Annotated Follow-on Survey

ResilienceII-FollowUp-Survey-documentation-updated1-3-11.doc

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

Annotated Follow-on Survey

OMB: 0703-0056

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THE FINAL PRINT VERSION OF THE SURVEY. OMB Clearance Expiration Date: 12/31/2010

FOLLOW-UP SURVEY

HEALTH OF TRANSITIONING MARINES


INSTRUCTIONS FOR COMPLETING THE QUESTIONNAIRE


All questions on this survey provide a set of possible answers. Please read all the answers before marking your choice. If none of the printed answers exactly apply to you, place an "X" on the square for the one answer that best fits your situation.

  • Use a pencil or pen to complete the survey. Erase cleanly or cross out clearly any answer you wish to change.

  • Put an "X" on the center of the square to indicate your answer. Do not use other marks.

CORRECT MARK INCORRECT MARK

●

x

  • If you are asked to give numbers or write letters in boxes, please enter your responses as shown below. Please enter one number or letter to a box.

    Telephone number

    5

    5

    5

    —

    5

    5

    5

    —

    5

    5

    5

    5

  • For many questions, you should place an "X" in only one square for your answer in the column below the question. However, some questions ask you to mark all the choices that apply. When asked to “mark all that apply,” please do so as shown here:

EXAMPLE: Have you ever had any of the following conditions? (Mark all that apply.)

Back pain

Ringing in the ears

Difficulty remembering

Trouble sleeping

Chronic headaches

Skin rashes

Difficulty breathing








PRIVACY ACT STATEMENT

Authority. 5 U.S.C. 301

Purpose. Medical research information will be collected in an experimental research project #NHRC.2007.0011, titled Status of Transitioning Marine Corps Personnel, to enhance basic medical knowledge, or to develop tests, procedures, and equipment to improve the diagnosis, treatment, or prevention of illness, injury, or performance impairment.

Routine Uses. Medical research information will be used for analysis and reports by the Departments of the Navy and Defense, and other U.S. Government agencies, provided this use is compatible with the purpose for which the information was collected. Use of the information may be granted to non‑Government agencies or individuals by the Navy Surgeon General following the provisions of the Freedom of Information Act or as may be indicated in the accompanying Informed Consent Form.

Disclosure. Completion of this questionnaire constitutes consent to participate in this survey. Provision of information is voluntary. There are no penalties for not providing the requested information, but failure to provide the requested information may result in failure to be accepted as a research volunteer in an experiment, or in removal from the program.











PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it

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P LEASE GO TO PAGE 2.



  1. Are you currently on active duty status?

1 Yes STOP. Thank you for taking time to consider this survey. Please return this entire questionnaire as instructed in the information you received.

2 No CONTINUE TO QUESTION 2.

  1. Are you currently serving in the National Guard or Reserve?

1 Yes

2 No

  1. What was your official date of separation from active duty?


/



/









D

D


M

M


Y

Y

Y

Y






  1. What is your marital status? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Married

2 Living as married (living with fiancé, boyfriend, or girlfriend but not married)

3 Separated and not living as married

4 Divorced and not living as married

5 Widowed and not living as married

6 Single, never married, and not living as married

  1. How many children do you have living at home?

1 1 child

2 2 children

3 3 or more children

4 I don’t have children living at home


  1. What is your current work status? [SOURCES: Based on Survey of Reserve Component Personnel, 2006 Department of Defense Reserve Component Survey, and National Survey of Drug use and Health (/NSDUH)]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No

a. Working full-time (35 hours or more per week on average)

1

2

b. Working part-time (less than 35 hours per week on average)

1

2

c. Working as self-employed in own business or profession

1

2

d. Unemployed and trying to find a job

1

2

e. Unemployed and not seeking employment

1

2



T he next few questions ask about your current financial situation.

  1. What is your current personal monthly income? Please estimate your monthly income from all sources before taxes are taken out. As with all information you provide on this survey, your answer to this question will be kept confidential.

1 $499 or less

2 $500 to $999

3 $1,000 to $1,499

4 $1,500 to $1,999

5 $2,000 to $2,999

6 $3,000 to $3,999

7 $4,000 to $4,999

8 $5,000 to $5,999

9 $6,000 to $6,999

10 $7,000 or more

  1. Are you currently receiving any service-related disability compensation?

1 Yes

2 No

  1. Do you have trouble paying your bills?

1 Yes

2 No

  1. Are you currently experiencing difficulty paying your mortgage or is a bank or mortgage broker in the process of foreclosing on your home?

1 Yes

2 No

  1. Do you have any significant outstanding or past due debts, alimony, or child support? [SOURCE: Based on Functional Assessment Section of the VA/DOD Clinical Practice Guideline for the Management of Post-Traumatic Stress Acute Stress Reaction (ASR) Module-Pocket Guide updated April 2005]

1 Yes

2 No

T he next set of questions asks about your health and physical activity.

  1. Do you currently have injuries or health problems as a result of your military experience?

1 Yes

2 No

If yes, are these injuries or health problems a result of your involvement in combat-related activities (including improvised explosive device or IED-related injuries)?

1 Yes, they are combat-related

2 No, they are not combat-related

  1. Do you currently have injuries or health problems not related to your service in the military?

1 Yes

2 No

  1. Are you currently working reduced hours because of illness or injury?

1 Yes

2 No


  1. Please describe the type and degree of physical pain you have experienced since leaving active duty. [SOURCE: Medical Outcomes Survey]

    (Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

    None

    Very Mild

    Mild

    Moderate

    Severe

    a. Headaches

    1

    2

    3

    4

    5

    b. Back or neck pain

    1

    2

    3

    4

    5

    c. Knee pain

    1

    2

    3

    4

    5

    d. Shoulder pain

    1

    2

    3

    4

    5

    e. Foot or ankle pain

    1

    2

    3

    4

    5

    f. Other (specify): ____________________ ________

    1

    2

    3

    4

    5

  2. Did you experience any bodily pain in the past 4 weeks? [SOURCE: Medical Outcomes Survey]

1 Yes

5 No (GO TO QUESTION 22)

  1. During the past 4 weeks, how often have you had pain or discomfort? [SOURCE: Medical Outcomes Survey]

1 Once or twice

2 A few times

3 Fairly often

4 Very often

5 Every day or almost every day


  1. When you had pain during the past 4 weeks, how long did it usually last? [SOURCE: Medical Outcomes Survey]

1 A few minutes

2 Several minutes to an hour

3 Several hours

4 A day or two

5 More than two days


  1. During the past 4 weeks, how much did pain interfere with the following things? [SOURCE: Medical Outcomes Survey]

(Mark an answer for each statement below. Indicate your answer by placing an “X” in the box for your response.)

Not At All

A Little Bit

Moderately

Quite a Bit

Extremely

a. Your mood

1

2

3

4

5

b. Your ability to walk or move about

1

2

3

4

5

c. Your sleep

1

2

3

4

5

d. Your normal work (including both work outside the home and housework

1

2

3

4

5

e. Your recreational activities

1

2

3

4

5

e. Your enjoyment of life

1

2

3

4

5

  1. Please select the one number that best describes your pain on the average over the past 4 weeks. [SOURCE: Medical Outcomes Survey]


No Pain


Pain as Bad as You can Imagine

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20



  1. Please select the one number that best describes your pain at its worst over the past 4 weeks. [SOURCE: Medical Outcomes Survey]


No Pain


Pain as Bad as You can Imagine

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20



  1. Please mark the items that best describe your current health concerns or conditions. (Mark all that apply.) [SOURCE: Post-Deployment Health Reassessment (PDHRA). Note: Subitems 24, 25, 26, 27 & 28 are not part of the PDHRA]

1 I do not have any of the health concerns or conditions listed below.

2 Chronic cough

3 Runny nose

4 Fever

5 Weakness

6 Headaches

7 Swollen, stiff, or painful joints (such as knees, shoulders, ankles, and elbows)

8 Back pain

9 Muscle aches

10 Numbness or tingling in hands or feet

11 Skin diseases or rashes

12 Ringing in the ears

13 Redness of eyes with tearing

14 Dimming of vision (like the lights were going out)

15 Chest pain or pressure

16 Racing heart or heart palpitations

17 Dizziness, fainting, light headedness

18 Difficulty breathing or shortness of breath

19 Diarrhea, vomiting, or frequent indigestion

20 Problems sleeping or still feeling tired after sleeping

21 Difficulty remembering

22 Increased irritability

23 Taking more risks such as driving faster

24 Hearing loss

25 Blurred vision

26 Chronic fatigue

27 Making more mental mistakes than in the past

28 Sexual dysfunction or other sexual problems

29 Other (specify): _____________________________

  1. Please mark the answer that best describes whether each of the following statements is true or false for you. [SOURCE: Medical Outcomes Survey Short Form-20]

    (Mark an answer for each statement below. Indicate your answer by placing an “X” in the box for your response.)

    Definitely True

    Mostly True

    Not Sure

    Mostly False

    Definitely False

    a. I am somewhat ill

    1

    2

    3

    4

    5

    b. I am as healthy as anybody I know

    1

    2

    3

    4

    5

    c. My health is excellent

    1

    2

    3

    4

    5

    d. I have been feeling bad lately

    1

    2

    3

    4

    5

  2. 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. [SOURCE: Medical Outcomes Survey Short Form-20]

    (Mark an answer for each question below. Indicate your answer by placing an “X” in the box for your response.)

    All the Time

    Most of the Time

    A Good Bit of the Time

    Some of the Time

    A Little of the Time

    None of the Time

    a. How much of the time, during the past month, has your health limited your social activities (like visiting with friends or close relatives)?

    1

    2

    3

    4

    5

    6

    b. How much of the time, during the past month, have you been a very nervous person?

    1

    2

    3

    4

    5

    6

    c. During the past month, how much of the time have you felt calm and peaceful?

    1

    2

    3

    4

    5

    6

    d. How much of the time, during the past month, have you felt downhearted and blue?

    1

    2

    3

    4

    5

    6

    e. During the past month, how much of the time have you been a happy person?

    1

    2

    3

    4

    5

    6

    f. How often, during the past month, have you felt so down in the dumps that nothing could cheer you up?

    1

    2

    3

    4

    5

    6

  3. Since leaving active duty, has your doctor told you that you have any of the following? [SOURCE: PDCAT (Note: Subitem “i” is not part of the Post-Deployment Clinical Assessment Tool (PDCAT). Note: Subitem “b” was modified by adding “or mental health problem.”]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No

a. Asthma, emphysema or chronic bronchitis (or chronic obstructive pulmonary disease)

1

2

b. Hypertension (high blood pressure)

1

2

c. Diabetes

1

2

d. Respiratory illness

1

2

e. Myocardial infarction, heart attack, or heart problems (including angina and chest pain)

1

2

f. High cholesterol

1

2

g. Serious wound or injury

1

2

h. Depression or mental health problem

1

2

i. Cancer

1

2


  1. Since leaving active duty, have you been hospitalized due to a serious illness, medical condition, or injury?

1 Yes

2 No

If yes, what illnesses or medical conditions were you hospitalized for? (Mark all that apply.)

1 Asthma, emphysema, or chronic bronchitis

2 Hypertension (high blood pressure)

3 Diabetes

4 Respiratory illness

5 Myocardial infarction, heart attack, or heart problems

6 Serious wound or injury

7 Depression or other mental health problem

8 Substance use problem

9 Other (specify): _________________________ ______________________________________

  1. Overall, how satisfied or dissatisfied are you with the quality of health care you have received since leaving active duty?

1 Very satisfied

2 Somewhat satisfied

3 Somewhat dissatisfied

4 Very dissatisfied

5 I have not received any health care since leaving active duty

  1. Since leaving active duty, how much of a problem, if any, were delays in health care while you waited for approval from your health plan?

1 A big problem

2 A small problem

3 Not a problem

  1. Since leaving active duty, 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?

1 Always

2 Usually

3 Sometimes

4 Never

5 I have not needed health care since leaving active duty

  1. Sometimes people have problems getting medical care or surgery when they need it. Since leaving active duty, was there any time when you needed medical care or surgery but did not get it?

1 Yes

2 No

If yes, what was the main reason you didn’t get the care you needed?

1 I did not have the money to pay for care.

2 I had to wait on approval from my health insurance.

3 I could not fit it into my schedule.

4 I could not afford to miss work.

5 I had to wait too long for an appointment.

6 I had to drive too far for the medical care.

7 Other (specify): _________________________ ______________________________________

  1. Do you have health care coverage/health insurance?

1 Yes

2 No

If yes, which of the following health care coverage do you have? [SOURCES: Status of Forces Survey of Reserve Component Members and 2006 Department of Defense Reserve Component Survey]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No

a. Your civilian employer’s health care
plan

1

2

b. Your school’s health care plan

1

2

c. Your spouse/family member’s civilian employer’s health care plan

1

2

d. Your active duty military health care coverage (TRICARE/TRICARE Reserve Select)

1

2

e. Your spouse/family member’s active duty/retired military health care
coverage

1

2

f. Medicare, Medicaid, or other government-sponsored coverage

1

2

g. Veterans Affairs (VA) coverage

1

2

h. Other private coverage

1

2

  1. Overall, how satisfied or dissatisfied are you with the health care available to you?

1 Very satisfied

2 Somewhat satisfied

3 Somewhat dissatisfied

4 Very dissatisfied


  1. During the past 30 days, how often did you engage in each of the following kinds of physical activity? [SOURCE: 2005 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

About Every Day

5–6
Days a Week

3–4
Days a Week

1–2
Days a Week

Less than 1 Day per Week

Not at All in the Past 30 Days

a. Moderate Physical Activity—A person should feel some exertion but should be able to carry on a conversation comfortably during the activity

1

2

3

4

5

6

b. Vigorous Physical Activity—A person should feel very exerted and find it difficult to carry on a conversation during the activity

1

2

3

4

5

6





T he next several questions ask about your use of cigarettes, alcohol, and drugs, as well as your experiences with the legal system. Remember that all information from this survey will be confidential.

  1. When was the last time you smoked a cigarette? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Today

2 During the past 30 days

3 1 to 3 months ago

4 4 to 6 months ago

6 7 to 12 months ago

7 1 to 3 years ago

8 More than 3 years ago

9 I never smoked cigarettes

  1. Think about the past 30 days. How many cigarettes did you usually smoke on a typical day? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 More than 35 cigarettes (about 2 packs or more a day)

2 26 to 35 cigarettes (about 1½ packs a day)

3 16 to 25 cigarettes (about 1 pack a day)

4 6 to 15 cigarettes (about ½ pack a day)

5 2 to 5 cigarettes

6 1 cigarette

7 Less than 1 cigarette a day, on the average

8 I did not smoke any cigarettes in the past 30 days

  1. During the past 30 days, on how many days did you drink alcohol? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 About every day

2 5 to 6 days a week

3 3 to 4 days a week

4 1 to 2 days a week

5 2 to 3 days in the past 30 days

6 Once in the past 30 days

7 I did not drink any alcohol in the past 30 days

  1. When you drank alcohol in the past 30 days, about how many drinks did you typically have? (By “drink” we mean a bottle or can of beer, a wine cooler or a glass of wine, a shot of liquor, or a mixed drink or cocktail.) [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 5 or more drinks

2 4 drinks

3 3 drinks

4 2 drinks

5 1 drink

6 Less than 1 drink

7 I did not drink any alcohol in the past 30 days

  1. During the past 30 days, what was the largest number of drinks you had on any one occasion? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

Enter the number of drinks in the boxes. Use both boxes, ONE number to a box. If you DID NOT drink any alcohol in the past 30 days, please enter “00.”


NUMBER OF DRINKS

  1. Since leaving active duty, have you ever drunk alcohol or used drugs more than you meant to? [SOURCE: Two-Item Constant-Screen (TICS) and PDHRA]

1 Yes

2 No

  1. Since leaving active duty, have you felt you wanted or needed to cut down on your drinking or drug abuse? [SOURCE: Two-Item Constant-Screen (TICS) and PDHRA]

1 Yes

2 No












  1. 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? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

NUMBER OF TIMES IN PAST 12 MONTHS

(Mark an answer for each statement below. Indicate your answer by placing an "X" in the box for your response.)

3 or more

2

1

0

I don’t drink

a. I received detoxification treatment because of my drinking. (People who go through detoxification are going through withdrawal. This type of therapy occurs in a hospital or residential center, where a person stays 24 hours a day, but can also occur in an outpatient setting.)

b. I had trouble on the job (civilian or military) because of my drinking.

c. I had trouble with the police (civilian or military) because of my drinking.

d. I found it harder to handle my problems because of my drinking.

e. I had to have emergency medical help because of my drinking.

f. I was hospitalized because of my drinking (excluding hospitalizations related to detoxification treatment).


  1. Since leaving active duty, have you. . . . .?

(Mark an answer for each item below. Indicate your answer by placing an "X" in the box for your response.)

Yes

No

a. Become involved in new hobbies that your family and/or friends find dangerous

b. Felt the need to carry a personal firearm with you to public places

c. Taken alcohol with you to inappropriate places

d. Found yourself becoming bored more easily

e. Done risky or dangerous things to make life more exciting (excluding hobbies as noted above)


  1. Please indicate how much each statement below describes you. [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel; Cherpital, 1999]

(Mark an answer for each statement below. Indicate your answer by placing an "X" in the box for your response.)

Quite a lot

Some

A little

Not at all

  1. I often act on the spur of the moment without stopping to think

1

2

3

4

  1. I get a real kick out of doing things that are a little dangerous

1

2

3

4

  1. People might say I act impulsively

1

2

3

4

  1. I like to test myself every now and then by doing something a little chancy

1

2

3

4

  1. Many of my actions seem to be hasty

1

2

3

4

  1. I'm always up for a new experience

1

2

3

4

  1. I like to try new things just for the excitement

1

2

3

4

  1. I go for the thrills in life when I get a chance

1

2

3

4

  1. I like to experience new and different sensations

1

2

3

4


  1. Since leaving active duty, have you been arrested?

1 Yes

2 No


  1. Are there currently any warrants for your arrest, restraining orders against you, or disciplinary actions pending against you? [SOURCE: Based on Functional Assessment Section of the VA/DOD Clinical Practice Guideline for the Management of Post-Traumatic Stress Acute Stress Reaction (ASR) Module-Pocket Guide updated April 2005]

1 Yes

2 No





  1. Are you currently on probation or parole? [SOURCE: Based on Functional Assessment Section of the VA/DOD Clinical Practice Guideline for the Management of Post-Traumatic Stress Acute Stress Reaction (ASR) Module-Pocket Guide updated April 2005]

1 Yes

2 No




The next set of questions asks about your mental or emotional health, stress, and some other things that
affect people in their work and family lives.

  1. During the past 30 days, how often did poor mental health keep you from doing your usual activities, such as work or recreation? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 28 to 30 days (about every day)

2 20 to 27 days (5 to 6 days a week on average)

3 11 to 19 days (3 to 4 days a week on average)

4 4 to 10 days (1 to 2 days a week on average)

5 2 to 3 days in the past 30 days

6 Once in the past 30 days

7 Never in the past 30 days

  1. During the past 30 days, how much stress did you experience at work? [SOURCE: Based On WRAIR’s, Martin, & Ickovics, 1987; used in 2008 Survey of Health-Related Behaviors Among Active Duty Personnel & 2006 DoD Reserve Component Survey]

1 A lot

2 Some

3 A little

4 None at all

  1. Since leaving active duty, have your coworkers or supervisors made negative comments about any recent changes in your appearance, quality of work, or relationships? [SOURCE: Based on Functional Assessment Section of the VA/DOD Clinical Practice Guideline for the Management of Post-Traumatic Stress Acute Stress Reaction (ASR) Module-Pocket Guide updated April 2005]

1 Yes

2 No

  1. Since leaving active duty, have you had a physical or mental condition that caused you to lose your job?

1 Yes

2 No


  1. Since leaving active duty, how often have you been late for work due to emotional or physical problems?

1 More than 10 times

2 9 or 10 times

3 6 to 8 times

4 3 to 5 times

5 1 or 2 times

6 0 times

  1. How many times have you changed jobs since leaving active duty?

Enter the number of job changes in the boxes. Use both boxes, ONE number to a box.

If you have NOT changed jobs since leaving active duty, please enter “00.”

If you have NOT had a job or you have been unemployed the entire period of time since you left active duty, please check the box below,

I have not had a job/I have been unemployed since leaving active duty.


NUMBER OF JOB CHANGES

  1. Since leaving active duty, how much stress have you experienced in your family life? “Family life” refers to your relationship(s) with your spouse and children, or with your live-in fiancé, boyfriend or girlfriend, or the person you date seriously. . [SOURCE: Based On WRAIR’s, Martin, & Ickovics, 1987; used in 2008 Survey of Health-Related Behaviors Among Active Duty Personnel & 2006 DoD Reserve Component Survey]

1 A lot

2 Some

3 A little

4 None at all

  1. How much stress has your spouse been under since you left active duty?

1 A lot

2 Some

3 A little

4 None at all

5 I don’t have a spouse


  1. Have you ever seriously considered suicide? [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Personnel]

1 Yes

2 No



  1. If you have ever seriously considered suicide, when did this occur? (Mark all that apply.) [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Personnel]

1 I have never seriously considered suicide

2 Within the past year

3 Since joining the military

4 Before joining the military

5 During a combat deployment

6 During a non-combat deployment

7 Since leaving the military


  1. Have you ever attempted suicide? [SOURCE: 2005 Survey of Health-Related Behaviors Among Active Duty Personnel]

1 Yes

2 No


  1. If you have ever attempted suicide, when did this occur? (Mark all that apply.) [SOURCE: 2008 Survey of Health-Related Behaviors Among Active Duty Personnel]

1 I have never attempted suicide

2 Within the past year

3 Since joining the military

4 Before joining the military

5 During a combat deployment

6 During a non-combat deployment

7 Since leaving the military


If you are having any suicidal thoughts or other psychological distress, please seek help immediately. We encourage you to contact a mental health professional. You could contact the counseling hotline at 1-800-784-2433 or 1‑800-SUICIDE. This is an anonymous, civilian hotline.


  1. During the past 30 days, how often have you been bothered by the following? [SOURCES: Post-Deployment Clinical Assessment Tool (PDCAT), Patient Health Questionnaire, and Warfighter Status Survey]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

More than Half of the Days

Several Days

Not at All

a. Feeling nervous, anxious, on edge, or worrying a lot about different things

1

2

3

b. Getting tired very easily

1

2

3

c. Muscle tension, aches, or soreness

1

2

3

d. Trouble falling asleep or staying asleep

1

2

3

e. Trouble concentrating on things, such as reading a book or watching TV

1

2

3

f. Becoming easily annoyed or irritable

1

2

3

g. Feeling restless so that it is hard to sit still

1

2

3


  1. Since leaving active duty, how often have you . . .

(Mark an answer for each question below. Indicate your answer by placing an “X” in the box for your response.)

Never

One Time

Two Times

Three or Four Times

Five or More Times

a. Gotten angry at someone and yelled or shouted at them?

1

2

3

4

5

b. Gotten angry with someone and kicked or smashed something, slammed the door, punched the wall, etc.?

1

2

3

4

5

c. Gotten into a fight with someone and hit the person?

1

2

3

4

5

d. Threatened someone with physical violence?

1

2

3

4

5







  1. Since leaving active duty, did you . . . [SOURCE: Based on multiple items from the 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

(Mark an answer for each question below. Indicate your answer by placing an “X” in the box for your response.)

Yes,
But Only 1 Time

Yes,
2 or 3 Times

Yes,
More Than 3 Times

No

a. Drive a car or other vehicle when you had too much to drink?

1

2

3

4

b. Drive or ride in a boat, canoe, or other watercraft when you had too much to drink?

1

2

3

4

c. Ride or drive a motorcycle without a helmet?

1

2

3

4



  1. Since leaving active duty, how much stress did you experience from each of the following? [SOURCE: 2005 Survey of Health-Related Behaviors Among Active Duty Military Personnel. Note: Subitems “r, s, & t are new)]



(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

A Lot

Some

A Little

None at All

a. Problems in my relationships with the people I work with

1

2

3

4

b. Problems in my relationship(s) with my immediate supervisor(s)

1

2

3

4

c. Increases in my workload

1

2

3

4

d. Decreases in my workload

1

2

3

4

e. Conflicts between my work and family responsibilities

1

2

3

4

f. Having a baby

1

2

3

4

g. Finding childcare/daycare

1

2

3

4

h. Death in the family

1

2

3

4

i. Divorce or breakup

1

2

3

4

j. Infidelity or unfaithfulness by me or my spouse, fiancé, boyfriend, or girlfriend

1

2

3

4

k. Problems with money

1

2

3

4

l. Problems with housing

1

2

3

4

m. Health problems that I had

1

2

3

4

n. Health problems that my family members had

1

2

3

4

o. Behavioral or emotional problems in some of my children

1

2

3

4

p. Unexpected events/problems (e.g., hurricane, flood, home robbery)

1

2

3

4

q. Problems obtaining appropriate/necessary health care

1

2

3

4

r. Problems getting along with others

1

2

3

4

s. Finding employment

1

2

3

4

t. Insufficient civilian job skills

1

2

3

4



  1. Indicate for each of the statements below, the degree to which this change happened to you as a result of your military service. [SOURCE: Post-Traumatic Growth Inventory (PTGI)]

    (Mark an answer for each statement below. Indicate your answer by placing an “X” in the box for your response.)

    I experienced this change to a very great degree

    I experienced this change to a great degree

    I experienced this change to a moderate degree

    I experienced this change to a small degree

    I experienced this change to a very small degree

    I did not ex-perience this change

    a. I changed my priorities about what is important in life

    1

    2

    3

    4

    5

    6

    b. I have a greater appreciation for the value of my own life

    1

    2

    3

    4

    5

    6

    c. I am able to do better things with my life

    1

    2

    3

    4

    5

    6

    d. I have a better understanding of spiritual matters

    1

    2

    3

    4

    5

    6

    e. I have a greater sense of closeness with others

    1

    2

    3

    4

    5

    6

    f. I established a new path for my life

    1

    2

    3

    4

    5

    6

    g. I know better that I can handle difficulties

    1

    2

    3

    4

    5

    6

    h. I have a stronger religious
    faith

    1

    2

    3

    4

    5

    6

    i. I discovered that I am stronger than I thought I was

    1

    2

    3

    4

    5

    6

    j. I learned a great deal about how wonderful people are

    1

    2

    3

    4

    5

    6

  2. Since leaving active duty, how much trouble have you had sleeping because of nightmares?

1 A lot

2 Some

3 A little

4 None at all



  1. How much trouble have you had adjusting to civilian life?

1 A lot

2 Some

3 A little

4 None at all

  1. Since leaving active duty, how much trouble have you had with anger, frustration, resentment, hostility, or losing your temper?

1 A lot

2 Some

3 A little

4 None at all



  1. Below is a list of ways you might have felt or behaved. Please indicate how often you felt this way during the past week. [SOURCES: Center for Epidemiological Studies Depression Scale (CES-D) and Warfighter Status Survey]

(Mark an answer for each statement below. Indicate your answer by placing an “X” in the box for your response.)

Most or All of the Time
(5–7 Days)

Occasionally or a Moderate Amount of the Time
(3–4 Days)

Some or a Little of the Time (1–2 Days)

Rarely or None of the Time (Less Than 1 Day)

a. I was bothered by things that usually don’t bother me

1

2

3

4

b. I did not feel like eating; my appetite was poor

1

2

3

4

c. I felt that I could not shake off the blues even with help from my family and friends

1

2

3

4

d. I felt that I was just as good as other people

1

2

3

4

e. I had trouble keeping my mind on what I was doing

1

2

3

4

f. I felt depressed

1

2

3

4

g. I felt like everything I did was an effort

1

2

3

4

h. I felt hopeful about the future

1

2

3

4

i. I thought my life had been a failure

1

2

3

4

j. I felt fearful

1

2

3

4

k. My sleep was restless

1

2

3

4

l. I was happy

1

2

3

4

m. I talked less than usual

1

2

3

4

n. I felt lonely

1

2

3

4

o. People were unfriendly

1

2

3

4

p. I enjoyed life

1

2

3

4

q. I had crying spells

1

2

3

4

r. I felt sad

1

2

3

4

s. I felt that people disliked me

1

2

3

4

t. I could not ”get going”

1

2

3

4




  1. 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. [SOURCES: PTSD Checklist Civilian Version (PCL-C) and Warfighter Status Survey]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Extremely

Quite a Bit

Moderately

A Little Bit

Not at All

a. Having repeated, disturbing memories, thoughts, or images of a stressful experience

1

2

3

4

5

b. Having repeated, disturbing dreams of a stressful experiences

1

2

3

4

5

c. Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it)

1

2

3

4

5

d. Feeling very upset when something reminded you of a stressful experience

1

2

3

4

5

e. Having physical reactions (e.g., heart pounding, trouble breathing, sweating) when something reminded you of a stressful experience

1

2

3

4

5

f. Avoiding thinking about or talking about a stressful experience or avoiding having feelings related to it

1

2

3

4

5

g. Avoiding activities or situations because they reminded you of a stressful experience

1

2

3

4

5

h. Having trouble remembering important parts of a stressful experience

1

2

3

4

5

i. Losing interest in activities you used to enjoy

1

2

3

4

5

j. Feeling distant or cut off from other people

1

2

3

4

5

k. Feeling emotionally numb or being unable to have loving feelings for those close to you

1

2

3

4

5

l. Feeling as if your future somehow will be cut short

1

2

3

4

5

m. Having trouble falling or staying asleep

1

2

3

4

5

n. Feeling irritable or having angry outbursts

1

2

3

4

5

o. Having difficulty concentrating

1

2

3

4

5

p. Being “super alert,” watchful, or on guard

1

2

3

4

5

q. Feeling jumpy or easily startled

1

2

3

4

5


  1. In general, how long have you experienced the problems listed in Question 67?

1 I have never had any of these problems or complaints

2 Less than 1 month

3 1 month

4 2 to 3 months

5 4 to 6 months

6 7 months or longer


















F or the next questions, “mental health professional” refers to a psychologist, psychiatrist, clinical social worker, or other mental health counselor.

  1. Since leaving active duty, have you received counseling or therapy for mental health or substance abuse from the following? [SOURCE: Based on 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No

a. Civilian mental health professional (e.g., psychologist, psychiatrist, clinical social worker, or other mental health counselor)

1

2

b. Civilian general medical doctor

1

2

c. VA mental health professional (e.g., psychologist, psychiatrist, clinical social worker, or other mental health counselor)

1

2

d. VA general medical doctor

1

2

e. Pastor, rabbi, or other pastoral counselor

1

2

f. Self-help group (e.g., Alcoholics Anonymous (AA), Narcotics Anonymous (NA))

1

2


  1. For what concerns did you seek counseling or therapy since leaving active duty? (Mark all that apply.) [SOURCE: Based on 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Depression

2 Anxiety

3 Family problems

4 Substance use problems

5 Anger management

6 Stress management

7 Combat/operational stress

8 Other (specify): ______________________________

9 I did not seek help from a mental health professional since leaving active duty

  1. Since leaving active duty, have you felt you needed counseling or therapy from a mental health professional? [SOURCE: Based on 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Yes

2 No

  1. Are you currently receiving counseling or therapy for mental health or substance abuse problems?

1 Yes

2 No

  1. Have you been prescribed medication for depression, anxiety, or sleeping problems by a doctor or other health professional? (Mark all that apply.) [SOURCE: Based on 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Yes, in the past 30 days

2 Yes, more than 30 days ago but since leaving active duty

3 No

  1. On average, how often in the past 12 months have you used each of the following medications?


NUMBER OF DAYS USED THIS TYPE OF DRUG IN PAST 12 MONTHS


(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

52 Days or More

25 to 51 Days

12 to 24 Days

6 to 11 Days

3 to 5 Days

1 to 2 Days

0 Days

I Have Never Used

a. Anti-depressant medication

b. Anti-anxiety medication

c. Sleeping medication

d. Pain medication



  1. Since leaving active duty, how many hours of sleep, on average, do you get each night?

1 7 hours or more

2 5 or 6 hours

3 3 or 4 hours

4 2 hours or less

  1. Since leaving active duty, have you had problems sleeping (e.g., getting to sleep, staying asleep, having nightmares)?

1 Yes

2 No

If yes, have your sleep problems worsened since leaving active duty?

1 Yes

2 No

3 I did not have sleep problems before leaving active duty

  1. Since leaving active duty, have your children experienced or behaved in any of the following ways?

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No 

I Do Not Have Any Children

a. Declining academic performance or grades

1

2

3

b. Disruptive or problem behavior

1

2

3

c. Social withdrawal from peers

1

2

3

d. Bullying

1

2

3

e. Alcohol or drug use

1

2

3




PLEASE CONTINUE WITH QUESTION 79.

T he next set of questions asks about your religious or spiritual practices.

  1. Since leaving active duty, how many times have you attended religious services? (Please do not include special occasions, such as weddings, funerals, or other special events in your answer.) [SOURCES: Based on National Survey of Drug use and Health (NSDUH) and 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 More than 26 times

2 12 to 25 times

3 6 to 11 times

4 3 to 5 times

5 1 to 2 times

6 0 times

  1. My religious/spiritual beliefs are a very important part of my life. [SOURCES: Based on National Survey of Drug use and Health (NSDUH) and 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree

  1. My religious/spiritual beliefs influence how I make decisions in my life. [SOURCE: Based on National Survey of Drug use and Health (NSDUH) and 2008 Survey of Health-Related Behaviors Among Active Duty Military Personnel]

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree




The next few questions ask about events that you may have experienced since leaving active duty.

  1. Since leaving active duty, I have experienced… [SOURCE: DRRI Post-Deployment Stressors Scale (2003; King, D.W., King, L.A., & Vogt, D.S. Boston, MA: National Center for PTSD.)]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No

a. a natural disaster (e.g., a flood or hurricane), a fire, or an accident in which I was hurt or my property was damaged

1

2

b. exposure to a toxic substance (such as dangerous chemicals or radiation).

1

2

c. combat or exposure to a war zone (as a civilian)

1

2

d. a serious surgery or operation

1

2

e. a mental illness (e.g., clinical depression or anxiety disorder) of someone close to me, or a life-threatening physical illness (e.g., cancer or heart disease) of someone close to me

1

2

f. the death of someone close to me

1

2

g. stressful legal problems (e.g., being sued or suing someone else)

1

2







  1. Since leaving active duty, I have…[SOURCE: DRRI Post-Deployment Stressors Scale (2003; King, D.W., King, L.A., & Vogt, D.S. Boston, MA: National Center for PTSD.) Note: Subitem c had the word “serious” removed; subitems j, k, l, m, and n were added and are not part of the DRRI.]

(Mark an answer for each item below. Indicate your answer by placing an “X” in the box for your response.)

Yes

No

a. witnessed someone being assaulted or violently killed

1

2

b. been robbed or had my home broken into

1

2

c. had a family member with a drug or alcohol problem

1

2

d. been unemployed and seeking employment for at least 3 months

1

2

e. been emotionally mistreated (e.g., shamed, embarrassed, ignored, or repeatedly told I was no good)

1

2

f. experienced unwanted sexual activity as a result of force, threat of harm, or manipulation

1

2

g. been physically injured by another person (e.g., hit, kicked, or beaten up)

1

2

h. been threatened with a weapon

1

2

i. lost my job

1

2

j. had problems getting access to adequate health care

1

2

k. lost my temper and hurt another person

1

2

l. been fired from a job…………………………………………………………………………………………….

1

2

m. gone through a divorce or been left by a partner or significant other

1

2

n. had a serious illness (e.g., cancer or heart disease)

1

2


The next questions ask about your current relationships and social support. Social support refers to the extent that people listen to and care about what happened to you.

  1. We are also interested in how you feel about the following statements. Read each statement carefully. Indicate how you feel about each statement. [Multidimensional Scale of Perceived Social Support (Zimet et al. 1988)]

(Mark an answer for each statement below. Indicate your answer by placing an “X” in the box for your response.)

Very Strongly Agree

Strongly Agree

Mildly Agree

Neutral

Mildly Disagree

Strongly Disagree

Very Strongly Disagree

a. There is a special person who is around when I am in need

1

2

3

4

5

6

7

b. There is a special person with whom I can share my joys and sorrows

1

2

3

4

5

6

7

c. My family really tries to help me.

1

2

3

4

5

6

7

d. I get the emotional help and support I need from my family

1

2

3

4

5

6

7

e. I have a special person who is a real source of comfort to me

1

2

3

4

5

6

7

f. My friends really try to help me

1

2

3

4

5

6

7

g. I can count on my friends when things go wrong

1

2

3

4

5

6

7

h. I can talk about my problems with my family

1

2

3

4

5

6

7

i. I have friends with whom I can share my joys and sorrows

1

2

3

4

5

6

7

j. There is a special person in my life who cares about my feelings.

1

2

3

4

5

6

7

k. My family is willing to help me make decisions

1

2

3

4

5

6

7

l. I can talk about my problems with my friends

1

2

3

4

5

6

7


  1. Do you know at least one military veteran who you talk to about your war experiences or other stressful deployment events?

1 Yes

2 No

If yes, has talking to another veteran helped you handle stress better?

1 Yes

2 No


  1. Do you have the opportunity to interact with a group of combat veterans?

1 Yes

2 No

If yes, what type of group(s)? (Mark all that apply.)

1 Social group (VFW, American Legion, etc.)

2 Support group

3 Reserve unit

4 Sports team

5 Friends or coworkers

6 Other (specify): __________________________


  1. The statements below are about your current relationships with others, including family and friends. [SOURCE: DRRI Post-Deployment Social Support Scale (2003; King, D.W., King, L.A., & Vogt, D.S. Boston, MA: National Center for PTSD.)]

(Mark an answer for each statement below. Indicate your answer by placing an “X” in the box for your response.)

Strongly Agree

Somewhat Agree

Neither Agree nor Disagree

Somewhat Disagree

Strongly Disagree

a. I am carefully listened to and understood by family members or friends

1

2

3

4

5

b. Among my friends or relatives, there is someone who makes me feel better when I am feeling down

1

2

3

4

5

c. I have problems that I can’t discuss with family or
friends

1

2

3

4

5

d. Among my friends or relatives, there is someone I go to when I need good advice

1

2

3

4

5

e. People at home just don’t understand what I have been through while in the Armed Forces

1

2

3

4

5

f. There are people to whom I can talk about my military experiences

1

2

3

4

5

g. The people I work with respect the fact that I am a veteran

1

2

3

4

5

h. My supervisor understands when I need time off to take care of personal matters

1

2

3

4

5

i. My friends or relatives would lend me money if I
needed it

1

2

3

4

5

j. My friends or relatives would help me move my belongings if I needed to

1

2

3

4

5

k. When I am unable to attend to daily chores, there is someone who will help me with these tasks

1

2

3

4

5

l. When I am ill, friends or family members will help out until I am well

1

2

3

4

5






THANK YOU VERY MUCH FOR YOUR TIME, EFFORT, AND COOPERATION IN COMPLETING THIS QUESTIONNAIRE.



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