (please specify)

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* 4. What emotions are feeling most strongly right now? (check all that apply)

Concerned

Frustrated

Anxious

Disoriented

Angry

Grieving

Distracted

Sad

Agitated

Confused

Shocked

Unsure

Numb

Nostalgic

Cautiously Optimistic

Focused

Inspired

Calm

Hopeful

Other (please specify)

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* 5. What areas of your life have been most affected by the COVID-19 crisis? (check all that apply)

Daily routines

Relationships with family and friends

Changes in personal caregiving responsibilities (kids, aging parents, others)

Employment (reduced hours, reduced income, job loss, etc.)

Business impacts (revenue decline, layoffs, closure, etc.)

Mental health

Physical health

Ability to plan for the future

Other (please specify)

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* 6. What type(s) of grief are you currently experiencing? (check all that apply)

Bereavement due to death of a family member/loved one/close friend

Bereavement due to a second degree loss (e.g. the death of your best friend's parent, or a colleague's spouse_

Anticipatory Grief (no loss of life, but an expectation or worry about the death of someone you care about_

Grief over divorce, broken relationships, and/or severe relationship difficulties

Grief over personal life altering events (job loss, business closure, accumulating debt, housing instability, difficulty meeting basic needs, etc.)

Grief/anxiety over the general loss of normalcy, and.or fear about the future of your family, community, country, etc.

I am just not sure

I do not believe I am experiencing grief at this time

Other (please specify)

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* 7. In spite of these circumstance, what are you most grateful for right now? (optional)

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* 8. What are you most looking forward to when this acute crisis is over? (optional)

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* 9. Is there anything else you would like to anonymously share?

Thank you for providing your valued perspective.