Crosswalk

Resilience-FUCrosswalk-1-3-11.xls

Mental Health Issues Among Deployed Personnel: Longitudinal Assessment of the Resilience of Deployed Sailors and Marines - Follow-up

Crosswalk

OMB: 0703-0056

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CROSSWALK OF RESILIENCE FOLLOW-UP AND FULL STUDY FOLLOW-UP SURVEY ITEMS




Pilot Follow-Up Survey Item # Question Full Study Follow-Up Survey Item # Changes
GENERAL All applicable items General Changed "Since leaving the military" to "Since leaving active duty."
1 Are you currently on Active Duty status? 1
2 Are you currently serving in the National Guard or Reserve? 2
3 What was your official date of separation from the military? 3
4 What is your marital status? 4
5 How many dependent children do you have? 5 WORD CHANGE: Changed to "How many children do you have living at home?" RESPONSE OPTION CHANGE: Last option changed to "I don't have children living at home."
6 Are you currently. . . ? (employment) 6 WORD CHANGE: Changed to "What is your current work status?" RESPONSE OPTION CHANGE: Response options simplified from 11 to 5 options including (a) working full-time, (b) working part-time, c) working as self-employed in own business or profession, (d) unemployed and trying to find a job, (e) unemployed and not seeking employment.
7 What is your current personal monthly income? 7 RESPONSE OPTION CHANGE: added options 1) $499 or less, 2) $500 to $999; revised $6,000 or more to $6,000 to $6,999; added 10) $7,000 or more
8 Are you currently receiving any service-related disability compensation? 8
9 Do you have trouble paying your bills? 9
10 Are you currently experiencing difficulty paying your mortgage or is a ban or mortgage broker in the process of foreclosing on your home? 10
11 Do you have any significant outstanding or past due debts, alimony, or child support? 11
12 Do you currently have injuries or health problems as a result of your military experience? 12 WORD CHANGE: Added "If yes, are these injuries injuries or health problems a result of your involvement in combat-related activities (including improvised explosive device or IED-related injuries)?
13 Do you currently have injuries or health problems not related to your service in the military? 13
14 Are you currently working reduced hours because of illness or injury? 14
15 How much bodily pain have you had during the past 4 weeks? 20 WORD AND RESPONSE OPTION CHANGE: Please select the one number that best describes your pain on the average over the past 4 weeks. (range of 1-20)
16 Please mark the items that best describe your current health concerns or conditions? 22
17 Please mark the answer that best describes whether each of the following statements is true or false for you. 23
18 For each of the following questions, please mark one answer for each question below that comes closest to the way you have been feeling during the past month? 24 WORD CHANGE: Changed to "For each of the following questions, please mark the one answer that comes closest to the way you have been feeling during the past month?"
19 Since leaving the military, has your doctor told you that you have any of the following? 25
20 Since leaving the military, have you been hospitalized due to a serious illness, medical condition, or injury? 26 WORD CHANGE: Added "If yes, what illness or medical conditions were you hospitalized for?
21 Overall, how satisfied or dissatisfied are you with the quality of health care you have received since leaving the military? 27
22 Since leaving the military, how much of a problem, if any, were delays in health care while you waited for approval from your health plan? 28
23 Since leaving the military, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you thought you needed it? 29
24 Sometimes people have problems getting medical care or surgery when they need it. Since leaving the military was there any time when you needed medical care or surgery but did not get it? If yes, what was the main reason you didn't get the care you needed? 30
25 Which of the following health care coverage do you have? 31 WORD CHANGE: Changed to "Do you have health care coverage/health insurance? If yes, which of the following health care coverage do you have?
26 Overall, how satisfied or dissatisfied are you with the health care available to you? 32
27 During the past 30 days, how often did you engage in each of the following kinds of physical activity? 33
28 When was the last time you smoked a cigarette? 34
29 Think about the past 30 days. How many cigarettes did you usually smoke on a typical day? 35
30 During the past 30 days, on how many days did you drink alcohol? 36
31 When you drank alcohol in the past 30 days, about how many drinks did you typically have? 37
32 During the past 30 days, what was the largest number of drinks you had on any one occasion? 38
33 Since leaving the military, have you even drunk alcohol or used drugs more than you meant to? 39
34 Have you felt you wanted or needed to cut down on your drinking or drug abuse since leaving the military? 40
35 Since leaving the military, have you been arrested? 44
36 Are there currently any warrants for your arrest, restraining orders against you, or disciplinary actions pending against you? 45
37 Are you currently on probation or parole? 46
38 Please indicate how much each statement below describes you. (impulsivity) 43
39 During the past 30 days, how often did poor mental health keep you from doing your usual activities, such as work or recreation? 47
40 During the past 30 days, how much stress did you experience at work? 48
41 Since leaving the military, have your co-workers or supervisors made negative comments about nay recent changes in your appearance, quality of work, or relationships? 49
42 Since leaving the military, have you had a physical or mental condition that caused you to lose your job? 50
43 How many times have you changed jobs since leaving the military? 52
44 Since leaving the military, how often have you been late for work due to emotional or physical problems? 51
45 Since leaving the military, how much stress have you experienced in your family life? 53
46 How much stress has your spouse been under since you left the military? 54
51 Please indicate how much you agree with the following statements as they apply to you over the last month. If a particular situation has not occurred recently, answer according to how you think you would have felt. (CD-RISC)
DELETED
47 Since leaving the military, how much stress did you experience from the following?
DELETED
48 During the past 30 days, how often have you been bothered by the following? 59
49 Over the past month, have you been bothered by thoughts that you would be better off dead or of hurting your self in some way? If yes, about how often have you been bothered by these thoughts?
DELETED
50 Below is a list of ways you might have felt or behaved. Please indicate how often you felt this way during the past week: (CES-D) 67
52 Below is a list of problems and complaints that people sometimes have in response to stressful experiences. Please indicate how much you have been bothered by each problem in the past month. 68
53 In general, how long have you experienced the problems listed in Question 53? 69 Updated item number included in question.
54 Since leaving the military, have you had problems sleeping because of nightmares? 64 WORD CHANGE: Change to "Since leaving activity duty, how much trouble have you had sleeping because of nightmares?"
55 Since leaving the military, have you had problems with anger, frustration, resentment, hostility, or losing your temper? 66
56 How much trouble have you had adjusting to civilian life? 65
57 Since leaving the military, did you drive a car/ride in boat when had too much to drink or ride/drive motorcycle without a helmet? 61 FORMAT CHANGE: Changed to "Since leaving active duty, did you . . ." had 3 subitems of a) drive a car or other vehicle when you had too much to drink, b) drive or ride in a boat, canoe, or other watercraft when you had too much to drink, c) ride or drive a motorcycle without helmet with 4 response options.
58 Since leaving the military, have you received counseling or therapy for mental health or substance abuse from the following? 70
59 For what concerns did you seek counseling or therapy since leaving the military? 71 RESPONSE OPTION CHANGE: Combined children's problems and marriage problems into one category of "family problems."
60 Since leaving the military, have you felt you needed counseling or therapy from a mental health professional? 72
61 Are you currently receiving counseling or therapy for mental health or substance abuse problems? 73
62 Have you been prescribed medication for depression, anxiety, or sleeping problems by a doctor or other health professional? 74
63 Since leaving the military, have your children experienced or behaved in any of the following ways? 78
64 Since leaving the military, how many times have you attended religious services? 79
65 My religious/spiritual beliefs are a very important part of my life. 80
66 My religious/spiritual beliefs influence how I make decisions in my life. 81
67 Since leaving the military, I have experienced. . . (DRRI post-deployment stressors) 82
68 Since leaving the military, I have . . . (DRRI post-deployment stressors) 83
69 The statements below are about your current relationships with others. 87 WORD CHANGE: Added "including family and friends" to the end of the item.
70 Do you know at least one military veteran that you talk to about your war experiences or other stressful deployment events? If yes, has talking to another veteran helped you handle stress better? 85
71 Do you have the opportunity to interact with a group of combat veterans? If yes, what type of group(s)? 86 RESPONSE OPTION CHANGE: Added friends or coworkers
NA
15 NEW: Please describe the type and degree of physical pain you have experienced since leaving active duty.
NA
16 NEW: Did you experience any bodily pain in the past 4 weeks?
NA
17 NEW: During the past 4 weeks, how often have you had pain or discomfort?
NA
18 NEW: When you had pain during the past 4 weeks, how long did it usually last?
NA
19 NEW: During the past 4 weeks, how much did pain interfere with the following things?
NA
21 NEW: Please select the one number that best describes your pain at its worst over the past 4 weeks.
NA
41 NEW: The statements below are about things that sometimes happen to people because of using alcohol. How many times in the past 12 months did each of the following happen to you?
NA
42 NEW: Since leaving active duty, have you . . .? (question on hobbies, carrying firearms, taking alcohol to inappropriate places, being bored, doing risky/dangerous things)
NA
55 NEW: Have you ever seriously considered suicide?
NA
56 NEW: If you have ever seriously considered suicide, when did this occur?
NA
57 NEW: Have you ever attempted suicide?
NA
58 NEW: If you have ever attempted suicide, when did this occur?
NA
60 NEW: Since leaving active duty, how often have you. . .? (gotten angry and yelled, gotten angry and hit something, got into fight, threatened someone
NA
62 NEW: Since leaving active duty, how much stress did you experience from the following?
NA
63 NEW: Indicate for each of the statements below, the degree to which this change happened to you as a result of your military service. (post-traumatic growth inventory)
NA
75 NEW: On average, how often in the past 12 months have you used each of the following medications? (anti-depressants, anti-anxiety, sleeping, pain)
NA
76 NEW: Since leaving active duty, how many hours of sleep, on average, do you get each night?
NA
77 NEW: Since leaving active duty, have you had problems sleeping (e.g., getting to sleep, staying asleep, having nightmares)? If yes, has your sleep problems worsened since leaving active duty?
NA
84 NEW: WE are also interested in how you feel about the following statements. (social support scale)

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File Typeapplication/vnd.ms-excel
Authorweimer
Last Modified Byhourani
File Modified2011-01-06
File Created2008-10-20

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