Screener/Demographic Survey (UK)

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1. Country

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2. Full Name

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3. Email Address

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4. Year of Birth

Age

Date

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5. Marital status

Single

In a relationship

Married

Divorced

Widowed

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6. Education Level (highest qualification obtained)

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7. What is your occupation?

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8. Is this your main source of income?

Yes

Other (please specify)

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9. Monthly income

£0 - £30,000

£31,000 - £60,000

£61,000 - £90,000

£91,000 - £120,000

£120,000+

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10. Do you have any children? If so, how many?

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11. Who lives with you in your household?

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12. Ethnic group

	White	Mixed or Multiple ethnic groups	Asian or Asian British	Black, Black British, Caribbean or African	Other ethnic group
Ethnic/Racial Categories	Ethnic/Racial Categories White menu	Ethnic/Racial Categories Mixed or Multiple ethnic groups menu	Ethnic/Racial Categories Asian or Asian British menu	Ethnic/Racial Categories Black, Black British, Caribbean or African menu	Ethnic/Racial Categories Other ethnic group menu

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13. Which city do you currently live in?

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14. How long have you been staying there?

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15. Are you or have you been diagnosed with any medical condition?

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16. Is anyone or has anyone in your household or family members been diagnosed with any medical condition?

Yes

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17. If so, are you an unpaid/family carer?

Yes

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18. What's your religion or spiritual affiliation (if any)

UCLA-LS4

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19. Please indicate how often you experience the following:

	Never	Rarely	Sometimes	Often
I feel in tune with the people around me	I feel in tune with the people around me Never	I feel in tune with the people around me Rarely	I feel in tune with the people around me Sometimes	I feel in tune with the people around me Often
No one really knows me well	No one really knows me well Never	No one really knows me well Rarely	No one really knows me well Sometimes	No one really knows me well Often
I can find companionship when I want it	I can find companionship when I want it Never	I can find companionship when I want it Rarely	I can find companionship when I want it Sometimes	I can find companionship when I want it Often
People are around me but not with me	People are around me but not with me Never	People are around me but not with me Rarely	People are around me but not with me Sometimes	People are around me but not with me Often

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20. During the past week, have you felt lonely?

Rarely or none of the time (e.g. less than 1 day)

Some or a little of the time (e.g. 1-2 days)

Occasionally or a moderate amount of time (e.g. 3-4 days)

All of the time (e.g. 5-7 days)

Screener/Demographic Survey (UK)

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* 1. Country

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* 2. Full Name

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* 3. Email Address

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* 4. Year of Birth

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* 5. Marital status

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* 6. Education Level (highest qualification obtained)

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* 7. What is your occupation?

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* 8. Is this your main source of income?

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* 9. Monthly income

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* 10. Do you have any children? If so, how many?

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* 11. Who lives with you in your household?

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* 12. Ethnic group

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* 13. Which city do you currently live in?

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* 14. How long have you been staying there?

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* 15. Are you or have you been diagnosed with any medical condition?

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* 16. Is anyone or has anyone in your household or family members been diagnosed with any medical condition?

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* 17. If so, are you an unpaid/family carer?

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* 18. What's your religion or spiritual affiliation (if any)

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* 19. Please indicate how often you experience the following:

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* 20. During the past week, have you felt lonely?

1. Country

2. Full Name

3. Email Address

4. Year of Birth

5. Marital status

6. Education Level (highest qualification obtained)

7. What is your occupation?

8. Is this your main source of income?

9. Monthly income

10. Do you have any children? If so, how many?

11. Who lives with you in your household?

12. Ethnic group

13. Which city do you currently live in?

14. How long have you been staying there?

15. Are you or have you been diagnosed with any medical condition?

16. Is anyone or has anyone in your household or family members been diagnosed with any medical condition?

17. If so, are you an unpaid/family carer?

18. What's your religion or spiritual affiliation (if any)

19. Please indicate how often you experience the following:

20. During the past week, have you felt lonely?