Competency and CIDI Screener

6464 Supported Employment Demonstration Attachment J4. Baseline Interview Digit Symbol Test Instructions 05-03-17

Digit Symbol Test Instructions
Materials Needed
Digit Symbol Coding Worksheet
Two number 2 pencils without erasers
Digit Symbol Scoring Template
Stopwatch
This instruction sheet
Description
Participant copies symbols that are paired with numbers, using a key that indicates which symbols
correspond to which numbers. RA scores the test, using the Digit Symbol Scoring Template, after
participant has completed the remainder of the CAPI interview. Participant’s score is the number of
correct symbols he or she draws within the 120-second time limit.
Administration
1. Write the participant’s name and study ID number on the worksheet in the designated spot.
2. Provide participant a flat, smooth surface on which to complete the test, i.e., a clean table top. If the
available surface is rough, place the Digit Symbol Coding Worksheet on a clipboard.
3. Introduce the task by saying,
I’m going to ask you to copy some symbols.
4. Place the Digit Symbol Coding Worksheet in front of the participant and hand him or her a pencil
without an eraser.
5. Point to the key above the test items, and say:
Look at these boxes. Notice that each has a number in the upper part and a special mark in
the lower part. Each number has its own mark.
Point to the “1” and its mark below, then point to “2” and its mark.
6. Point to the Sample Items (seven squares), to the left of the heavy black line, and say:
Now look down here where the squares have numbers in the top part but the squares at the
bottom are empty. In each of the empty squares, put the mark that should go there. Like
this.
Point to the first Sample Item, then point back to the key to show its corresponding mark, and say:
Here is a 2; the 2 has this mark. So I put it in this empty square, like this.
Write in the symbol. Point to the second Sample Item and say:
Here is a 1; the 1 has this mark (point to the second Sample Item, then to the mark below the 1 in
the key), so I put it in this square.
Write in the symbol.
Point to the third Sample Item and say:

This number is a 3; the 3 has this mark (point to the third square and to the mark below the 3 in
the key). So I put it in the square (write in the symbol).
After marking the first three Sample Items, say:
Now you fill in the squares up to this heavy line.
If the participant makes an error on any of the Sample Items, correct the error immediately and review
the use of the key. Continue to provide the participant help with the Sample Items, if needed. Do not
proceed with the test until the participant clearly understands the task.
When the participant completes a Sample Item correctly, offer encouragement by saying Yes or Right.
7. When all the Sample Items have been completed, say:
Now you know how to do them. When I tell you to start, you do the rest of them.
Point to the first square to the right of the heavy line and say:
Begin here and fill in as many squares as you can, one after the other without skipping any.
Keep working until I tell you to stop. Work as quickly as you can without making any
mistakes.
Sweep across the first row with your finger and say:
When you finish this line, go on to this one.
Point to the first square in the second row. Then point to the heavy black line and say:
Go ahead.
BEGIN TIMING.
8. If participant asks what to do if he or she makes a mistake, encourage them to keep working as fast as
they can without making mistakes.
If, after completing a row, a participant tries to complete the next row in reverse order, remind the
participant to start at the beginning of the row and not to skip any.
If the participant skips an item or starts to do only one type (e.g., only the 1’s), say Do them in order.
Don’t skip any. Point to the first item omitted and say Do this one next.
Provide no other type of assistance except to remind the participant to continue until instructed to stop.
9. At the end of 120 seconds, say STOP.
10. After the baseline interview has been completed, use the Digit Symbol Scoring Template to score the
worksheet. Place the template over the worksheet so that the numbered rows of the template cover the
corresponding worksheet boxes. A response is scored as correct if it is clearly identifiable as the symbol
on the template, even if the symbol is drawn imperfectly or if it is a correction of an initially incorrect
symbol. Each correctly drawn symbol earns one point. Maximum score is 133 points.
11. Write the score on the bottom of the worksheet in the designated spot.
12. Enter the score in the Management Information System.
13. File the worksheet in the participant’s casefile.

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW (CIDI)
Thank you for agreeing to participate in this interview for the Supported Employment Demonstration, a research
study by the Social Security Administration (SSA). I work for Westat, the research company that SSA has contracted
to carry out this study.
The Supported Employment Demonstration seeks to find out if providing high quality employment services and
behavioral health services helps people who were recently denied Social Security disability benefits find good jobs
they want and function better overall in their daily lives. SSA also wants to know which services and treatments work
best and what they cost.
This interview will last approximately 40 minutes and will ask questions about your mental and emotional health.
Afterwards you will receive $45 as a thank you for your time.
Your participation is voluntary. You can decide not to participate in this interview or stop participating without penalty.
If you are appealing your denial or reapplying for SSA benefits, you can still participate in this interview and your
participation will not affect your appeal or reapplication.
During this interview, you may experience anxiety, fatigue or frustration. If this happens, you can take a break, skip
any section, or stop the interview. If you become particularly upset, I may offer to refer you to crisis management
services that you can use if you wish.
Do you have any questions? [ANSWER ALL QUESTIONS]
OK let’s begin.

1

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SC19. (READ SLOWLY) This interview asks about your physical and emotional well-being and about areas of your life that
could affect your physical and emotional well-being. It is important for us to get accurate information. In order to do this,
you will need to think carefully before answering the following questions.
Are you willing to do this?
INTERVIEWER: PROBE NEGATIVE RESPONSES BY ASKING IF THERE IS A BETTER TIME TO COME
BACK FOR THE INTERVIEW. REPEAT *SC19 AS NECESSARY. R MUST ANSWER AFFIRMATIVELY TO
CONTINUE WITH THE INTERVIEW. TERMINATE IF R DOES NOT ANSWER AFFIRMATIVELY.
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ...................................... 9
MHQ: What is the main reason that you applied for Social Security Disability benefits?
INTERVIEWER: If respondent indicates any of the following, begin with that corresponding module once screener Is completed.
Otherwise, go in order below. Stop CIDI and move onto Baseline interview once first positive diagnosis is triggered
Depression
Generalized anxiety disorder
Panic disorder
Social phobia
Agoraphobia
Neurasthenia [somatoform dx]
PTSD
OCD
Psychosis
Mania
Eating disorder
Explosive disorder
Personality screen then disorder
Specific phobia

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
INTERVIEWER: READ FOLLOWING QUESTIONS SLOWLY
*SC20. Have you ever in your life had an attack of fear or panic
when all of a sudden you felt very frightened, anxious, or
uneasy?
*SC20a. Have you ever had an attack when all of a
sudden
 you became very uncomfortable,
 you either became short of breath, dizzy,
nauseous, or your heart pounded,
 or you thought that you might lose control,
die, or go crazy?
*SC20.1 Have you ever in your life had attacks of anger when all of a
sudden you lost control and broke or smashed something
worth more than a few dollars?
*SC20.2. Have you ever had attacks of anger when all of a sudden
you lost control and hit or tried to hurt someone?
*SC20.3 Have you ever had attacks of anger when all of a sudden
you lost control and threatened to hit or hurt someone?
*SC21. Have you ever in your life had a period of time lasting
several days
or longer when most of the day you felt sad, empty or
depressed?
*SC22. Have you ever had a period of time lasting several days or
longer when most of the day you were very discouraged
about how things were going in your life?
*SC23. Have you ever had a period of time lasting several days or
longer when you lost interest in most things you usually
enjoy like work, hobbies, and personal relationships?
*SC24. Some people have periods of time lasting four days or
longer when they feel much more excited and full of energy
than usual. Their minds go too fast. They talk a lot. They
are very restless or unable to sit still and they sometimes do
things that are unusual for them, such as driving too fast or
spending too much money. Have you ever had a period like
this lasting several days or longer?
*SC25. Have you ever had a period of time lasting four days or
longer when most of the time you were very irritable,
grumpy, or in a bad mood?
*SC25a. Have you ever had a period of time lasting four
days or longer when most of the time you were so
irritable that you either started arguments, shouted
at people, or hit people?
*SC26. Did you ever have a time in your life when you were a
“worrier” – that is, when you worried a lot more about
things than other people with the same problems as you?
*SC26a. Did you ever have a time in your life when you
were much more nervous or anxious than most
other people with the same problems as you?
*SC26b. Did you ever have a period lasting one month or
longer when you were anxious and worried most
days?

3

YES
(1)
1
GO TO
*SC20.1

NO
(5)

DK
(8)

RF
(9)

5

8

9

1

5

8

9

1

5

8

9

1
GO TO
*SC21

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

5

8

9

1

5
GO TO
*SC26

8
GO TO
*SC26

9
GO TO
*SC26

1

5

8

9

1
GO TO
*SC27

5

8

9

1
GO TO
*SC27

5

8

9

5

8

9

1

1

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
INTERVIEWER: READ FOLLOWING QUESTIONS SLOWLY.
*SC27. (RB, PG 1) The next questions are about things that make some people afraid even though they know there is no
real danger. Looking at page 1 in your booklet, was there ever a time in your life when you had a strong fear of any
of the following things?

*SC27a.
*SC27b.

*SC27c.

*SC27d.

*SC27e.

*SC27f.

First, bugs, snakes, dogs, or any other animals?
(KEY PHRASE: animals)
Second, still water, like in a swimming pool or a lake, or
weather events, like storms, thunder, or lightning?
(KEY PHRASE: water)
Third, going to the dentist or doctor, getting a shot or
injection, seeing blood or injury, or being in a hospital or
doctor’s office?
(KEY PHRASE: blood, injury, or medical settings)
Fourth, closed spaces, like caves, tunnels, closets, or
elevators?
(KEY PHRASE: closed spaces)
Fifth, high places like roofs, balconies, bridges, or
staircases?
(KEY PHRASE: high places)
Sixth, flying or airplanes?
(KEY PHRASE: flying)

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*SC27.1 INTERVIEWER CHECKPOINT (SEE *SC27 SERIES):
AT LEAST ONE RESPONSE CODED ‘1’ ................... 1
ALL OTHERS ................................................................ 5

GO TO *SC29

*SC27.2.You feared (KEY PHRASE OF ENDORSED ITEMS IN *SC27a-*SC27f SERIES). Was there ever a time in your
life when you became very upset or nervous whenever you were faced with (this situation/one of these situations)?
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ...................................... 9

*SC27.3. Did you ever stay away from (this situation/these situations) whenever you could because of your fear?
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ...................................... 9

*SC27.4 Do you think your fear was ever much stronger than it should have been?
YES ................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ......................................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SC28. INTERVIEWER CHECKPOINT (SEE *SC27.2, *SC27.3, *SC27.4):
(*SC27.2 EQUALS ‘1’ OR *SC27.3 EQUALS ‘1’) AND *SC27.4 EQUALS ‘1’ ........1
ALL OTHERS ...................................................................................................................2

INTERVIEWER: READ FOLLOWING QUESTIONS SLOWLY.
*SC29. (RB, PG 2) Looking at page 2 in your booklet, was there
ever a time in your life when you felt very afraid or really,
really shy with people, like meeting new people, going to
parties, going on a date, or using a public bathroom?
*SC29a. Was there ever a time in your life when you felt
very afraid or uncomfortable when you had to do
something in front of a group of people, like
giving a speech or speaking in class?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO
*SC29.1

5

8

9

5
GO TO
*SC30

8
GO TO
*SC30

9
GO TO
*SC30

1

*SC29.1. Was there ever a time in your life when you became very upset or nervous (IF *SC29 EQUALS ‘1’: whenever you
were in a social situation/ ALL OTHERS: when you had to do something in front of a group)?
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ...................................... 9

*SC29.2. Did you ever stay away from (IF *SC29 EQUALS ‘1’: social situations/ ALL OTHERS: situations where you had to do
something in front of a group) whenever you could because of your fear?
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ......................................... 9

*SC29.3. Do you think your fear was ever much stronger than it should have been?
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ...................................... 9

*SC29.4. INTERVIEWER CHECKPOINT (SEE *SC29.1, *SC29.2, *SC29.3):
(*SC29.1 EQUALS ‘1’ OR *SC29.2 EQUALS ‘1’) AND *SC29.3 EQUALS ‘1’ ........1
ALL OTHERS ...................................................................................................................2

*SC30. (RB, PG 2) Looking at the bottom of page 2 in your booklet, was there ever a time in your life when you felt afraid of
either being in crowds, going to public places, traveling by yourself, or traveling away from home?
YES ................................................................................... 1
NO ............................................................................5
DON’T KNOW .......................................................8
REFUSED................................................................9

GO TO *SC31
GO TO *SC31
GO TO *SC31
5

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*SC30.1. Was there ever a time in your life when you became very upset or nervous whenever you were in crowds, public
places, or traveling?
YES........................................................................ 1
NO ......................................................................... 5
DON’T KNOW ..................................................... 8
REFUSED ..............................................................9

*SC30.2. Did you ever stay away from these situations whenever you could because of your fear?
YES ................................................................................ 1
NO ......................................................................... 5
DON’T KNOW ..................................................... 8
REFUSED ......................................................... 9

*SC30.3. Do you think your fear was ever much stronger than it should have been?
YES.................................................. 1
NO ................................................... 5
DON’T KNOW ............................... 8
REFUSED ....................................... 9

*SC30.4. INTERVIEWER CHECKPOINT (SEE *SC30.1, *SC30.2, *SC30.3):
(*SC30.1 EQUALS ‘1’ OR *SC30.2 EQUALS ‘1’) AND *SC30.3 EQUALS
‘1’……1 ALL OTHERS...................................................................................................2

*SC36. INTERVIEWER CHECKPOINT: (SEE *SC20, *SC20a, *SC21, *SC22, *SC23, *SC24, *SC25, *SC25a,
*SC26, *SC26a, *SC26b, *SC28, *SC29.4, *SC30.4)
FOLLOW SKIP FOR FIRST ENDORSED ITEM.
*SC21 EQUALS ‘1’..................................................................................... 1

GO TO *D1, NEXT SECTION

*SC22 EQUALS ‘1’..................................................................................... 2

GO TO *D2

*SC23 EQUALS ‘1’..................................................................................... 3

GO TO *D9

*SC24 EQUALS ‘1’..................................................................................... 4

GO TO *M1

*SC25a EQUALS ‘1’................................................................................... 5

GO TO *M5

*SC20 EQUALS ‘1’..................................................................................... 6

GO TO *PD1 INTRO 1

*SC20a EQUALS ‘1’................................................................................... 7

GO TO *PD1 INTRO 2

*SC28 EQUALS ‘1’..................................................................................... 8

GO TO *SP1

*SC29.4 EQUALS ‘1’.................................................................................. 9

GO TO *SO1

*SC30.4 EQUALS ‘1’.................................................................................. 10 GO TO *AG1
*SC26 EQUALS ‘1’..................................................................................... 11 GO TO *G1 INTRO 1
*SC26a EQUALS ‘1’................................................................................... 12 GO TO *G1 INTRO 2
*SC26b EQUALS ‘1’ .................................................................................. 13 GO TO *G1 INTRO 3
ALL OTHERS .............................................................................................. 14 GO TO *IED1
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
DEPRESSION (D)

*D1. Earlier in the interview, you mentioned having periods that lasted several days or longer when you felt sad, empty,
or depressed most of the day. During episodes of this sort, did you ever feel discouraged about how things were
going in your life?
YES........................................ 1
NO ......................................... 5
DON’T KNOW ..................... 8
REFUSED ............................. 9

GO TO *D1b
GO TO *D1b
GO TO *D1b

*D1a. During the episodes of being sad, empty, or depressed, did you ever lose interest in most things like work,
hobbies, and other things you usually enjoy?
YES ........................... 1
NO............................. 5
DON’T KNOW......... 8
REFUSED................. 9

GO TO *D3
GO TO *D4
GO TO *D4
GO TO *D4

*D1b. During the episodes of being sad, empty, or depressed, did you ever lose interest in most things like work,
hobbies, and other things you usually enjoy?
YES ........................... 1
NO............................. 5
DON’T KNOW......... 8
REFUSED................. 9

GO TO *D5
GO TO *D6
GO TO *D6
GO TO *D6

*D2. Earlier in the interview you mentioned having periods that lasted several days or longer when you felt discouraged
about how things were going in your life. During episodes of this sort, did you ever lose interest in most things like
work, hobbies, and other things you usually enjoy?
YES...................................... 1
NO ....................................... 5
DON’T KNOW.................... 8
REFUSED............................ 9

*D3.

GO TO *D7
GO TO *D8
GO TO *D8
GO TO *D8

INTERVIEWER INSTRUCTION:
USE KEY PHRASE “SAD, DISCOURAGED, OR UNINTERESTED” THROUGHOUT THE SECTION
GO TO *D12

*D4.

INTERVIEWER INSTRUCTION:
USE KEY PHRASE “SAD OR DISCOURAGED” THROUGHOUT THE SECTION
GO TO *D12

7

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D5.

INTERVIEWER INSTRUCTION:
USE KEY PHRASE “SAD OR UNINTERESTED” THROUGHOUT THE SECTION
GO TO *D12

*D6.

INTERVIEWER INSTRUCTION:
USE KEY PHRASE “SAD” THROUGHOUT THE SECTION
GO TO *D12

*D7.

INTERVIEWER INSTRUCTION:
USE KEY PHRASE “DISCOURAGED OR UNINTERESTED” THROUGHOUT THE SECTION
GO TO *D12

*D8.

INTERVIEWER INSTRUCTION:
USE KEY PHRASE “DISCOURAGED” THROUGHOUT THE SECTION
GO TO *D12

*D9. Earlier in the interview, you mentioned having periods that lasted several days or longer when you lost interest in
most things like work, hobbies, and other things you usually enjoy. Did you ever have a period of this sort that
lasted most of the day nearly every day for two weeks or longer?
YES.....................................................1
NO.......................................................5
DON’T KNOW .................................. 8
REFUSED .......................................... 9

GO TO *D11

*D9a. What is the longest period of days you ever had when you lost interest in most things you usually enjoy?
INTERVIEWER: “LESS THAN ONE DAY” CODE 0
NUMBER
CIRCLE UNIT
OF TIME:

DAYS ... 1

WEEKS .... 2

MONTHS.... 3

YEARS..... 4

PROBE DK: Was it three days or longer?
DON’T KNOW ........................... 998
REFUSED ................................... 999
USE THE KEY PHRASE “UNINTERESTED” THROUGHOUT THE SECTION

*D10.

INTERVIEWER CHECKPOINT: (SEE *D9a)
DURATION OF 3 DAYS OR LONGER.................................................1
ALL OTHERS..........................................................................................2

8

GO TO *D14
GO TO *D87.1

GO TO *D10

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D11. INTERVIEWER INSTRUCTION: USE KEY PHRASE “UNINTERESTED” THROUGHOUT THE SECTION
GO TO *D16

*D12. Did you ever have a period of being (sad/or/discouraged/or/uninterested in things) that lasted most of the day,
nearly every day, for two weeks or longer?
YES .................................................1
NO ...................................................5
DON’T KNOW ...............................8
REFUSED .......................................9

GO TO *D16

*D12a. How long was the longest period of days you ever had when you were
(sad/or/discouraged/or/uninterested) most of the day?
INTERVIEWER: “LESS THAN ONE DAY” CODE 0
DAYS
DON’T KNOW 998
REFUSED .........................999

*D13. INTERVIEWER CHECKPOINT: (SEE *D12a)
DURATION OF 3 DAYS OR LONGER............................................... 1
ALL OTHERS........................................................................................ 2

*D14.

GO TO *D14
GO TO *D87.1

Did you ever have a year or more in your life when you had several different episodes of being
(sad/or/discouraged/or/uninterested) each of which lasted several days or longer?
YES .................................................1
NO ...................................................5
DON’T KNOW ...............................8
REFUSED .......................................9

GO TO *D87.1
GO TO *D87.1
GO TO *D87.1

*D14a. Did you ever have a year or more in your life when just about every month you had an episode of this sort?
YES ...................................1
NO.....................................5
DON’T KNOW.................8
REFUSED.........................9

*D15.

GO TO *D87.1
GO TO *D87.1
GO TO *D87.1

Think of times lasting several days or longer when (this problem/these problems) with your mood (was/were)
most severe and frequent. During those times, did your feelings of (sadness/or/discouragement/or/lack of interest)
usually last less than 1 hour, between 1 and 3 hours, between 3 and 5 hours, or more than 5 hours?
LESS THAN 1 HOUR ..................................1 GO TO D87.1
BETWEEN 1 AND 3 HOURS......................2 GO TO D17
BETWEEN 3 AND 5 HOURS......................3 GO TO D17
MORE THAN 5 HOURS..............................4 GO TO D17
DON’T KNOW .............................................8 GO TO D17
REFUSED .....................................................9 GO TO D17

INTERVIEWER: ASK ABOUT PERIODS LASTING "SEVERAL DAYS OR LONGER" FOR THE REMAINDER OF
THE SECTION.
GO TO *D17
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D16. Think of times lasting two weeks or longer when (this problem/these problems) with your mood (was/were)
most severe and frequent. During those times, did your feelings of (sadness/or/discouragement/or/lack of
interest) usually last less than 1 hour, between 1 and 3 hours, between 3 and 5 hours, or more than 5 hours?
LESS THAN 1 HOUR ..................................1 GO TO *D87.1
BETWEEN 1 AND 3 HOURS ...................... 2
BETWEEN 3 AND 5 HOURS ...................... 3
MORE THAN 5 HOURS .............................. 4
DON’T KNOW ............................................. 8
REFUSED………………………………….. 9
INTERVIEWER: ASK ABOUT PERIODS LASTING "TWO WEEKS OR LONGER" FOR THE REMAINDER
OF THE SECTION.

*D17.

How severe was your emotional distress during those times -- mild, moderate, severe, or very severe?
MILD.............................................. 1
MODERATE ...................................2
SEVERE ..........................................3
VERY SEVERE ............................. 4
DON’T KNOW .............................. 8
REFUSED .......................................9

*D18.

How often, during those times, was your emotional distress so severe that nothing could cheer you up -- often,
sometimes, rarely, or never?
OFTEN ........................................... 1
SOMETIMES ..................................2
RARELY .........................................3
NEVER............................................4
DON’T KNOW ...............................8
REFUSED .......................................9

*D19.

How often, during those times, was your emotional distress so severe that you could not carry out your daily
activities -- often, sometimes, rarely, or never?
OFTEN ........................................... 1
SOMETIMES ..................................2
RARELY .........................................3
NEVER............................................4
DON’T KNOW .............................. 8
REFUSED .......................................9

*D20.

INTERVIEWER CHECKPOINT: (SEE *D17, *D18, *D19)
*D17 EQUALS ‘1’ AND *D18 EQUALS ‘4’ AND *D19 EQUAL ‘4’ ........1 GO TO *D87.1
ALL OTHERS................................................................................................. 2

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D21.

People with episodes of being (sad/or/discouraged/or/uninterested) often have other problems at the
same time. These include things like changes in sleep, appetite, energy, the
ability to concentrate and remember, feelings of low self-worth, and other problems. Did you ever have any of
these problems during one of your episodes of being (sad/or/discouraged/or/uninterested)?
YES ..........................................................1
NO............................................................5
DON’T KNOW .......................................8
REFUSED ...............................................9

*D22.

GO TO *D87.1
GO TO *D87.1
GO TO *D87.1

(READ SLOWLY) Please think of an episode of being (sad/or/discouraged/or/uninterested) lasting (several
days/two weeks) or longer when you also had the largest number of these other problems at the same time. Is there
one particular episode of this sort that stands out in your mind as the worst one you ever had?
YES ............................................................................. 1
NO ............................................................................... 5
DON’T KNOW ........................................................... 8
REFUSED. .................................................................. 9

GO TO *D22c
GO TO *D22c
GO TO *D22c

*D22a. How old were you when that worst episode started?
YEARS OLD
DON’T KNOW ........................998
REFUSED ................................999

*D22b. How long did that worst episode last?
NUMBER
CIRCLE UNIT OF TIME:

GO TO *D23
DAYS ...... 1

DON’T KNOW...................... 98
REFUSED.............................. 99

WEEKS .......2

MONTHS...... 3

YEARS ......... 4

GO TO *D23
GO TO *D23

*D22c. Then think of the last time you had a bad episode [of being (sad/or/discouraged/or/uninterested)] like
this. How old were you when that last episode occurred?
YEARS OLD
DON’T KNOW ........................998
REFUSED ................................999

*D22d. How long did that episode last?
NUMBER
CIRCLE UNIT OF TIME:

DAYS ...... 1

WEEKS .......2

DON’T KNOW ........................98
REFUSED ................................99

11

MONTHS ...... 3

YEARS ....... 4

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D23. Was there something going on in your life shortly before that episode started that caused it to occur?
YES .................................................1
NO ...................................................5
DON’T KNOW ...............................8
REFUSED .......................................9

GO TO *D24
GO TO *D24
GO TO *D24

*D23a. (RB, PG 3) (IF NEC: [Look at page 3 in your booklet.] Briefly, what was going on that caused the
episode to occur?)
CIRCLE ALL MENTIONS.
STRESS
OVERWORK.............................................................................1
TENSION...................................................................................2
DEATH OF LOVED ONE.........................................................3
MARITAL SEPARATION/DIVORCE .....................................4
JOB LOSS ..................................................................................5
STRESS .....................................................................................6
OTHER STRESSFUL EXPERIENCE (SPECIFY BELOW) ....7
PHYSICAL ILLNESS/INJURY/CONDITION
EXHAUSTION ..........................................................................10
MENSTRUAL CYCLE ............................................................. 11
PREGNANCY/POSTPARTUM ................................................12
HEART DISEASE .....................................................................13
THYROID DISEASE................................................................. 14
CANCER ................................................................................... 15
OVERWEIGHT ......................................................................... 16
OTHER PHYSICAL ILLNESS OR INJURY
(SPECIFY BELOW) ..................................................................17
OTHER
OTHER (SPECIFY BELOW) .................................................... 82
DON'T KNOW .......................................................................... 98
REFUSED .................................................................................. 99

SPECIFY

12

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D24.

(RB, PG 4. FOR EACH ITEM ENDORSED, ASK R TO MARK IT IN THE RB.) Look at page 4 in your
booklet. In answering the next questions, think about the period of (several days/two weeks) or longer during
that episode when your (sadness/and/discouragement/and/loss of interest) and other problems were most
severe and frequent. During that period, which of the following problems did you have most of the day nearly
every day:

*D24a. Did you feel sad, empty, or depressed most of the day nearly every day
during that period of (several days/ two weeks) or longer?

*D24b. Did you feel so sad that nothing could cheer you up nearly every day?

*D24c. During that period of (several days/ two weeks) or longer, did you feel
discouraged about how things were going in your life most of the day
nearly every day?

*D24d. Did you feel hopeless about the future nearly every day?

*D24e. During that period of (several days/ two weeks) or longer, did you lose
interest in almost all things like work and hobbies and things you like
to do for fun?

*D24f. Did you lose the ability to take pleasure in having good things happen
to you, like winning something or being praised or complimented?

*D25.

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

GO
TO
*D24c

GO
TO
*D24c

GO
TO
*D24c

1

5

8

9

1

5

8

9

GO
TO
*D24e

GO
TO
*D24e

GO
TO
*D24e

1

5

8

9

1

5

8

9

1

5

8

9

INTERVIEWER CHECKPOINT: (SEE *D24a-*D24f)
ONE OR MORE RESPONSES CODED ‘1’ ............................. 1
ALL OTHERS........................................................................... 2

13

GO TO *D87.1

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D26. (RB, PG 4-5. FOR EACH ITEM ENDORSED, ASK R TO MARK
IT IN THE RB.)
*D26a. Did you have a much smaller appetite than usual nearly every day
during that period of (several days/ two weeks)?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

GO
TO
*D26e

GO
TO
*D26e

GO
TO
*D26e

998

999

5

8

9

GO
TO
*D26g

GO
TO
*D26g

GO
TO
*D26g

998

999

GO
TO
*D26e
*D26b.
day?

Did you have a much larger appetite than usual nearly every

*D26c. Did you gain weight without trying to during that period of (several
days/ two weeks)?
IF R REPORTS BEING PREGNANT OR GROWING, CODE "7"
AND GO TO *D26g
*D26d.

How much did you gain?
NUMBER

GO TO *26g

CIRCLE UNIT OF MASS: POUNDS ................. 1 GO TO *26g
KILOS ..................... 2 GO TO *26g

*D26e. Did you lose weight without trying to?
1
IF R REPORTS BEING ON A DIET OR PHYSICALLY ILL,
CODE "NO" AND GO TO *D26g

*D26f. How much did you lose?
NUMBER
CIRCLE UNIT OF MASS:

POUNDS ........ 1
KILOS ............ 2

*D26g. Did you have a lot more trouble than usual either falling asleep,
staying asleep, or waking too early nearly every night during
that period of (several days/ two weeks)?

1

5

8

9

5

8

9

5

8

9

GO
TO
*D26i
*D26h. Did you sleep a lot more than usual nearly every night during that
period of (several days/ two weeks)?

1
GO
TO
*D26j

*D26i. Did you sleep much less than usual and still not feel tired or sleepy?

14

1

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D26j. Did you feel tired or low in energy nearly every day during that
period of (several days/ two weeks) even when you had not been
working very hard?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

GO
TO
*D26l
*D26k. Did you have a lot more energy than usual nearly every day during
that period of (several days/ two weeks)?

1

5

8

9

*D26l. Did you talk or move more slowly than is normal for you nearly
every day?

1

5

8

9

GO
TO
*D26n

GO
TO
*D26n

GO
TO
*D26n

1

5

8

9

GO
TO
*D26p

GO
TO
*D26p

GO
TO
*D26p

GO
TO
*D26p

1

5

8

9

GO
TO
*D26p

GO
TO
*D26p

GO
TO
*D26p

1

5

8

9

1

5

8

9

*D26m. Did anyone else notice that you were talking or moving slowly?

*D26n. Were you so restless or jittery nearly every day that you paced up
and down or couldn't sit still?

*D26o. Did anyone else notice that you were restless?
*D26p. Did your thoughts come much more slowly than usual or seem
mixed up nearly every day during that period of (several days/ two
weeks)?

GO
TO
*D26r
*D26q. Did your thoughts seem to jump from one thing to another or race
through your head so fast you couldn't keep track of them?

1

5

8

9

*D26r. Did you have a lot more trouble concentrating than is normal for
you nearly every day?

1

5

8

9

*D26s. Were you unable to make up your mind about things you ordinarily
have no trouble deciding about?

1

5

8

9

1

5

8

9

1

5

8

9

GO
TO
*D26w

GO
TO
*D26w

GO
TO
*D26w

5

8

9

*D26t. Did you lose your self-confidence?
*D26u. Did you feel that you were not as good as other people nearly every
day?

*D26v. Did you feel totally worthless nearly every day?

1

15

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

YES
(1)
1
GO
TO
*D26x

NO
(5)

DK
(8)

RF
(9)

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*D26z. During that time, did you have any sudden attacks of intense fear or
panic?

1

5

8

9

*D26aa. Did you often think a lot about death, either your own, someone
else’s, or death in general?

1

5

8

9

*D26bb. During that period, did you ever think that it would be better if you
were dead?

1

5

8

9

1

5

8

9

GO
TO
*D26ff

GO
TO
*D26ff

GO
TO
*D26ff

1

5

8

9

1

5

8

9

*D26ff. Did you feel that you could not cope with your everyday
responsibilities?

1

5

8

9

*D26gg. Did you feel like you wanted to be alone rather than spend time with
friends or relatives?

1

5

8

9

1

5

8

9

1

5

8

9

*D26w. Did you have feelings of extreme guilt nearly every day?

*D26w.1. Did you feel a lot more guilty than you should have nearly every
day?
*D26x. Did you feel irritable, grouchy, or in a bad mood nearly every day?
*D26y. Did you feel nervous or anxious most days?

*D26cc. Did you think about committing suicide?

*D26dd. Did you make a suicide plan?
*D26ee. Did you make a suicide attempt?

*D26hh. Did you feel less talkative than usual?
*D26ii. Were you often in tears?

*D27.

INTERVIEWER CHECKPOINT: (SEE *D24 - *D26ii)
PROGRAMMER: IF AT LEAST ONE ‘1’ RESPONSE IN *D24a- *D24d, INCREMENT COUNT BY ONE.
IF AT LEAST ONE ‘1’ RESPONSE IN *D24e- *D24f, INCREMENT COUNT BY ONE. INCREMENT
COUNT BY ONE FOR EACH ‘1’ RESPONSE IN *D26a - *D26ii.
COUNT EQUALS TWO OR MORE .......................................................1
ALL OTHERS..........................................................................................2

16

GO TO *D87.1

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D28.

You mentioned having (two of the/a number of the) problems I just asked you about. How much did your
(sadness/or/discouragement/or/lack of interest) and these other problems interfere with either your work, your social
life, or your personal relationships during that episode– not at all, a little, some, a lot, or extremely?
NOT AT ALL....................................1
A LITTLE..........................................2
SOME...................................................... 3
A LOT............................................... 4
EXTREMELY ...................................5
DON'T KNOW ..................................8
REFUSED .........................................9

GO TO *D29
GO TO *D29

GO TO *D29

*D28a. How often during that episode were you unable to carry out your daily activities because of your
(sadness/or/discouragement/or/lack of interest) – often, sometimes, rarely, or never?
OFTEN ...............................1
SOMETIMES .....................2
RARELY ............................3
NEVER ...............................4
DON’T KNOW .................8
REFUSED .........................9

*D29. When I use the word “episode” in the next questions, I mean a time lasting (several days/two weeks) or longer
when nearly every day you were (sad/or/discouraged/or/uninterested) and also had some of the other problems
we talked about. The episode ends when you no longer have the problems for two weeks in a row. With this
definition in mind, about how many different episodes did you ever have in your entire life?
NUMBER
DON’T KNOW ............................... 998
REFUSED....................................... 999
*D29a. Episodes of this sort sometimes occur as a result of physical causes such as physical illness or injury or the
use of medication, drugs, or alcohol. Do you think your [IF D29= ‘1’: episode/or/IF D29>1: episodes] of
[IF *D24a EQUALS ‘1’: sadness/ or/ IF *D24c EQUALS: discouragement/ or/ IF *D24e EQUALS ‘1’:
lack of interest] ever occurred as the result of such physical causes?
YES ......................................... 1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO *D29d
GO TO *D29d
GO TO *D29d

*D29b. Do you think your [IF D29= ‘1’: episode was/or/IF D29>1: episodes were] always the result of physical
causes?
YES ......................................... 1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO *D29d
GO TO *D29d
GO TO *D29d

*D29c. Briefly, what do you think the physical cause was?

17

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D29d.

INTERVIEWER CHECKPOINT (SEE *D29)
*D29 EQUALS “1” ..........1
ALL OTHERS .................2

GO TO *D37d

*D37d. Episodes of feeling (sad/or/discouraged/or/uninterested) sometimes occur “out of the blue”, other times they
occur after the death of someone close to you, and other times they occur in response to some stressful
experience. What about (your/the very first time you had an) episode of this sort – did it start out of the blue,
after the death of someone close to you, or did it start in response to some stressful experience that occurred to
you?
OUT OF THE BLUE.......................................................... 1
DEATH OF SOMEONE CLOSE ....................................... 2
RESPONSE TO STRESS ................................................... 3
DON’T KNOW .................................................................. 8
REFUSED .......................................................................... 9

*D37e. INTERVIEWER CHECKPOINT: (SEE *D29)
*D29 EQUALS “1 - 3” ...................1
ALL OTHERS................................ 2

GO TO *D37g

*D37f. As we just mentioned, episodes of feeling (sad/or/discouraged/or/uninterested) sometimes occur “out of the
blue” and other times they occur in response to some stressful experience and sometimes after the death of
someone close to you. Including your first episode, about how many of your lifetime episodes started out of the
blue, about how many episodes started in response to some stressful experience, and about how many episodes
started after the death of someone close to you?
*D37f.1. NUMBER OUT OF THE BLUE DON’T
KNOW
998
REFUSED ..................................... 999
*D37f.2. NUMBER IN RESPONSE TO STRESS DON’T
KNOW
998
REFUSED ..................................... 999
*D37f.3. NUMBER AFTER THE DEATH OF SOMEONE CLOSE TO YOU DON’T
KNOW
998
REFUSED ..................................... 999

*D37g. INTERVIEWER CHECKPOINT: (SEE *D29)
*D29 EQUALS “1” .......................1
ALL OTHERS .............................. 2

GO TO *D38

18

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D38. Think of the past 12 months. During this time, did you have an episode of being
(sad/or/discouraged/or/uninterested) that lasted (several days or longer/two weeks or longer) and included some of the
problems listed on pages 4-5 in your booklet?
YES....................................................1
NO......................................................5
DON’T KNOW .................................8
REFUSED ......................................9

GO TO *D38a

*D38.1. INTERVIEWER CHECKPOINT: (SEE *D29)
*D29 LIFETIME EPISODES EQUALS “1-3” ................ 1
ALL OTHER ...............................
........................... 2

GO TO *D72
GO TO *D38c

*D38a. How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH ............................... 1
2-6 MONTHS AGO ........................ 2
MORE THAN 6 MONTHS AGO...3
DON’T KNOW ............................... 8
REFUSED ....................................... 9
*D38a.1. When I use the word “episode” in the next questions, I mean a time lasting (several days/two weeks) or
longer when nearly every day you were (sad/or/discouraged/or/uninterested) and also had some of the
other problems. The episode ends when you no longer have the problems for two weeks in a row. With
this definition in mind, how many different episodes did you have in the past 12 months?
NUMBER
DON’T KNOW ............................... 998
REFUSED ....................................... 999

*D38a.2. INTERVIEWER CHECKPOINT: (SEE *D38a.1)
*D38a.1 EQUALS ‘1’…………..1
ALL OTHERS………………….2

GO TO *D38a.7

*D38a.3. In what month did that episode start?
/
MONTH

YEAR

DON’T KNOW ............................... 998
REFUSED ....................................... 999

*D38a.5. INTERVIEWER CHECKPOINT: (SEE *D38a)
*D38a EQUALS ‘1’……………..1
ALL OTHERS………………….2 GO TO *D38b

19

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D38a.6. Has this episode ended or is it still going on?
ENDED…………………………………….1
STILL GOING ON………………………...5
DON’T KNOW……………………………..8
REFUSED………………………………….9
GO TO D38b

*D38a.7. How long did the first of these (NUMBER FROM *D38a.1) episodes last?
NUMBER
CIRCLE UNIT OF TIME:

DAYS ...... 1

WEEKS ...... 2

MONTHS ...... 3

DON’T KNOW ............................... 998
REFUSED ....................................... 999

*D38a.8. INTERVIEWER CHECKPOINT: (SEE *D38a)
D38a EQUALS ‘1’……………..1
ALL OTHERS………………….2

GO TO *D38b

*D38a.9. Has the most recent episode ended or is it still going on?
ENDED ....................................... 1
STILL GOING ON ..................... 5
DON’T KNOW ........................... 8
REFUSED ................................... 9

*D38b. About how many days out of the last 365 were you in an episode?
DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999

D38b.1. INTERVIEWER CHECKPOINT: (SEE *D29)
*D29 EQUALS ‘1’.............................1 GO TO *D62.2
*D29 EQUALS ‘2’ or ‘3’...................2 GO TO *D54
ALL OTHERS...................................3 GO TO *D39

*D62.1. INTERVIEWER CHECKPOINT: (SEE *D38)
*D38 EQUALS ‘1’ ............................1
ALL OTHERS...................................2

GO TO *D72

*D62.2. INTERVIEWER CHECKPOINT
20

YEARS ....... 4

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
R CAN READ ...................................1
ALL OTHERS...................................2

GO TO *D64

*D62.3. (RB, PG 6-8) For the next questions I need you to think about the period of (several days/two weeks) or more
during the past 12 months when your (sadness/or/discouragement/or/lack of interest) was most severe and
frequent. Please read each of the fourteen sets of statements on page 6-8 in your booklet and circle the one
response for each of the fourteen that best describes how you were during those (several days/two weeks). As
you finish each set, please tell me the number of the statement you have circled.
GO TO *D64a

*D64.

(RB, PG 6-8) For the next questions I need you to think about the period of (several days/two weeks) or more
during the past 12 months when your (sadness/or/discouragement/or/lack of interest) was most severe and
frequent. I’m going to read fourteen series of statements. Please pick the one statement in each series that
comes closest to your experience during that worst (several days/two weeks).

*D64a. Here’s the first series, which deals with problems falling asleep:
One:
Two:
Three:
Four:

You never took longer than 30 minutes to fall asleep.
You took at least 30 minutes to fall asleep, less than half the time.
You took at least 30 minutes to fall asleep, more than half the time.
You took more than 60 minutes to fall asleep, more than half the time.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)

NUMBER
DON’T KNOW
.............. 998
REFUSED ...................................... 999
*D64b. Here’s the next series, which deals with waking up at night:
One:
Two:
Three:
Four:

You did not wake up at night.
You had a restless, light sleep with few brief awakenings each night.
You woke up at least once a night, but you got back to sleep easily.
You woke up more than once a night and stayed awake for 20 minutes or more, more than half the time.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)

21

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999
*D64c. Here’s the next series, which deals with waking up too early in the morning:
One: Most of the time, you woke up no more than 30 minutes before you needed to get up.
Two: More than half the time, you woke up more than 30 minutes before you needed to get up.
Three: You almost always woke up at least one hour or so before you needed to, but you went back to sleep
eventually.
Four: You woke up at least one hour before you needed to and couldn’t get back to sleep.
(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)

NUMBER
DON’T KNOW
.............. 998
REFUSED ...................................... 999

*D64d. Here’s the next series, which deals with the amount of sleep you got each night:
One:
Two:
Three:
Four:

You slept no longer than 7-8 hours/night, without napping during the day.
You slept no longer than 10 hours in a 24-hour period including naps.
You slept no longer than 12 hours in a 24-hour period including naps.
You slept longer than 12 hours in a 24-hour period including naps.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)

NUMBER
DON’T KNOW
.............. 998
REFUSED ...................................... 999

*D64e. Here’s the next series, which deals with feeling sad:
One:
Two:
Three:
Four:

You did not feel sad.
You felt sad less than half the time.
You felt sad more than half the time.
You felt sad nearly all the time.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)

NUMBER
DON’T KNOW
.............. 998
REFUSED ...................................... 999

22

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*D64f. Here’s the next series, which deals with your ability to concentrate and make decisions:
One:
Two:
Three:
Four:

There was no change in your usual capacity to concentrate or make decisions.
You occasionally felt indecisive or found that your attention wandered.
Most of the time, you struggled to focus your attention or to make decisions.
You couldn’t concentrate well enough to read or you couldn’t make even minor decisions.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*D64g. Here’s the next series, which deals with feeling down on yourself:
One:
Two:
Three:
Four:

You saw yourself as equally worthwhile and deserving as other people.
You were more self-blaming than usual.
You largely believed that you caused problems for others.
You thought almost constantly about major and minor defects in yourself.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*D64h. Here’s the next series, which deals with your interest in daily activities:
One:
Two:
Three:
Four:

There was no change from usual in how interested you were in other people or activities.
You noticed that you were less interested in people or activities.
You found you had interest in only one or two of your formerly pursued activities.
You had virtually no interest in formerly pursued activities.

(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

23

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D64i. Here’s the next series, which deals with your energy:
One: There was no change in your usual level of activity.
Two: You got tired more easily than usual.
Three: You had to make a big effort to start or finish your usual daily activities (for example, shopping,
homework, cooking, or going to work).
Four: You really couldn’t carry out most of your usual daily activities because you just didn’t have the energy.
(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*D64j. Here’s the next series, which deals with a change in your appetite:
One:
Two:
Three:
Four:

There was no change in your usual appetite.
You ate somewhat less often or lesser amounts of food than usual.
You ate much less than usual and only with personal effort.
You rarely ate within a 24-hr period, and only with extreme personal effort or when others persuaded you
to eat.

Five: You felt a need to eat more frequently than usual.
Six:
You regularly ate more often and/or greater amounts of food than usual
Seven: You felt driven to overeat both at mealtime and between meals.

(IF NEC: Which of these seven statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*D64k. Here’s the next series, which deals with changes in your weight:
One:
Two:
Three:
Four:
Five:
Six:
Seven:

You did not have a change in your weight.
You felt as if you had a slight weight loss.
You lost 2 pounds or more.
You lost 5 pounds or more.
You felt as if you had a slight weight gain.
You gained 2 pounds or more.
You gained 5 pounds or more.

(IF NEC: Which of these seven statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D64l. Here’s the next series, which deals with thoughts of death or suicide:
One:
You did not think of suicide or death.
Two:
You felt that life was empty or wondered if it was worth living.
Three: You thought of suicide or death several times a week for several minutes.
Four: You thought of suicide or death several times a day in some detail, or you made specific
plans for suicide or actually tried to take your own life.
(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*D64m.

Here’s the next series, which deals with feeling slowed down:
One:

You thought, spoke, and moved at your usual rate of

speed.
Two:
You found that your thinking was slowed down or your voice sounded dull or flat.
Three: It took you several seconds to respond to most questions, and you’re sure your thinking
was slowed.
Four: You were often unable to respond to questions without extreme effort.
(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999
*D64n. Here’s the last series, which deals with feeling restless:
One:
You did not feel restless.
Two:
You were often fidgety, wringing your hands, or needing to shift how you were sitting.
Three: You had impulses to move about and were quite restless.
Four: At times, you were unable to stay seated and needed to pace around.
(IF NEC: Which of these four statements was most true of you during your worst (several days/two weeks) of
being (sad/or/discouraged/or/uninterested) in the past 12 months?)
NUMBER
DON’T KNOW .............................. 998
REFUSED ...................................... 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

No
Interference
0

*D66.

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

(RB, PG 9) Think about the period lasting one month or longer in the past 12 months when your
(sadness/or/discouragement/or/lack of interest) was most severe. Using the 0 to 10 scale on page 9 of your
booklet, where 0 means no interference and 10 means very severe interference, what number describes how
much your (sadness/or/discouragement/or/lack of interest) interfered with each of the following activities during
that period?
(IF NEC: How much did your (sadness/or/discouragement/or/lack of interest) interfere with (ACTIVITY)
during that period?)
(IF NEC: You can use any number between 0 and 10 to answer.)

NUMBER (0-10)

*D66a.

Your home management, like cleaning,
shopping, and working around the (house/ apartment)
(or yard)?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*D66b.

Your ability to work?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*D66c.

Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*D66d.

Your social life?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*D67.

INTERVIEWER CHECKPOINT: (SEE *D66a - *D66d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’.................................................1
ALL OTHERS..........................................................................................2

26

GO TO *D72

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D68.

About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your (sadness/or/discouragement/or/lack of interest)?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999

*D72.

Did you ever in your life talk to a medical doctor or other professional about your
(sadness/or/discouragement/or/ lack of interest)? (By professional we mean psychologists, counselors, spiritual
advisors, herbalists, acupuncturists, and other healing professionals.)
YES ......................................................... 1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9
*D72a.

GO TO *D87.1
GO TO *D87.1
GO TO *D87.1

How old were you the first time [you talked to a professional about your (sadness/or/
discouragement/or/lack of interest)]?
YEARS OLD
DON’T KNOW ....................... 998
REFUSED................................ 999

*D84.

Did you ever get treatment for your (sadness/or/discouragement/or/lack of interest) that you considered helpful
or effective?
YES ........................................................1
NO ..........................................................5
DON’T KNOW ......................................8
REFUSED ..............................................9

GO TO *D84c
GO TO *D84c
GO TO *D84c

*D84a. How old were you the first time [you got helpful treatment for your (sadness/or/ discouragement/or/lack
of interest)]?
YEARS OLD
DON’T KNOW ............................... 998
REFUSED ....................................... 999
*D84b. How many professionals did you ever talk to about your (sadness/or/discouragement/or/lack of interest),
up to and including the first time you got helpful treatment?
NUMBER OF PROFESSIONALS GO TO *D86
DON’T KNOW...............98
REFUSED.......................99

GO TO *D86
GO TO *D86

*D84c. How many professionals did you ever talk to about your (sadness/or/discouragement/or/lack of
interest)?
NUMBER OF PROFESSIONALS
DON’T KNOW ............................... 98
REFUSED ....................................... 99
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*D86.

Did you receive professional treatment for your (sadness/or/discouragement/or/lack of interest) at any time in the past
12 months?
YES ................................... 1
NO .................................... 5
DON’T KNOW ................. 8
REFUSED......................... 9

*D87. Were you ever hospitalized overnight for your (sadness/or/discouragement/or/lack of interest)?
YES ................................................. 1
NO....................................................5
DON’T KNOW ...............................8
REFUSED .......................................9

GO TO *D87.1
GO TO *D87.1
GO TO *D87.1

*D87a. How old were you the first time [you were hospitalized overnight because of your (sadness/or/
discouragement/or/lack of interest)]?
YEARS OLD
DON’T KNOW.............. 998
REFUSED...................... 999

*D87.1. How many of your close relatives – including your biological parents, brothers, sisters, and children – ever had
episodes of being (sad/or/discouraged/or/uninterested in things) that either caused them a lot of distress or that
interfered with their lives?
NUMBER
DON’T KNOW .............................. 998
REFUSED...................................... 999

IF POSTIVE FOR DEPRESSSION, END SCREENER. IF NEGATIVE, D88.
*D88. INTERVIEWER CHECKPOINT (SEE *SC20, *SC20a, *SC24, *SC25a, *SC26, *SC26a, *SC26b, *SC28,
*SC29.4, *SC30.4): FOLLOW SKIP FOR FIRST ENDORSED ITEM.
*SC26 EQUALS ‘1’........................................................................... GO TO *G1 INTRO 1
*SC26a EQUALS ‘1’......................................................................... GO TO *G1 INTRO 2
*SC26b EQUALS ‘1’ ........................................................................ GO TO *G1 INTRO 3
*SC20 EQUALS ‘1’...........................................................................GO TO *PD1 INTRO 1
*SC20a EQUALS ‘1’......................................................................... GO TO *PD1 INTRO 2
*SC29.4 EQUALS ‘1’........................................................................ GO TO *SO1
*SC30.4 EQUALS ‘1’........................................................................ GO TO *AG1
[IF NONE OF THE ABOVE, GO TO *N1]

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

GENERALIZED ANXIETY DISORDER SECTION (G)
*G1 INTRO 1. (RB, PG 18-19)
Earlier you mentioned having a
time in your life when you were
"a worrier". The next questions
are about that time. Looking at
pages 18-19 in your booklet,
what sorts of things were you
worried or nervous or anxious
about during that time?

*G1 INTRO 2. (RB, PG 18-19)
Earlier you mentioned having a
time in your life when you were
much more nervous or anxious
than most other people. The next
questions are about that time.
Looking at pages 18-19 in your
booklet, what sorts of things were
you nervous or anxious about
during that time?

*G1 INTRO 3. (RB, PG 18-19)
Earlier you mentioned having a
period lasting one month or
longer when you were anxious or
worried most days. The next
questions are about that time.
Looking at pages 18-19 in your
booklet, what sorts of things were
you anxious or worried about
during that time?

PROBE FOR UP TO THREE EXAMPLES: Anything else [that made you (worried or anxious/nervous or anxious/anxious or
worried)]?
CIRCLE ALL MENTIONS.
DIFFUSE WORRIES
EVERYTHING ........................................................................................................................................... 1
NOTHING IN PARTICULAR ................................................................................................................... 2
PERSONAL PROBLEMS
FINANCES ................................................................................................................................................. 3
SUCCESS AT SCHOOL OR WORK........................................................................................................ 4
SOCIAL LIFE ............................................................................................................................................. 5
LOVE LIFE ................................................................................................................................................. 6
RELATIONSHIPS AT SCHOOL OR WORK .......................................................................................... 7
RELATIONSHIPS WITH FAMILY .......................................................................................................... 8
PHYSICAL APPEARANCE ...................................................................................................................... 9
PHYSICAL HEALTH .................................................................................................................................10
MENTAL HEALTH ................................................................................................................................... 11
SUBSTANCE USE ..................................................................................................................................... 12
OTHER PERSONAL PROBLEMS (SPECIFY) ........................................................................................13
PHOBIC AND OBSESSIVE-COMPULSIVE SITUATIONS
SOCIAL PHOBIAS (E.G., MEETING PEOPLE AFTER MOVING TO A NEW TOWN). ...................14
AGORAPHOBIA (E.G., LEAVING HOME ALONE AFTER A DIVORCE)........................................ 15
SPECIFIC PHOBIAS (E.G., FEARS OF BUGS, HEIGHTS, OR CLOSED SPACES) ...........................16
OBSESSIONS (E.G., WORRY ABOUT GERMS) ...................................................................................17
COMPULSIONS (E.G., REPETITIVE HANDWASHING)…………………………………………...18
NETWORK PROBLEMS
BEING AWAY FROM HOME OR APART FROM LOVED ONES.......................................................19
THE HEALTH OR WELFARE OF LOVED ONES - FIRST MENTION ...............................................20
THE HEALTH OR WELFARE OF LOVED ONES - SECOND MENTION ......................................... 21
THE HEALTH OR WELFARE OF LOVED ONES - THIRD MENTION ..............................................22
OTHER NETWORK PROBLEMS (SPECIFY).........................................................................................23
SOCIETAL PROBLEMS
CRIME / VIOLENCE ..................................................................................................................................24
THE ECONOMY .........................................................................................................................................25
THE ENVIRONMENT (E.G., GLOBAL WARMING, POLLUTION) ....................................................26
MORAL DECLINE OF SOCIETY (E.G., COMMERCIALISM, DECLINE OF THE FAMILY)..........27
WAR / REVOLUTION ...............................................................................................................................28
OTHER SOCIETAL PROBLEMS (SPECIFY) .........................................................................................29
OTHER PROBLEMS (SPECIFY)
FIRST (SPECIFY) ..................................................................................................................................... 30
SECOND (SPECIFY) ................................................................................................................................ 31

29

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
THIRD (SPECIFY) ............................................................................................................................ 32

30

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*G3.

Do you think your (worry or anxiety/nervousness or anxiety/anxiety or worry) was ever excessive or unreasonable or a
lot stronger than it should have been?
YES .....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

*G4.

How often did you find it difficult to control your (worry or anxiety/nerves or anxiety/anxiety or worry) -- often,
sometimes, rarely, or never?
OFTEN................................1
SOMETIMES .................... 2
RARELY ........................... 3
NEVER .............................. 4
DON’T KNOW ................. 8
REFUSED ........................ 9
*G4a.

How often were you so nervous or worried that you could not think about anything else, no matter how hard
you tried -- often, sometimes, rarely, or never?
OFTEN ...................................... 1
SOMETIMES ............................ 2
RARELY ................................... 3
NEVER ...................................... 4
DON’T KNOW ......................... 8
REFUSED ............................... 9

*G5.

What is the longest period of months or years in a row you ever had when you were (worried or anxious/nervous or
anxious/anxious or worried) most days?
IF VOL “WHOLE LIFE” OR “AS LONG AS I CAN REMEMBER,”
DON’T KNOW OR REFUSED – GO TO *G5.1

CODE 995 YEARS GO TO *G6

NUMBER
*G5.TUnit.
CIRCLE UNIT OF TIME:
DAYS…1
WEEKS…2

*G5.1.

MONTHS…3

YEARS…4

GO TO *G6

Did you ever have a time lasting 6 months or longer?
YES.....................................1 GO TO *G6
NO .......................................5
DON’T KNOW ..................8
REFUSED ..........................9 GO TO *G6

*G5.2. Did you ever have a time lasting 1 month or longer?
YES ..........................1
NO............................5
DON’T KNOW ...... 8
REFUSED. .............. 9

31

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G6.

INTERVIEWER CHECKPOINT: (SEE *G5, *G5.1, *G5.2)
(G5 EQUALS 1-5 MONTHS) OR (G5.2 EQUALS ‘1’) ...........................................2 GO TO *G7
(G5 EQUALS 6 MONTHS OR LONGER OR ‘995’) OR (G5.1 EQUALS ‘1’) ......3 GO TO *G8
ALL OTHERS ............................................................................................................1 GO TO *IED1, NEXT SECTION

*G7.

INTERVIEWER INSTRUCTION: ASK ABOUT “PERIODS LASTING ONE MONTH OR LONGER” FOR THE
REMAINDER OF THE SECTION GO TO *G9

*G8.

INTERVIEWER INSTRUCTION: ASK ABOUT “PERIODS LASTING SIX MONTHS OR LONGER” FOR THE
REMAINDER OF THE SECTION GO TO *G9

32

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*G9.

Think of your worst period lasting (one month / six months) or longer
when you were (worried or anxious/nervous or anxious/anxious or
worried): During that episode, did you often have any of the following
associated problems:

YES
(1)

NO
(5)

DK
(8)

RF
(9)

*G9a. Did you often feel restless, keyed up, or on edge?

1

5

8

9

*G9b. Did you often get tired easily?

1

5

8

9

*G9c. Were you often more irritable than usual?

1

5

8

9

*G9d. Did you often have difficulty concentrating or keeping your mind
on what you were doing?

1

5

8

9

*G9e. Did you often have tense, sore, or aching muscles?

1

5

8

9

*G9f. Did you often have trouble falling or staying asleep?

1

5

8

9

YES
(1)

NO
(5)

DK
(8)

RF
(9)

*G10a. Did your heart often pound or race?

1

5

8

9

*G10b. Did you often sweat?

1

5

8

9

*G10c. Did you often tremble or shake?

1

5

8

9

*G10d. Did you often have a dry mouth?

1

5

8

9

*G10e. Were you sad or depressed most of the time?

1

5

8

9

*G10.

*G11.

INTERVIEWER CHECKPOINT: (SEE*G9, *G10)
ZERO RESPONSES CODED ‘1’ IN *G9 AND *G10 SERIES...............................1 GO TO *IED1, NEXT SECTION
ZERO RESPONSES CODED ‘1’ IN *G10 SERIES.................................................2 GO TO *G12
FOUR OR MORE RESPONSES CODED ‘1’ IN *G9 AND *G10 SERIES...........3 GO TO *G15
ALL OTHERS..............................................................................................................4 GO TO *G13

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G12.

INTERVIEWER CHECKPOINT: (SEE *G9a-g)
TWO OR MORE RESPONSES CODED ‘1’ IN *G9 SERIES.......... 1
ALL OTHERS....................................................................................... 2

*G13.

GO TO *G15
GO TO *IED1, NEXT SECTION

INTERVIEWER QUERY: TOTAL NUMBER RESPONSES
CODED ‘1’ IN *G9 SERIES IS
CODED ‘1’ IN *G10 SERIES IS

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1
GO TO
*G13g

5

8

9

1

5

8

9

1
GO TO
*G13i.

5

8

9

1

5

8

9

1
GO TO
*G13k

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

GO TO *G15 AS SOON AS FIVE RESPONSES CODED ‘1’
IN *G9, G10, G13 SERIES
*G13a. Did you often feel dizzy or lightheaded?
*G13b. Were you often short of breath?
*G13c. Did you often feel like you were choking?
*G13d. Did you often have pain or discomfort in your chest?
*G13e. Did you often have pain or discomfort in your stomach?

*G13f. Did you often have nausea?
*G13g. Did you often feel that you were unreal?

*G13h. Did you often feel that things around you were unreal?
*G13i. Were you often afraid that you might lose control or go crazy?

*G13j. Were you often afraid that you might pass out?
*G13k. Were you often afraid that you might die?
*G13l. Did you often have hot flushes or chills?
*G13m. Did you often have numbness or tingling sensations?
*G13n. Did you often feel like you had a lump in your throat?
*G13o. Were you easily startled?

34

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G14.

INTERVIEWER CHECKPOINT: (SEE *G9, *G10, *G13)
TWO OR MORE RESPONSES CODED ‘1’ IN *G9 SERIES....................................1
THREE OR MORE RESPONSES CODED ‘1’ IN *G9, 10, 13 SERIES ..................2
ALL OTHERS ....................................................................................................... 3

*G15.

GO TO *IED1, NEXT SECTION

How much emotional distress did you ever experience because of your (worry or anxiety/nervousness or anxiety/anxiety
or worry) – no distress, mild distress, moderate distress, severe distress, or very severe distress?
NO.......................................1
MILD ..................................2
MODERATE ......................3
SEVERE .............................4
VERY SEVERE .................5
DON’T KNOW ..................8
REFUSED ..........................9

*G17.

How much did your (worry or anxiety/nervousness or anxiety/anxiety or worry) ever interfere with either your work,
your social life, or your personal relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL.....................1
A LITTLE...........................2
SOME......................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO *G17.1
GO TO *G17.1

GO TO *G17.1

*G17a. How often were you unable to carry out your daily activities because of your (worry or
anxiety/nervousness or anxiety/anxiety or worry) -- often, sometimes, rarely, or never?
OFTEN ...............................1
SOMETIMES .....................2
RARELY................................ 3
NEVER ...............................4
DON’T KNOW ..................8
REFUSED .............................. 9

*G17.1. INTERVIEWER CHECKPOINT: (SEE *G15, *G17)
*G15 EQUALS ‘3’, ‘4’, OR ‘5’ OR *G17 EQUALS ‘3’, ‘4’, OR ‘5’................... 1
ALL OTHERS..............................................................................................................2

GO TO *IED1, NEXT SECTION

35

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G18a. (Worry and anxiety/Nervousness and anxiety/Anxiety and worry) sometimes occur as a result of physical
causes such as physical illness or injury or the use of medication, drugs, or alcohol. Do you think your (worry
or anxiety/nervousness or anxiety/anxiety or worry) ever occurred as the result of such physical causes?
YES ....................................................... 1
NO ......................................................... 5
DON’T KNOW ..................................... 8
REFUSED ............................................. 9

GO TO *G26
GO TO *G26
GO TO *G26

*G18b. Do you think your (worry and anxiety/nervousness and anxiety/anxiety and worry) were always the
result of physical causes?
YES........................................................ 1
NO ......................................................... 5
DON’T KNOW...................................... 8
REFUSED ............................................. 9
*G18c. Briefly, what do you think the physical cause was?

*G26.

Think of the very first time in your life you had an episode lasting (one month / six months) or longer when (you were
worried or anxious most days/you were nervous or anxious most days/you were anxious or worried most days) and also
had some of the other problems we just reviewed. Can you remember your exact age?
YES ....................................................1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9

GO TO *G26b
GO TO *G26b
GO TO *G26b

*G26a. (IF NEC: How old were you?)
AGE

GO TO *G26c

DON’T KNOW ..................998
REFUSED ..........................999
*G26b. About how old were you?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL ......................4
BEFORE TEENAGER.................................... 12
NOT BEFORE TEENAGER .......................... 13
WHOLE LIFE OR DON’T KNOW................ 998
REFUSED .................................................... 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G26c. Was that episode brought on by some stressful experience? Or did it happen out of the blue?
BROUGHT ON BY STRESS ...............................1
OUT OF THE BLUE ............................................2
DON’T REMEMBER...........................................3
DON’T KNOW ....................................................8
REFUSED ............................................................9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G27.

Did you have an episode of being (worried or anxious/nervous or anxious/anxious or worried), lasting at least one month
or longer, in the past 12 months?
YES .....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO *G27c
GO TO *G27c
GO TO *G27c

*G27a. How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH.................................................1
2-6 MONTHS AGO .........................................2
MORE THAN 6 MONTHS .............................3
DON’T KNOW ................................................8
REFUSED ........................................................9
*G27a.1 When I use the word “episode” in the next questions, I mean a time lasting one month or longer when nearly every
day you were (worried or anxious/nervous or anxious/anxious or worried) and also had some of the other problems we
just reviewed). The episode ends when you no longer have these feelings for a full month. With this definition in
mind, how many different episodes did you have in the past 12 months?
NUMBER
DON’T KNOW ............................... 998
REFUSED ....................................... 999

*G27a.2. INTERVEIWER CHECKPOINT: (SEE *G27a.1)
*G27a.1 EQUALS ‘1’ ........................................................................... 1
ALL OTHERS ....................................................................................... 2

GO TO *G27a.3
GO TO *G27a.7

*G27a.3. In which month did that episode start?
/
MONTH

YEAR

DON’T KNOW ............................. 998
REFUSED ..................................... 999
*G27a.4. How long did that episode last (IF *G27a EQUALS ‘1’: so far)?
NUMBER
CIRCLE UNIT OF TIME:

DAYS ......... 1

WEEKS....... 2

MONTHS ..... 3

YEARS ......... 4

DON’T KNOW ............................. 998
REFUSED ..................................... 999

*G27a.5. INTERVIEWER CHECKPOINT (SEE *G27a):
*G27a EQUALS ‘1’ .............................................................................. 1
ALL OTHERS ....................................................................................... 2

GO TO *G28

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G27a.6. Has this episode ended or is it still going on?
ENDED .................................................................................................. 1
STILL GOING ON ................................................................................ 2
DON’T KNOW ...................................................................................... 8
REFUSED .............................................................................................. 9
GO TO *G28

*G27a.7. How long did the first of these (NUMBER FROM *G27a.1) episodes last?
NUMBER
CIRCLE UNIT OF TIME:

DAYS...... 1

WEEKS....... 2

MONTHS ..... 3

YEARS ......... 4

DON’T KNOW ............................. 998
REFUSED ..................................... 999

*G27a.8. INTERVIEWER CHECKPOINT (SEE *G27a):
*G27a EQUALS ‘1’ ................................................................................ 1
ALL OTHERS ......................................................................................... 2

GO TO *G27b

*G27a.9. Has the most recent episode ended or is it still going on?
ENDED .................................................................................................. 1
STILL GOING ON ................................................................................ 2
DON’T KNOW ...................................................................................... 8
REFUSED .............................................................................................. 9

*G27b. How many months in the past 12 months were you in an episode of this sort?
MONTHS
DON’T KNOW
.........................98
REFUSED .........................................99
GO TO *G28
*G27c. How old were you the last time you had one of these episodes?
YEARS OLD
DON’T KNOW 998
REFUSED .........................................999

*G28.

How many episodes of (worry or anxiety/nervousness or anxiety/anxiety or worry) lasting one month or longer have you
ever had in your life?
NUMBER
DON’T KNOW ................................ 998
REFUSED ...................................... 999

39

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G29.

INTERVIEWER CHECKPOINT: (SEE *G28)
*G28 EQUALS ‘1’................................................ 1
ALL OTHERS ....................................................... 2

*G30.

GO TO *G31

How long did that episode last?
IF STILL GOING ON: How long did it last so far?
NUMBER

GO TO *G35

CIRCLE UNIT OF TIME:

DAYS ...... 1

DON’T KNOW .................................98
REFUSED .........................................99

*G31.

WEEKS ....... 2

MONTHS ..... 3

YEARS ........ 4

MONTHS ..... 3

YEARS ......... 4

GO TO *G35
GO TO *G35

How long did the longest of these episodes last?
NUMBER
CIRCLE UNIT OF TIME:

DAYS...... 1

WEEKS....... 2

DON’T KNOW ................................ 98
REFUSED ...................................... 99

*G31.1. How many of these episodes were brought on by some stressful experience?
NUMBER
DON’T KNOW .................................998
REFUSED ...................................... 999

*G32.

How many different years in your life did you have at least one episode?
YEARS
DON’T KNOW .................................998
REFUSED ...................................... 999

*G33.

INTERVIEWER CHECKPOINT: (SEE *G32)
*G32 EQUALS ‘1’ ...........................1
ALL OTHERS ...................................2

*G34.

GO TO *G35

What is the longest continuous number of years in a row in which you had at least one episode per year?
YEARS
DON’T KNOW .................................998
REFUSED .........................................999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G35.

INTERVIEWER CHECKPOINT: (SEE *G27)
*G27 EQUALS ‘1’.............1
ALL OTHERS....................2

*G36.

GO TO *G44

For the next questions, think of the period lasting a month or longer in the past 12 months when your (worry or
anxiety/nervousness or anxiety/anxiety or worry) was most severe and frequent. During that period, how often did you
have each of the following feelings?
(IF NEC: often, sometimes, occasionally, or never?)

*G36a. How often did you feel tense
and wound up – often,
sometimes, occasionally, or
never?
*G36b. How often during that period
did you get a sort of frightened
feeling like butterflies in the
stomach?
*G36c. How often did you feel restless
as if you had to be on the
move?
*G36d. How often did you get sudden
feelings of panic?
*G36e. How often did you have
worrying thoughts go through
your mind?
*G36f. How often could you sit at ease
and feel relaxed?
*G36g. How often did you get a
frightened feeling as if
something awful was about to
happen?

*G37.

OFTEN
(1)

SOME
(2)

OCCASION
(3)

NEVER
(4)

DK
(8)

RF
(9)

1

2

3

4

8

9

1

2

3

4

8

9

1

2

3

4

8

9

1

2

3

4

8

9

1

2

3

4

8

9

1

2

3

4

8

9

1

2

3

4
GO TO
*G38

8
GO TO
*G38

9
GO TO
*G38

Did this frightened feeling worry you badly, not badly, or not at all?
BADLY...............................1
NOT BADLY .....................2
NOT AT ALL .....................3
DON’T KNOW ................. 8
REFUSED ........................ 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

No
Interference
0
*G38.

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

(RB, PG 9) Think about the month or longer in the past 12 when your (worry or anxiety/ nervousness or anxiety/
anxiety or worry) was most severe. Using the 0 to 10 scale on page 9 of your booklet, where 0 means no interference
and 10 means very severe interference, what number describes how much your (worry or anxiety/ nervousness or
anxiety/ anxiety or worry) interfered with each of the following activities during that time?
(IF NEC: How much did your (worry or anxiety/ nervousness or anxiety/ anxiety or worry) interfere with
(ACTIVITY) during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)
NUMBER (0-10)

*G38a.

Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY .............. 97
DON’T KNOW ..................... 98
REFUSED ............................. 99

*G38b.

Your ability to work?
DOES NOT APPLY .............. 97
DON’T KNOW ..................... 98
REFUSED ............................. 99

*G38c.

Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY .............. 97
DON’T KNOW ..................... 98
REFUSED ............................. 99

*G38d.

Your social life?
DOES NOT APPLY .............. 97
DON’T KNOW ..................... 98
REFUSED ............................. 99

*G39.

INTERVIEWER CHECKPOINT: (SEE *G38a - *G38d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’ ............ 1
ALL OTHERS ..................................................... 2

GO TO *G44

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G40.

About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your (worry or anxiety/ nervousness or anxiety/ anxiety or worry)?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW .................998
REFUSED .........................999

*G44.

Did you ever in your life talk to a medical doctor or other professional about your (worry or anxiety/ nervousness or
anxiety/ anxiety or worry)? (By professional we mean psychologists, counselors, spiritual advisors, herbalists,
acupuncturists, and other healing professionals.)
YES ......................................................... 1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9
*G44a.

GO TO *G59.1
GO TO *G59.1
GO TO *G59.1

How old were you the first time [you talked to a professional about your (worry or anxiety/ nervousness or
anxiety/ anxiety or worry)]?
YEARS OLD
DON’T KNOW...................... 998
REFUSED .............................. 999

G56.

Did you ever get treatment for your (worry or anxiety/ nervousness or anxiety/ anxiety or worry) that you considered
helpful or effective?
YES ...................................1
NO ....................................5
DON’T KNOW.................8
REFUSED.........................9

GO TO *G56c
GO TO *G56c
GO TO *G56c

*G56a. How old were you the first time [you got helpful treatment for your (worry or anxiety/ nervousness or
anxiety/ anxiety or worry)]?
YEARS OLD
DON’T KNOW ................ 998
REFUSED ........................ 999

*G56b. How many professionals did you ever talk to about your (worry or anxiety/ nervousness or anxiety/
anxiety or worry), up to and including the first time you got helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW............. 98
REFUSED..................... 99

GO TO *G58

GO TO *G58
GO TO *G58

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*G56c. How many professionals did you ever talk to about your (worry or anxiety/ nervousness or
anxiety/ anxiety or worry)?
NUMBER OF PROFESSIONALS
DON’T KNOW ............. 98
REFUSED ..................... 99

*G58.

Did you receive professional treatment for your (worry or anxiety/ nervousness or anxiety/ anxiety or worry)
at any time in the past 12 months?
YES ................................... 1
NO..................................... 5
DON’T KNOW ................. 8
REFUSED ......................... 9

*G59. Were you ever hospitalized overnight for your (worry or anxiety/ nervousness or anxiety/ anxiety or worry)?
YES ..................................................... 1
NO .......................................................5
DON’T KNOW...................................8
REFUSED ...........................................9

GO TO *G59.1
GO TO *G59.1
GO TO *G59.1

*G59a. How old were you the first time [you were hospitalized overnight because of your (worry or
anxiety/ nervousness or anxiety/ anxiety or worry)]?
YEARS OLD
DON’T KNOW ............... 998
REFUSED ....................... 999

*G59.1. How many of your close relatives – including your biological parents, brothers and sisters, and children – were
very nervous or anxious people?
NUMBER
DON’T KNOW ................. 998
REFUSED ......................... 999

*SC20 EQUALS ‘1’...........................................................................GO TO *PD1 INTRO 1
*SC20a EQUALS ‘1’......................................................................... GO TO *PD1 INTRO 2
*SC29.4 EQUALS ‘1’........................................................................ GO TO *SO1
*SC30.4 EQUALS ‘1’........................................................................ GO TO *AG1
[IF NONE OF THE ABOVE, GO TO *N1]

PANIC DISORDER (PD)

44

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PD1. INTRO 1
Earlier you mentioned having attacks of fear or panic
when all of a sudden you felt very frightened, anxious,
or uneasy. Think of a bad attack like that. During that
attack, which of the following problems did you have?

*PD1. INTRO 2
Earlier you mentioned having attacks when all of a sudden
you had several problems like being short of breath, your
heart pounding or feeling dizzy, and being afraid you would
die or go crazy. Think of a bad attack like that. During that
attack, which of the following problems did you have?

SKIP TO *PD2 AFTER SIX “YES” RESPONSES

YES
(1)

NO
(5)

DK
(8)

RF
(9)

*PD1a.

Did your heart pound or race? (KEY PHRASE: heart racing)

1

5

8

9

*PD1b.

Were you short of breath? (KEY PHRASE: being short of breath)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1
GO TO
*PD1m

5

8

9

1

5

8

9

1

5

8

9

*PD1n.
Were you afraid that you might die?
(KEY PHRASE: fearing that you might die)

1

5

8

9

*PD1o.
flushes)

1

5

8

9

1

5

8

9

*PD1c.
Did you have nausea or discomfort in your stomach?
(KEY PHRASE: having nausea)
*PD1d.
Did you feel dizzy or faint? (KEY PHRASE: feeling dizzy)
*PD1e.

Did you sweat? (KEY PHRASE: sweating)

*PD1f.

Did you tremble or shake? (KEY PHRASE: trembling)

*PD1g.

Did you have a dry mouth? (KEY PHRASE: having a dry mouth)

*PD1h.

Did you feel like you were choking? (KEY PHRASE: choking)

*PD1i.
Did you have pain or discomfort in your chest?
(KEY PHRASE: having discomfort in your chest)
*PD1j.
Were you afraid that you might lose control of yourself or go
crazy? (KEY PHRASE: fearing that you might lose control of yourself)
*PD1k.
Did you feel that you were “not really there”, like you were
watching a movie of yourself?
(KEY PHRASE: feeling unreal)
*PD1l.
Did you feel that things around you were unreal or like a dream?
(KEY PHRASE: feeling that things around you were unreal)
*PD1m.
Were you afraid that you might pass out?
(KEY PHRASE: fearing that you might pass out)

Did you have hot flushes or chills? (KEY PHRASE: having hot

*PD1p.
Did you have numbness or tingling sensations?
(KEY PHRASE: having numbness)

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD2.

INTERVIEWER CHECKPOINT: (SEE *PD1 SERIES)

ZERO TO THREE RESPONSES CODED ‘1’ ......................1
ALL OTHERS ......................................................................................... 2

GO TO *PD66

*PD3.
During your attacks did the problems like (PARENTHETICAL PHRASE OF FIRST THREE YES
RESPONSES IN *PD1 SERIES) begin suddenly and reach their peak within ten minutes after the attacks began?
(IF NEC: Did they begin within ten minutes after the start of the attack?) YES
(IF VOL) SOMETIMES ...................................3
NO ...................................................5
GO TO *PD66
DON’T KNOW ...............................8
GO TO *PD66
REFUSED .......................................9
GO TO *PD66

*PD4.

1

About how many of these sudden attacks have you had in your entire lifetime?

NUMBER OF ATTACKS
IF R REPORTS MORE THAN 900 ........................................................... 900
IF R REPORTS “MORE THAN I CAN REMEMBER” ............................ 995
DON’T KNOW .......................................................................................... 998
REFUSED .................................................................................................. 999

*PD5.

INTERVIEWER CHECKPOINT: (SEE *PD4)

*PD4 EQUALS ‘1’ ........................................................ 1
ALL OTHERS...............................................2

GO TO *PD9

*PD6.
When did the attack occur – in the past month, two to six months ago, seven to twelve months ago, or more
than twelve months ago?
PAST MONTH .............................................1 GO TO *PD8 TWO TO
SIX MONTHS ..............................2 GO TO *PD8 SEVEN TO TWELVE
MONTHS ................3 GO TO *PD8
MORE THAN TWELVE MONTHS.............................. 4
DON’T KNOW .............................................................. 8
REFUSED ...................................................................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD7.

Can you remember your exact age when the attack occurred?

YES ................................................... 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *PD7b
GO TO *PD7b
GO TO *PD7b

*PD7a. (IF NEC: How old were you?)
YEARS OLD

GO TO *PD8

DON’T KNOW ...................................................998
REFUSED ...........................................................999
*PD7b. About how old were you?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL .......................................................4
BEFORE TEENAGER .................................................................... 12
NOT BEFORE TEENAGER ........................................................... 13
WHOLE LIFE OR DON’T KNOW .................................................998
REFUSED ................................................................................... 999

*PD8.
Attacks of this sort can occur in three different situations. The first are when the attacks occur
unexpectedly “out of the blue.” The second are when a person has an unreasonably strong fear. For example, some
people have a terrible fear of bugs or of heights or of being in a crowd. The third are when a person is in real danger,
like a car accident or a bank robbery.
Which of these three describes your attack – did it occur unexpectedly “out of the blue,” in a situation that you
strongly fear, or in a situation of real danger?
IF R THOUGHT THERE WAS REAL DANGER EVEN THOUGH IT TURNED OUT NOT TO BE DANGEROUS,
CODE “REAL DANGER.”
OUT OF THE BLUE...................................................... 1
STRONG FEAR ............................................................. 2
REAL DANGER ............................................................ 3
DON’T KNOW .............................................................. 8
REFUSED ...................................................................... 9
GO TO *PD66

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD9. Can you remember your exact age the very first time you had one of these attacks?
YES ................................................... 1
NO ....................................... 5
DON’T KNOW.................... 8
REFUSED............................ 9
*PD9a.

GO TO *PD9b
GO TO *PD9b
GO TO *PD9b

(IF NEC: How old were you?)
YEARS OLD

GO TO *PD10

DON’T KNOW .............................................................. 998
REFUSED ...................................................................... 999
*PD9b. About how old were you?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL ......................................................................4
BEFORE TEENAGER ................................................................................... 12
NOT BEFORE TEENAGER ...........................................................................13
WHOLE LIFE OR DON’T KNOW ............................................................... 998
REFUSED ................................................................................................. 999

*PD10. Did you have one of these attacks at any time in the past 12 months?
YES ................................................... 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *PD10d
GO TO *PD10d
GO TO *PD11

*PD10a. How recently – in the past month, between two and six months ago, or more than six months ago?
PAST MONTH........................................................................................... 1
BETWEEN TWO AND SIX MONTHS AGO ........................................... 2
MORE THAN SIX MONTHS AGO .......................................................... 3
DON'T KNOW ........................................................................................... 8
REFUSED .................................................................................................. 9
*PD10b. How many weeks in the past 12 months did you have at least one attack?
NUMBER
DON’T KNOW ...................................................98
REFUSED ...........................................................99

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD10c. And how many attacks in all did you have in the past 12 months?
NUMBER GO TO *PD11
DON’T KNOW ..............98
REFUSED ......................99

GO TO *PD11
GO TO *PD11

*PD10d. How old were you the last time you had one of these attacks?
YEARS OLD
DON’T KNOW .....................................................998
REFUSED .............................................................999

*PD11. What is the largest number of attacks you ever had in any single year of your life?
NUMBER OF ATTACKS
DON’T KNOW
998
REFUSED .......................................... 999

*PD12. About how many separate years in your life did you have at least one attack?
YEARS
DON’T KNOW ..................................... 998
REFUSED .......................................... 999
*PD13. After having one of these attacks, did you ever have any of the following
experiences:

*PD13a. A month or more when you often worried that you might have another
attack?

*PD13b. A month or more when you worried that something terrible might
happen because of the attacks, like having a car accident, having a heart attack, or
losing control?

*PD13c. A month or more when you changed your everyday activities because of
the attacks?

PD13d. A month or more when you avoided certain situations because of fear
about having another attack?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO
*PD14

5

8

9

1
GO TO
*PD14

5

8

9

1
GO TO
*PD14

5

8

9

1
GO TO
*PD14

5

8

9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD14. INTERVIEWER CHECKPOINT: (SEE *PD13a-d)
AT LEAST ONE RESPONSE CODED ‘1’ ............................................... 1
ALL OTHERS........................................................................... 2

GO TO *PD17

*PD15. How old were you the first time you had a month when you either often worried, changed your everyday
activities, or avoided certain situations because of the attacks?
YEARS OLD
DON’T KNOW
998
REFUSED ......................................... 999

*PD16.

Did you have a month of worry or change in activity like that in the past 12 months?

YES ................................................... 1
NO ................................ 5 GO TO *PD16e DON’T
KNOW ............ 8 GO TO *PD16e REFUSED ....................
9 GO TO *PD16e
*PD16a.
ago?

How recently – in the past month, between two and six months ago, or more than six months

PAST MONTH........................................................ 1
BETWEEN TWO AND SIX MONTHS.................. 2
MORE THAN SIX MONTHS ................................ 3
DON’T KNOW ....................................................... 8
REFUSED ............................................................... 9
*PD16b. How many months of worry or change in activity did you have in the past 12 months?
NUMBER OF MONTHS
DON’T KNOW .................................................. 98
REFUSED .......................................................99
*PD16c. During the time in the past 12 months when your worry about having another attack was most frequent
and severe, did you worry nearly all the time, most of the time, often, sometimes, or only rarely?
NEARLY ALL THE TIME .............................................................................1
MOST OF THE TIME .....................................................................................2
OFTEN ............................................................................................................ 3
SOMETIMES ...................................................................................................4
ONLY RARELY ..............................................................................................5
DON’T KNOW ............................................................................................... 8
REFUSED ................................................................................................. 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD16d. And how severe was the worry during this time -- mild, moderate, severe, or so severe that you were
unable to carry out important tasks?
MILD ................................................................................................................1
MODERATE ....................................................................................................2
SEVERE ....................................................................................................................... 3
SO SEVERE .....................................................................................................4
DON’T KNOW ................................................................................................8
REFUSED ................................................................................................. 9
GO TO *PD17
*PD16e. About how old were you the last time you had a month like this when you worried about having another
attack?
YEARS OLD
DON’T KNOW ...................................................998
REFUSED ...........................................................999

*PD17. Attacks of this sort can occur in three different situations. The first is when the attacks occur unexpectedly
“out of the blue.” The second is when a person has an unreasonably strong fear. For example, some people have a
terrible fear of bugs or of heights or of being in a crowd. The third is when a person is in real danger, like a car
accident or a bank robbery.
The next question is about how many of your attacks occurred in each of these three kinds of situations. Did you
ever have an attack that occurred unexpectedly “out of the blue?”
YES ..................................................................1
NO ...................................................5
DON’T KNOW ...............................8
REFUSED .......................................9
*PD17a.

GO TO *PD18
GO TO *PD18
GO TO *PD18

About how many attacks in your lifetime occurred unexpectedly “out of the blue?”
NUMBER OF ATTACKS

IF R REPORTS MORE THAN 900 ..........................................................................900
IF R REPORTS “MORE THAN I CAN REMEMBER” .............................................995
DON’T KNOW ......................................................................................................... 998
REFUSED ................................................................................................................. 999

*PD18. About how many attacks in your lifetime occurred in situations where you were not in real danger, but
where you had an unreasonably strong fear of the situations?
NUMBER OF ATTACKS
IF R REPORTS MORE THAN 900 ........................................................... 900
IF R REPORTS “MORE THAN I CAN REMEMBER” ............................ 995
DON’T KNOW .......................................................................................... 998
REFUSED .................................................................................................. 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD19. About how many attacks in your lifetime occurred in situations where you were in real danger?
IF R THOUGHT THERE WAS REAL DANGER EVEN THOUGH IT TURNED OUT NOT TO BE
DANGEROUS CODE “REAL DANGER.”
NUMBER OF ATTACKS

IF R REPORTS MORE THAN 900 ........................................................... 900
IF R REPORTS “MORE THAN I CAN REMEMBER” ............................ 995
DON’T KNOW .......................................................................................... 998
REFUSED .................................................................................................. 999

*PD20. INTERVIEWER CHECKPOINT: (SEE *PD17)
*PD17 EQUALS ‘1’ ........................................1
ALL OTHERS.................................2

GO TO *PD66

*PD20a.INTERVIEWER CHECKPOINT: (SEE *PD18 - *PD19)
*PD18 EQUALS ‘0’ AND *PD19 EQUALS ‘0’ ....................................1
ALL OTHERS ...........................................................................................................2

GO TO *PD22

*PD21. How old were you (when you had the attack/the first time you had an attack) “out of the blue” for no
obvious reason?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL .......................................................4
BEFORE TEENAGER .................................................................... 12
NOT BEFORE TEENAGER ............................................................13
WHOLE LIFE OR DON’T KNOW ................................................ 998
REFUSED ................................................................................... 999

*PD22. How much did (this/these) unexpected “out of the blue” attack(s) or worry about having another attack ever
interfere with either your work, your social life, or your personal relationships – not at all, a little, some, a lot, or
extremely?
NOT AT ALL................................................1
A LITTLE .....................................................2
SOME ............................................................................. 3
A LOT ............................................................................ 4
EXTREMELY ................................................................ 5
DON’T KNOW .............................................................. 8
REFUSED .....................................................9

GO TO *PD23
GO TO *PD23

GO TO *PD23

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD22a. How often during that time were you unable to carry out your daily activities or to take care of yourself
because of this/these unexpected “out of the blue” attacks(s) or worry about having another attack – often,
sometimes, not very often, or never?
OFTEN ......................................................................................... 1
SOMETIMES ............................................................................... 2
NOT VERY OFTEN .................................................................... 3
NEVER......................................................................................... 4
DON’T KNOW ............................................................................ 8
REFUSED .................................................................................... 9

*PD23. INTERVIEWER CHECKPOINT: (SEE *PD17a)
*PD17A EQUALS ‘1’....................................................................... 1
ALL OTHERS ................................................................. 2

GO TO *PD24a

*PD24. Did this unexpected “out of the blue” attack occur while you were asleep?

*PD25a. Attacks of this sort sometimes occur as a result of physical causes such as physical illness or injury or the use
of medication, drugs, or alcohol. Do you think any of your attacks ever occurred as the result of such physical causes?
YES ..................................................................1
NO...................................5
GO
TO
*PD33
DON’T
KNOW...............8 GO TO *PD33 REFUSED.......................9
GO TO *PD33
*PD25b. Do you think all of your attacks were the result of physical causes?
YES ..................................................................1
NO...................................5
GO
TO
*PD33
DON’T
KNOW...............8 GO TO *PD33 REFUSED.......................9
GO TO *PD33

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PD25c. Briefly, what were the physical causes?

*PD33. INTERVIEWER CHECKPOINT: (SEE *PD20a)
*PD20a EQUALS ‘1’...................................... 1
ALL OTHERS.................................2

GO TO *PD35

*PD34. INTERVIEWER CHECKPOINT: (SEE *PD10)
*PD10 EQUALS ‘1’ .......................1
ALL OTHERS.................................2

GO TO *PD40
GO TO *PD39

*PD35. INTERVIEWER CHECKPOINT: (SEE *PD10)
*PD10 EQUALS ‘1’ ........................................1
ALL OTHERS.................................2

GO TO *PD39

*PD36. How many unexpected “out of the blue” attacks did you have in the past 12 months?
NUMBER OF ATTACKS
DON’T KNOW
998
REFUSED ....................................................... 999

*PD37. INTERVIEWER CHECKPOINT: (SEE *PD36)
*PD36 EQUALS “0”........................................1
*PD36 EQUALS “1” ......................2

GO TO *PD38

ALL OTHERS.................................3

GO TO *PD37b

*PD37a. How old were you the last time you had an unexpected “out of the blue” attack?
_YEARS OLD
DON’T KNOW...............98
REFUSED.......................99

GO TO *PD39
GO TO *PD39
GO TO *PD39

*PD37b. About how many weeks in the past 12 months did you have at least one of these attacks?
NUMBER

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

DON’T KNOW ................................................98
REFUSED ........................................................99

*PD38. How recently did you have an unexpected “out of the blue” attack – in the past month, between two and
six months ago, or more than six months ago?
PAST MONTH............................................................... 1
BETWEEN TWO AND SIX MONTHS......................... 2
MORE THAN SIX MONTHS ....................................... 3
DON’T KNOW .............................................................. 8
REFUSED ...................................................................... 9
GO TO *PD40

*PD39. INTERVIEWER CHECKPOINT: (SEE *PD16)
*PD16 EQUALS ‘1’ ......................1
ALL OTHERS ................................2

GO TO *PD41
GO TO *PD50

*PD40. When you had an attack in the past 12 months, how much emotional distress did it cause you during the attack
itself -- none, mild, moderate, severe, or so severe that you were unable to concentrate and had to stop what you were
doing?
NONE ..................................................................1
MILD ...................................................................2
MODERATE .......................................................3
SEVERE ..............................................................4
SO SEVERE ........................................................5
DON’T KNOW ...................................................8
REFUSED ...........................................................9

*PD41. Sometimes people with attacks get upset by physical sensations that remind them of the attacks. Examples
include being out of breath after physical exercise, feeling speeded up after drinking coffee or caffeinated beverages,
feeling out of control after using alcohol or drugs, and feeling tingly while watching a scary motion picture or
television show. In the past 12 months, did you ever get upset by any physical sensations that reminded you of your
attacks?
YES .............................................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO *PD44
GO TO *PD44
GO TO *PD44

*PD41a. How strong was your discomfort with any physical sensations like these in the past 12 months – mild,
moderate, severe, or so severe that you became very worried that these sensations might cause you to have another
attack?
MILD ..................................1
MODERATE ......................2
SEVERE................................. 3
SO SEVERE .......................4

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

DON’T KNOW ...................................................8
REFUSED ...........................................................9

*PD42. How often did you avoid situations or activities that might cause these physical sensations in the past 12
months – all the time, most of the time, sometimes, rarely, or never?
ALL THE TIME..................................................1
MOST OF THE TIME ........................................2
SOMETIMES ......................................................3
RARELY ...........................................4
NEVER..............................................5
DON’T KNOW .................................8
REFUSED .........................................9

GO TO *PD44
GO TO *PD44
GO TO *PD44
GO TO *PD44

*PD43. How much did avoidance of these situations interfere with either your work, your social life, or your personal
relationships over the past 12 months -- not at all, a little, some, a lot, or extremely?
NOT AT ALL ......................................................1
A LITTLE ............................................................2
SOME ......................................................................... 3
A LOT..................................................................4
EXTREMELY .....................................................5
DON’T KNOW ...................................................8
REFUSED ........................................................9

No
Interference
0

Mild
1

Moderate
2

3

4

Very Severe
Interference

Severe
5

6

7

8

9

10

*PD44. (RB, PG 9) Think about the month or longer in the past 12 when your attack(s) or worry about the attacks
(was/were) most severe. Using the 0 to 10 scale on page 9 of your booklet, where 0 means no interference and 10
means very severe interference, what number describes how much the attack(s) or worry about the attacks interfered
with each of the following activities during that time?
(IF NEC: How much did the attacks interfere with (ACTIVITY) during that time?) (IF NEC:
You can use any number between 0 and 10 to answer.)
NUMBER (0-10)
*PD44a.
Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY ..................................................................................................................... 97
DON’T KNOW ............................................................................................................................ 98
REFUSED .................................................................................................................................... 99
*PD44b. Your ability to work?
DOES NOT APPLY ..................................................................................................................... 97
DON’T KNOW ............................................................................................................................ 98
REFUSED .................................................................................................................................... 99
*PD44c.

Your ability to form and maintain close

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

DOES NOT APPLY ............................. 97
DON’T KNOW ..................................... 98
REFUSED............................................. 99

relationships with other people?

*PD44d. Your social life?
DOES NOT APPLY ..................................................................................................................... 97
DON’T KNOW ............................................................................................................................ 98
REFUSED .................................................................................................................................... 99

*PD45. INTERVIEWER CHECKPOINT: (SEE *PD44a - *PD44d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’............................................................... 1
GO TO *PD50
ALL OTHERS ......................................................................................................................... 2
*PD46. About how many days out of 365 in the past 12 months were you totally unable to work or carry out your
normal activities because of your attacks or because of worry about the attacks?
(IF NEC: You can use any number between 0 and 365 to answer)
NUMBER OF DAYS
DON’T KNOW ................................. 998
REFUSED ......................................... 999

*PD50. Did you ever in your life talk to a medical doctor or other professional about your attacks? (By professional
we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other healing professionals.)
YES ............................................................................. 1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9

GO TO *PD65.1
GO TO *PD65.1
GO TO *PD65.1

*PD50a. How old were you the first time (you talked to a professional about your attacks)?
YEARS OLD
DON’T KNOW .......................................................... 998
REFUSED .................................................................. 999

*PD62. Did you ever get treatment for your attacks that you considered helpful or effective?
YES ................................................... 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9
*PD62a.

GO TO *PD62c
GO TO *PD62c
GO TO *PD62c

How old were you the first time (you got helpful treatment for your attacks)?
YEARS OLD

DON’T KNOW

998

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
REFUSED ........................................................ 999
*PD62b. How many professionals did you ever talk to about your attacks, up to and including the first time you got
helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW .............98
REFUSED .....................99

GO TO *PD64

GO TO *PD64
GO TO *PD64

*PD62c. How many professionals did you ever talk to about your attacks?
NUMBER OF PROFESSIONALS
DON’T KNOW ................................................ 98
REFUSED ........................................................ 99
*PD64. Did you receive professional treatment for your attacks at any time in the past 12 months?
YES ................................................... 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ......................................... 9

*PD65. Were you ever hospitalized overnight for your attacks?
YES ............................................................................. 1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9

GO TO *PD65.1
GO TO *PD65.1
GO TO *PD65.1

*PD65a. How old were you the first time (you were hospitalized overnight because of your attacks)?
YEARS OLD
DON’T KNOW ................................................ 998
REFUSED ........................................................ 999

*PD65.1. How many of your close relatives – including your biological parents, brothers and sisters, and children – ever had
attacks of this sort?
NUMBER
DON’T KNOW ................................................ 998
REFUSED ........................................................ 999

*PD66. INTERVIEWER CHECKPOINT (SEE *SC26, *SC26a, *SC26b, *SC28, *SC29.4, *SC30.4): FOLLOW SKIP
FOR FIRST ENDORSED ITEM.
*SC29.4 EQUALS ‘1’........................................................................ GO TO *SO1
*SC30.4 EQUALS ‘1’........................................................................ GO TO *AG1
[IF NONE OF THE ABOVE, GO TO *N1]
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

SOCIAL PHOBIA SECTION (SO)

INTERVIEWER INSTRUCTION: AFTER EACH “YES” RESPONSE, ASK R TO CHECK OFF
CORRESPONDING SITUATION IN BOOKLET.
*SO1. (RB, PG 15) Earlier you mentioned having a time in your life when you felt very shy, afraid, or uncomfortable
with other people or in social situations. Looking at page 15 in your booklet, was there ever a time in your life
when you felt shy, afraid, or uncomfortable in the following situations?

*SO1a. Meeting new people?
*SO1b. Talking to people in authority?

YES
(1)

NO
(5)

N/A
(7)

DK
(8)

RF
(9)

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

*SO1c. Speaking up in a meeting or class?
(KEY PHRASE: speaking up at a meeting)
*SO1d. Going to parties or other social gatherings?

*SO1e.

(KEY PHRASE: going to parties)
Acting, performing, or giving a talk in front of an audience?

(KEY PHRASE: performing in front of an audience)
*SO1f. Taking an important exam or interviewing for a job, even
though you were well prepared?
(KEY PHRASE: taking an important exam)
*SO1g. Working while someone watches?
*SO1h. Entering a room when others are already present?
*SO1i. Talking with people you don’t know very well?
*SO1j. Expressing disagreement to people you didn’t know very well?
(KEY PHRASE: disagreeing with people)
*SO1k. Writing or eating or drinking while someone watches?
*SO1l. Urinating in a public bathroom or using a bathroom away from
home?
(KEY PHRASE: using a public bathroom)
*SO1m. Being in a dating situation?
(KEY PHRASE: dating)
*SO1n. Any other social or performance situation where you could be
the center of attention or where something embarrassing might
happen?

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*SO2.

INTERVIEWER CHECKPOINT: (SEE *SO1a - *S01n SERIES)
ZERO RESPONSES CODED ‘1’.........................................................1
ONE - THREE RESPONSES CODED ‘1’ ..........................................2
FOUR OR MORE RESPONSES CODED ‘1’.....................................3

GO TO *SO40
GO TO *SO3 INTRO1
GO TO *SO3 INTRO2

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SO3. INTRO1
You had a fear of (KEY PHRASE OF ALL “YES”
RESPONSES IN *SO1 SERIES). Can you remember your
exact age the very first time you had a fear of (this/ any of
these) situation(s)?

*SO3. INTRO2
You had a fear of a number of social or performance situations
on the list. Can you remember your exact age the very first
time you had a fear of any of these situations?

YES .................................... 1
NO ..................................... 5 GO TO *SO3b
DON’T KNOW ................ 8 GO TO *SO3b
REFUSED ......................... 9 GO TO *SO3b

*SO3a.

YES .................................... 1
NO ..................................... 5 GO TO *SO3b
DON’T KNOW ................ 8 GO TO *SO3b
REFUSED ......................... 9 GO TO *SO3b

(IF NEC: How old were you?)
YEARS OLD GO TO *SO6
DON’T KNOW ......................998
REFUSED ..............................999

*SO3b.

About how old were you?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL .................. 4
BEFORE TEENAGER ................................ 12
NOT BEFORE TEENAGER ....................... 13
DON’T KNOW ............................................ 998
REFUSED ................................................. 999

*SO6.

INTERVIEWER CHECKPOINT: (SEE *SC29.2)
*SC29.2 EQUALS ‘1’ ................ 1
ALL OTHERS ............................ 2

*SO6a.

GO TO *SO8

Earlier in the interview you mentioned having times when you avoided social or performance situations
because of your fear. How old were you when you first started this avoidance?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL .................. 4
BEFORE TEENAGER ................................ 12
NOT BEFORE TEENAGER ....................... 13
DON’T KNOW ............................................ 998
REFUSED ................................................. 999
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*SO8.

Think of the time in your life when your fear (and avoidance) was most severe. When you were faced with
(this situation/ these situations), or thought you would have to be, did you ever have any of the following
experiences?
GO TO *SO9 AFTER ONE “YES” IN *SO8a-*SO8c

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

*SO8a. Did you ever blush or shake?

*SO8b. Did you ever fear that you might lose control of your
bowels or bladder?
*SO8c. Did you ever fear that you might vomit?

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*SO9. (RB, PG 14) When you were faced with (IF *SO2 EQUALS ‘2’ : KEY PHRASE/ ALL OTHERS : these
situations), did you ever have two or more of the reactions on Page 14?
READ LIST BELOW STARTING WITH SO9a ONLY IF R PREFERS TO HAVE QUESTIONS READ
YES ......................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED ........................9
GO TO *SO10
GO TO *SO10 AFTER TWO “YES” RESPONSES
*SO9a.

Did your heart ever pound or race?

*SO9b.

Did you sweat?

*SO9c.

Did you tremble?

*SO9d.

Did you feel sick to your stomach?

*SO9e.

Did you have a dry mouth?

*SO9f.

Did you have chills or hot flushes?

*SO9g.

Did you feel numbness or have tingling sensations?

*SO9h.

Did you have trouble breathing normally?

*SO9i.

Did you feel like you were choking?

*SO9j.

Did you have pain or discomfort in your chest?

*SO9k.

Did you feel dizzy or faint?

*SO9l.

Were you afraid that you might die?

*SO9m.
*SO9n.

Did you ever fear that you might lose control, go crazy, or
pass out?
Did you feel like you were distant from the situation, “not
really there”, or like you were watching yourself in a movie?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

5

8

9

GO TO
*SO10
*SO9o.

Did you feel that things around you were unreal or like a
dream?

1

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SO10. When you were in (IF *SO2 EQUALS ‘2’: this situation/ ALL OTHERS: these situations), were you ever afraid that
you might have a panic attack?
YES ......................................... 1
NO ..................................... 5 GO TO *SO11
DON’T KNOW ................ 8 GO TO *SO11
REFUSED ......................... 9 GO TO *SO11

*SO10a. Did you ever have a panic attack in (this situation / one of these situations)?
YES ........................................... 1
NO ........................................ 5
DON’T KNOW .................... 8
REFUSED ......................... 9

*SO11. Were you afraid that you might be trapped or unable to escape?
YES ......................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED ........................ 9

*SO12. When you were in (IF *SO2 EQUALS ‘2’: this situation/ ALL OTHERS: these situations) were you afraid you might
do something embarrassing or humiliating?
YES ................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED ........................ 9

GO TO *SO15

*SO12a. Were you afraid that you might embarrass other people?
YES ................................ 1
NO .................................. 5
DON’T KNOW .............. 8
REFUSED .................... 9

GO TO *SO15

*SO13. Were you afraid that people might look at you, talk about you, or think negative things about you?
YES ................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED ........................ 9

GO TO *SO15

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SO14. Were you afraid that you might be the focus of attention?
YES ................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED ........................ 9

GO TO *SO15

*SO14a. What was it you feared most about (IF *SO2 EQUALS ‘2’ : KEY PHRASE/ ALL OTHERS : these
situations)?
REAL DANGER (SPECIFY BELOW) ................. 1
OTHER (SPECIFY BELOW) ................................ 5
DON’T KNOW ....................................................... 8
REFUSED ............................................................ 9

*SO15. Was your fear related to embarrassment about having a physical or mental health problem or disability?
YES ......................................... 1
NO ..................................... 5 GO TO *SO16
DON’T KNOW ................ 8 GO TO *SO16
REFUSED ......................... 9 GO TO *SO16
*SO15a.

Briefly, what was the health problem?
INTERVIEWER: CIRCLE ALL THAT APPLY
MENTAL HEALTH PROBLEM.................................................. 1
ALCOHOL OR DRUG PROBLEM ............................................. 2
SPEECH, VISION, OR HEARING PROBLEM .......................... 3
MOVEMENT OR COORDINATION PROBLEM ..................... 4
FACIAL / BODY DISFIGUREMENT OR
WEIGHT / BODY IMAGE PROBLEM ....................................... 5
BAD ODOR OR SWEATING. ..................................................... 6
PREGNANCY ............................................................................... 7
OTHER PHYSICAL HEALTH PROBLEM. ............................... 8
DON’T KNOW .............................................................................. 9
REFUSED .................................................................................10

*SO16. How much did your fear (or avoidance) ever interfere with either your work, your social life, or your personal
relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL .................................................. 1
A LITTLE ........................................................ 2
SOME............................................................... 3
A LOT .............................................................. 4
EXTREMELY ................................................. 5
DON’T KNOW ................................................ 8
REFUSED........................................................ 9

GO TO *SO17
GO TO *SO17

GO TO *SO17

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
SO16.1. How often during that time were you unable to carry out your daily activities or to take care of yourself
because of your fear (or avoidance) – often, sometimes, not very often, never?
OFTEN ............................. 1
SOMETIMES................... 2
NOT VERY OFTEN ........ 3
NEVER ............................ 4
DON’T KNOW ................ 8
REFUSED ........................ 9

*SO17. Was there ever a time in your life when you felt very emotionally upset, worried, or disappointed with yourself because
of your fear (or avoidance) of (IF *SO2 EQUALS ‘2’ : this situation/ ALL OTHERS : this situation/ these situations)?
YES ......................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED ........................ 9

*SO18. When was the last time you either strongly feared or avoided (IF *SO2 EQUALS ‘2’: this situation/ any of these
situations) – within the past month, between two and six months ago, between seven and twelve months ago, or more
than twelve months ago?
WITHIN PAST MONTH.. ............................. 1
2 AND 6 MONTHS........... ............................. 2
7 AND 12 MONTHS ........ ............................. 3
MORE THAN 12 MONTHS ........................... 4
DON’T KNOW ................................................ 8
REFUSED ........................................................ 9

GO TO *SO19
GO TO *SO19
GO TO *SO19

*SO18a. How old were you the last time [you either strongly feared or avoided (IF *SO2 EQUALS ‘2’ : this situation/
ALL OTHERS : any of these situations)]?
YEARS OLD
DON’T KNOW ............................... 998
REFUSED ....................................... 999

*SO19. What if you were faced with (IF *SO2 EQUALS ‘2’ : this situation/ ALL OTHERS : one of these situations) today:
How strong would your fear be – not at all, mild, moderate, severe, or very severe?
(IF VOLUNTEERED “IT DEPENDS ON WHICH SITUATION,” PROBE: What if you were faced with the situation
that scares you most: How strong would your fear be – not at all, mild, moderate, severe, or very severe?)
NOT AT ALL .................................................. 1
MILD................................................................ 2
MODERATE ................................................... 3
SEVERE...................................................................4
VERY SEVERE............................................... 5
DON’T KNOW ................................................ 8
REFUSED ..................................................... 9

GO TO *SO25
GO TO *SO25

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SO20. During the past 12 months, how often did you avoid (IF *SO2 EQUALS ‘2’ : KEY PHRASE/ ALL OTHERS : any of
these situations) -- all the time, most of the time, sometimes, rarely, or never?
(IF VOL “IT DEPENDS ON WHICH THING,” PROBE: How about for the thing that you avoided most: Did you
avoid it all the time, most of the time, sometimes, rarely, or never?)
ALL THE TIME .............................................. 1
MOST OF THE TIME..................................... 2
SOMETIMES................................................... 3
RARELY .......................................................... 4
NEVER ............................................................ 5
DON’T KNOW ................................................ 8
REFUSED ........................................................ 9

No
Interference
0

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

*S021. (RB, PG 9) Think about the month or longer in the past 12 when your fear (or avoidance) of social or performance
situations was most severe. Using the 0 to 10 scale on page 9 of your booklet, where 0 means no interference and 10
means very severe interference, what number describes how much your fear (or avoidance) of social or performance
situations interfered with each of the following activities during that time?
[IF NEC: How much did the fear (or avoidance) interfere with (ACTIVITY) during that time?]
[IF NEC: You can use any number between 0 and 10 to answer.]
NUMBER (0-10)

*SO21a. Your home management, like cleaning, shopping,
and taking care of the (house/ apartment)?
DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99
*SO21b. Your ability to work?
DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99
*SO21c. Your ability to form and maintain close relationships
with other people?
DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99
*SO21d. Your social life?

DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SO22. INTERVIEWER CHECKPOINT: (SEE *SO21a - *SO21d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’...............................................................1
ALL OTHERS ........................................................................................................ 2

GO TO *SO25

*SO23. About how many days in the past 12 months were you totally unable to work or carry out your normal activities
because of your fear (or avoidance)?
(IF NEC: You may use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ......................... 998
REFUSED ................................. 999

*SO25. Did you ever in your life talk to a medical doctor or other professional about your fear (or avoidance) of (IF *SO2
EQUALS ‘2’ : KEY PHRASE/ ALL OTHERS : these situations)? (By other professional we mean psychologists,
counselors, spiritual advisors, herbalists, acupuncturists, and other healing professionals.)
YES ......................................... 1
NO ...................................... 5
DON’T KNOW ................. 8
REFUSED.......................... 9

GO TO *SO39.1
GO TO *SO39.1
GO TO *SO39.1

*SO25a. How old were you the first time (you talked to a professional about your fear)?
YEARS OLD
DON’T KNOW ............................. 998
REFUSED ..................................... 999

*SO36. Did you ever get treatment for your fear that you considered helpful or effective?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *SO36c
GO TO *SO36c
GO TO *SO36c

*SO36a. How old were you the first time (you got helpful treatment for your fear)?
YEARS OLD
DON’T KNOW .............. 998
REFUSED ...................... 999

*SO36b. How many professionals did you ever talk to about your fear, up to and including the first time you got
helpful treatment?
NUMBER OF PROFESSIONALS GO TO *SO38
DON’T KNOW.............. 98 GO TO *SO38
REFUSED ...................... 99 GO TO *SO38
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SO36c. How many professionals did you ever talk to about your fear?
NUMBER OF PROFESSIONALS
DON’T KNOW ............... 98
REFUSED ....................... 99

*SO38. Did you receive professional treatment for your fear at any time in the past 12 months?
YES .........................................1
NO ...................................... 5
DON’T KNOW ................. 8
REFUSED ....................... 9

*SO39. Were you ever hospitalized overnight for your fear?
YES .................................... 1
NO ...................................... 5
DON’T KNOW ................. 8
REFUSED.......................... 9

GO TO *SO39.1
GO TO *SO39.1
GO TO *SO39.1

*SO39a. How old were you the first time (you were hospitalized overnight because of your fear)?
YEARS OLD
DON’T KNOW .............. 998
REFUSED ...................... 999
*SO39.1. How many of your close relatives – including your biological parents, brothers and sisters, and children –
ever had a strong fear of social or performance situations?
NUMBER
DON’T KNOW .............................. 998
REFUSED .................................... 999

*SO40. INTERVIEWER CHECKPOINT (SEE *SC26, *SC26a, *SC26b, *SC30.4): FOLLOW SKIP FOR FIRST
ENDORSED ITEM.
*SC30.4 EQUALS ‘1’........................................................................ GO TO *AG1
[OTHERWISE, GO TO *N1]

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

AGORAPHOBIA SECTION (AG)

INTERVIEWER INSTRUCTION: AFTER EACH “YES” RESPONSE, ASK R TO CHECK
CORRESPONDING SITUATION IN BOOKLET.
*AG1. (RB, PG 16) Earlier you mentioned having a strong fear of things like crowds, public places, and traveling
away from home. The next questions are about which of these things you feared. Looking at page 16 in your
booklet, did you ever strongly fear any of the following situations:
YES
(1)

NO
(5)

N/A
(7)

DK
(8)

RF
(9)

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

1

5

7

8

9

*AG1a. Being home alone?
(KEY PHRASE: being home alone)
*AG1b. Being in crowds?
(KEY PHRASE: being in crowds)
*AG1c. Traveling away from home?
(KEY PHRASE: traveling away from home)
*AG1d. Traveling alone or being alone away from home?
(KEY PHRASE: traveling alone)
*AG1e. Using public transportation?

*AG1f.

(KEY PHRASE: using public transportation)
Driving a car?

(KEY PHRASE: driving a car)
*AG1g. Standing in a line in a public place?
(KEY PHRASE: standing in a line)
*AG1h. Being in a department store, shopping mall, or supermarket?
(KEY PHRASE: being in stores or malls)
*AG1i.

Being in a movie theater, auditorium, lecture hall, or
church?
(KEY PHRASE: being in large auditoriums)

*AG1j. Being in a restaurant or any other public place?
(KEY PHRASE: being in restaurants)
*AG1k. Being in a wide, open field or street?
(KEY PHRASE: being in open places)
*AG2. INTERVIEWER CHECKPOINT: (SEE *AG1a - *AG1k SERIES)
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
ZERO - ONE RESPONSES CODED ‘1’.................................................... 1
TWO - THREE RESPONSES CODED ‘1’ ................................................ 2

GO TO *AG39
GO TO *AG3 INTRO 1

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
FOUR OR MORE RESPONSES CODED ‘1’............................................ 3

GO TO *AG3 INTRO 2

*AG3. INTRO 1
You had a fear of (KEY PHRASE OF ALL “YES”
RESPONSES IN *AG1 SERIES). Can you remember your
exact age the very first time you had a fear of one of these
situations?

*AG3. INTRO 2
You had a fear of a number of the situations on the list. Can
you remember your exact age the very first time you had a fear
of one of these situations?

YES ..................................................... 1
NO ..................................... 5 GO TO *AG3b DON’T
KNOW ................ 8 GO TO *AG3b REFUSED
......................... 9 GO TO *AG3b

YES ..................................................... 1
NO ..................................... 5 GO TO *AG3b DON’T
KNOW ................ 8 GO TO *AG3b REFUSED
......................... 9 GO TO *AG3b

*AG3a.

(IF NEC: How old were you?)
YEARS OLD

GO TO *AG4

DON’T KNOW ............................................................998
REFUSED.....................................................................999

*AG3b. About how old were you?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL......................................................... 4
BEFORE TEENAGER....................................................................... 12
NOT BEFORE TEENAGER ............................................................. 13
DON’T KNOW .................................................................................. 998
REFUSED ..................................................................................... 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*AG4.
People with fears like this differ in what it is they fear about the situations. Which of the following
fears did you experience:
YES
NO
DK
RF
(1)
(5)
(8)
(9)
*AG4a. Fear of being alone or of being separated from your loved ones?
1
5
8
9
*AG4b. Fear that there was some real danger, like that you might be robbed
or assaulted?
*AG4c. Fear that you might get sick to your stomach or have diarrhea?
*AG4d. Fear that you might have a panic attack?
*AG4e. Fear that you might have a heart attack or some other emergency?
*AG4f. Fear that you might become physically ill and be unable to get help?
*AG4g. Fear that it might be difficult or embarrassing to escape?
*AG4h. Fear that some other terrible thing might happen?
*AG4i. Fear that help might not be available if you needed it?

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*AG6. INTERVIEWER CHECKPOINT: (SEE *SC30.2)
*SC30.2 EQUALS ‘1’ ............................... 1
ALL OTHERS ..........................2

GO TO *AG8

*AG6a. Earlier in the interview, you mentioned having times when you avoid these situations because of your fears.
How old were you when you first avoided these situations?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL ...................................................... 4
BEFORE TEENAGER .................................................................... 12
NOT BEFORE TEENAGER ........................................................... 13
DON’T KNOW ................................................................................ 998
REFUSED ................................................................................... 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*AG8. Was there a particular incident or event that caused your fear of these situations to start the very first time?
YES............................................................... 1
NO ..................................... 5 GO TO *AG9
DON’T KNOW ................ 8 GO TO *AG9
REFUSED ......................... 9 GO TO *AG9
*AG8a.

Did you have a panic attack as a result of that incident or event?

YES ......................................................................... 1
NO ........................................................................... 5
DON’T KNOW ....................................................... 8
REFUSED .............................................................. 9

*AG9. Think of the time in your life when your fear (and avoidance) was most severe and
frequent. When you were faced with these situations, or thought you would have to be, did
you ever have any of the following experiences?
*AG9a.

Did your heart ever pound or race?

*AG9b.

Did you ever sweat?

*AG9c.

Did you tremble or shake?

*AG9d.

Did you have a dry mouth?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*AG10. INTERVIEWER INSTRUCTION: (SEE *AG9a-d)
ZERO RESPONSES CODED ‘1’.........................................................1

GO TO *AG12a

ONE RESPONSE CODED ‘1’ .............................................................2

GO TO *AG11

ALL OTHERS .......................................................................................3

GO TO *AG12a

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*AG11. (RB, PG 17) When you were faced with these situations, or thought you would have to be, did you ever
have one or more of these reactions on Page 17?
READ LIST BELOW STARTING WITH AG11a ONLY IF R PREFERS TO HAVE QUESTIONS READ YES
.................................................................. 1
NO ..................................................... 5
DON’T KNOW ................................. 8
REFUSED ...................................... 9
GO TO *AG12a

GO TO *AG12a AFTER ONE “YES” RESPONSE
*AG11a. Did you have trouble breathing normally?
*AG11b. Did you feel like you were choking?
*AG11c. Did you have pain or discomfort in your chest?
*AG11d. Did you feel sick to your stomach?
*AG11e. Did you feel dizzy or faint?
*AG11f. Did you ever fear that you might lose control, go crazy,
or pass out?
*AG11g. Were you afraid that you might die?
*AG11h. Did you have chills or hot flashes?
*AG11i. Did you feel numbness or have tingling sensations?
*AG11j. Did you feel like you were “not really there”, like you
were watching a movie of yourself?
*AG11k. Did you feel that things around you were not real or like a
dream?

YES
(1)

NO (5)

DK (8)

RF (9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*AG12a. Fearful reactions of this kind sometimes occur as a result of physical causes such as physical illness or injury or the
use of medication, drugs, or alcohol. Do you think any of your fearful reactions (or your avoidance of fearful situations) ever
occurred as the result of such physical causes?
YES................................................................. 1
NO .................................. 5 GO TO *AG13
DON’T KNOW.............. 8 GO TO *AG13
REFUSED ...................... 9 GO TO *AG13
*AG12b. Do you think all of your fearful reactions (or avoidance of fearful situations) were the result of physical causes?
YES................................................................. 1
NO .................................. 5 GO TO *AG13
DON’T KNOW.............. 8 GO TO *AG13
REFUSED ...................... 9 GO TO *AG13
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*AG12c. Briefly, what were the physical causes?

*AG13. Now we want to ask you about how your fear (or avoidance) may have impacted your life. Were you ever unable to
leave your home for an entire day because of your fear?
*AG13a. What is the longest period of days, weeks, months or years you were unable to leave your home?
NUMBER
CIRCLE UNIT
OF TIME:

DAYS ....1

WEEKS .... 2

MONTHS....3

YEARS ... 4

DON’T KNOW ..................................................... 998
REFUSED ............................................................. 999

*AG14. Some people are unable to go out of their home unless they have someone they know with them, like a family member or
friend. Was this ever true for you?
YES............................................................. 1
NO ........................................................ 5
DON’T KNOW.................................... 8
REFUSED ......................................... 9

*AG15. How much did your fear (or avoidance) of these situations ever interfere with either your work, your social life, or your
personal relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL .................................................. 1
A LITTLE ........................................................ 2
SOME................................................................................. 3
A LOT ................................................................................ 4
EXTREMELY ................................................................... 5
DON’T KNOW.................................................................. 8
REFUSED........................................................ 9

GO TO *AG16
GO TO *AG16

GO TO *AG16

*AG15.1. How often during that time were you unable to carry out your daily activities or to take care of yourself because of
your fear (or avoidance) of these situations – often, sometimes, not very often, never?
OFTEN ............................................................................... 1
SOMETIMES .................................................................... 2
NOT VERY OFTEN ......................................................... 3
NEVER .............................................................................. 4
DON’T KNOW.................................................................. 8
REFUSED .......................................................................... 9
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*AG16. Was there ever a time in your life when you felt very emotionally upset, worried, or disappointed with yourself because
of your fear (or avoidance)?
YES............................................................. 1
NO ........................................................ 5
DON’T KNOW.................................... 8
REFUSED ......................................... 9

*AG17. Did you either strongly fear or avoid any of these situations at any time in the past 12 months?
YES .................................................................................... 1
NO ................................................................... 5
DON’T KNOW .............................................. 8
REFUSED........................................................ 9

GO TO *AG17b
GO TO *AG17b
GO TO *AG18

*AG17a. How recently -- in the past month, between two and six months ago, or more than six months ago?
PAST MONTH ............................................. 1
2-6 MONTHS AGO ...................................... 2
MORE THAN 6 MONTHS AGO ................. 3
DON'T KNOW .............................................. 8
REFUSED ..................................................... 9
GO TO *AG18
*AG17b. How old were you the last time (you either strongly feared or avoided one of these situations)?
YEARS OLD
DON’T KNOW
998
REFUSED ................................................................. 999

*AG18. What if you were faced with one of these situations today: How strong would your fear be – not at all, mild, moderate,
severe, or very severe?
(IF VOL “IT DEPENDS ON WHICH SITUATION,” PROBE: What if you were faced with the situation that scares you most:
How strong would your fear be – not at all, mild, moderate, severe, or very severe?)
NOT AT ALL ................................................. 1
MILD ............................................................... 2
MODERATE ..................................................................... 3
SEVERE.......................................................................................4
VERY SEVERE................................................................. 5
DON’T KNOW.................................................................. 8
REFUSED ...................................................................... 9

GO TO *AG24
GO TO *AG24

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*AG19. During the past 12 months, how often did you avoid these feared situations - - all the time, most of the time, sometimes,
rarely, or never?
(IF VOL “IT DEPENDS ON WHICH THING,” PROBE: How about for the situation that you avoided most: Did you avoid
it all the time, most of the time, sometimes, rarely, or never?)
ALL THE TIME ................................................................ 1
MOST OF THE TIME....................................................... 2
SOMETIMES .................................................................... 3
RARELY............................................................................ 4
NEVER .............................................................................. 5
DON’T KNOW.................................................................. 8
REFUSED .......................................................................... 9

No
Interference
0

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

*AG20. (RB, PG 9) Think about the month or longer in the past 12 when your fear (or avoidance) was most severe. Using the 0
to 10 scale on page 9 of your booklet, where 0 means no interference and 10 means very severe interference, what number
describes how much your fear (or avoidance) interfered with each of the following activities during that time?
(IF NEC: How much did the fear (or avoidance) interfere with (ACTIVITY) during that time?) (IF NEC:
You can use any number between 0 and 10 to answer.)
NUMBER (0-10)
*AG20a. Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY ....................97
DON’T KNOW............................98
REFUSED ....................................99
*AG20b. Your ability to work?
DOES NOT APPLY .............................................................................................................................................97
DON’T KNOW.....................................................................................................................................................98
REFUSED .............................................................................................................................................................99
*AG20c. Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY .........................97
DON’T KNOW ................................98
REFUSED.........................................99
*AG20d. Your social life?
DOES NOT APPLY .............................................................................................................................................97
DON’T KNOW.....................................................................................................................................................98
REFUSED .............................................................................................................................................................99

*AG21. INTERVIEWER CHECKPOINT: (SEE *AG20a - *AG20d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’.............1
ALL OTHERS ....................................................................... 2

GO TO *AG24
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*AG22. About how many days in the past 12 months were you totally unable to work or carry out your normal activities because
of your fear (or avoidance)?
(IF NEC: You may use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW .......................................... 998
REFUSE ..................................................... 999
*AG24. Did you ever in your life talk to a medical doctor or other professional about your fear (or avoidance) of these
situations? (By other professional we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other
healing professionals.)
YES.............................................................................. 1
NO ................................................... 5
DON’T KNOW............................... 8
REFUSED....................................... 9

GO TO *AG38.1
GO TO *AG38.1
GO TO *AG38.1

*AG24a. How old were you the first time (you talked to a professional about your fear)?
YEARS OLD
DON’T KNOW...........................................................998
REFUSED ...................................................................999

*AG35. Did you ever get treatment for your fear that you considered helpful or effective?
YES ................................................... 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *AG35c
GO TO *AG35c
GO TO *AG35c

*AG35a. How old were you the first time (you got helpful treatment for your fear)?
YEARS OLD
DON’T KNOW ............................................... 998
REFUSED ....................................................... 999
*AG35b.How many professionals did you ever talk to about your fear, up to and including the first time you got helpful
treatment?
NUMBER OF PROFESSIONALS

GO TO *AG37

DON’T KNOW ............ 98 GO TO *AG37
REFUSED .................... 99 GO TO *AG37

*AG35c. How many professionals did you ever talk to about your fear?
NUMBER OF PROFESSIONALS
DON’T KNOW ............................................... 98
REFUSED ....................................................... 99
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*AG37. Did you receive professional treatment for your fear at any time in the past 12 months?
YES............................................................. 1
NO ........................................................ 5
DON’T KNOW.................................... 8
REFUSED ......................................... 9

*AG38.

Were you ever hospitalized overnight for your fear?

YES. .................................................................... 1
NO ................................................. 5
DON’T KNOW............................. 8
REFUSED ..................................... 9

GO TO *AG38.1
GO TO *AG38.1
GO TO *AG38.1

*AG38a. How old were you the first time (you were hospitalized overnight because of your fear)?
YEARS OLD
DON’T KNOW ............................................... 998
REFUSED ....................................................... 999

*AG38.1 How many of your close relatives -- including your biological parents, brothers and sisters, and children -- ever
had a strong fear of being home alone, being in crowds, or being away from home?
NUMBER
DON’T KNOW................................................... 998
REFUSED ........................................................... 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

NEURASTHENIA SECTION (N)
*N1. (READ SLOWLY) Did you ever in your life have a period lasting several months or longer when you became very
tired, weak, or exhausted either while performing minor everyday physical tasks like working, shopping, housekeeping,
and walking, or while performing everyday mental tasks like reading, writing, and doing paperwork?
YES .................................... 1
NO ...................................... 5
DON’T KNOW ................. 8
REFUSED ......................... 9

*N2.

GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION

What would happen when you tried to rest or relax — would you fully regain your energy and strength? Or would you
still feel tired or weak?
FULLY REGAIN ............................. 1
STILL FEEL TIRED/WEAK ........... 2
DON’T KNOW ................................. 8
REFUSED ......................................... 9

*N3.

During the months or years when this problem was most severe, how often did you get tired — nearly every day, most
days, about half the days, or less than half the days?
NEARLY EVERY DAY .................. 1
MOST DAYS.................................... 2
ABOUT HALF THE DAYS ............ 3
LESS THAN HALF THE DAYS .... 4
DON’T KNOW ................................ 8
REFUSED......................................... 9

*N4.

GO TO *FD1, NEXT SECTION

GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION

How much did your tiredness ever interfere with either your work, your social life, or your personal relationships – not
at all, a little, some, a lot, or extremely?
NOT AT ALL ................................... 1
A LITTLE ......................................... 2
SOME ...................................................... 3
A LOT ............................................... 4
EXTREMELY .................................. 5
DON’T KNOW ................................. 8
REFUSED......................................... 9
*N4a.

GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION

GO TO *FD1, NEXT SECTION

How often were you too tired to carry out your daily activities – often, sometimes, rarely, or never?
OFTEN ......................................................1
SOMETIMES............................................2
RARELY ...................................................3
NEVER .....................................................4
DON’T KNOW ........................................ 8
REFUSED ............................................. 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*N5.

Still thinking of the months or years when this problem with frequent
tiredness was most severe, did you also have any of the following problems
during that time:
*N5a.

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

Did you have frequent headaches?

(KEY PHRASE: headaches)
*N5b.
Did you often oversleep or wake feeling unrefreshed?
(KEY PHRASE: sleep problems)
*N5c.
Did you have frequent muscle aches or pains?
(KEY PHRASE: aches and pains)
*N5d.
Did you often feel dizzy?
(KEY PHRASE: dizziness)
*N5e.
Were you often unable to relax?
(KEY PHRASE: inability to relax)
*N5f.
Were you often impatient or irritable?
(KEY PHRASE: irritability)
*N5g. Were you often sad or depressed?
(KEY PHRASE: sad or depressed)
*N5h. Were you often nervous or worried?
(KEY PHRASE: nervous or worried)
*N6.

INTERVIEWER CHECKPOINT: (SEE *N5a – *N5f SERIES)
AT LEAST ONE ‘YES’ RESPONSE IN *N5a – *N5f SERIES........................ 1
ALL OTHERS ......................................................................................................2

GO TO *FD1, NEXT SECTION

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*N7.

Did you ever talk to a medical doctor about your frequent tiredness and other related problems?
YES .................................... 1
NO ...................................... 5
DON’T KNOW .................. 8
REFUSED .......................... 9
*N7a.

GO TO *N8

Experiences of this sort sometimes occur as a result of physical causes such as illness or injury or
the use of medication, drugs, or alcohol. Do you think your frequent tiredness ever occurred as the
result of such physical causes?
YES ............................................1
NO ..............................................5
DON’T KNOW .........................8
REFUSED..................................9

*N7b.

Do you think your frequent tiredness was always the result of physical causes?
YES ............................................1
NO ..............................................5
DON’T KNOW ..........................8
REFUSED ..................................9

*N7c.

GO TO *N15
GO TO *N15
GO TO *N15

GO TO *N15
GO TO *N15
GO TO *N15

What do you think the cause was?

GO TO *N15

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*N8. What did the doctor say was the cause?
IF VOL “MORE THAN ONE DOCTOR,” PROBE: What were all the causes the different doctors told you?
CIRCLE ALL THAT APPLY.

PSYCHOLOGICAL PROBLEMS
PANIC. .................................................................................................... 1
ANXIETY ............................................................................................... 2
DEPRESSION ......................................................................................... 3
NERVES/EMOTIONS/MENTAL HEALTH. ..........................................4
OTHER PSYCHOLOGICAL (SPECIFY BELOW)................................ 5
STRESS
OVERWORK ...........................................................................................10
TENSION .................................................................................................11
OTHER STRESSFUL EXPERIENCE (SPECIFY BELOW) ...................12
PHYSICAL ILLNESS/INJURY/CONDITION
CHRONIC FATIGUE SYNDROME ...................................................... 20
EXHAUSTION ....................................................................................... 21
HYPERVENTILATION ......................................................................... 22
HYPOCHONDRIASIS............................................................................ 23
MENSTRUAL CYCLE ............................................................................24
PREGNANCY/POSTPARTUM...............................................................25
HEART DISEASE................................................................................... 26
HIGH BLOOD PRESSURE .................................................................... 27
OVERWEIGHT....................................................................................... 28
OTHER PHYSICAL ILLNESS (SPECIFY BELOW) ............................ 29
MEDICATION/DRUGS/ALCOHOL
MEDICATION (SPECIFY BELOW)...................................................... 30
DRUGS (SPECIFY BELOW) ................................................................. 31
ALCOHOL .............................................................................................. 32
OTHER
NO DEFINITIVE DIAGNOSIS ...............................................................81
OTHER (SPECIFY BELOW) ..................................................................82
DON'T KNOW ........................................................................................ 88
REFUSED ................................................................................................99

SPECIFY:

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*N9.

INTERVIEWER CHECKPOINT: (SEE *N8) FOLLOW SKIP FOR FIRST ENDORSED ITEM
ONE OR MORE RESPONSES ARE CIRCLED IN 1-12 SERIES
(PSYCHOLOGICAL/STRESS) ....................................................................................1
ONE OR MORE RESPONSES ARE CIRCLED IN 30-32 SERIES
(MED/DRUGS/ALC)......................................................................................................2
ONE OR MORE RESPONSES ARE CIRCLED IN 20-29 SERIES
(PHYSICAL ILLNESS)..................................................................................................3
ALL OTHERS.................................................................................................................4

*N10.

GO TO *N14
GO TO *N13

GO TO *N15

INTERVIEWER CHECKPOINT: (SEE *N8)
ONE OR MORE RESPONSES ARE CIRCLED IN 20-29 SERIES
(PHYSICAL ILLNESS) ........................................................................................ 1
ALL OTHERS ........................................................................................................ 2

*N12.

GO TO *N10

Was your frequent tiredness always the result of taking medication, drugs, or alcohol?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

*N11.

GO TO *N16

GO TO *N15

When the tiredness was not due to taking medication, drugs, or alcohol, was it always the result of a
physical illness, or injury [such as (MENTIONS IN *N8)]?
YES ................................... 1
NO ..................................... 5
DON’T KNOW ................. 8
REFUSED ......................... 9
GO TO *N15

*N13.

Did they find anything abnormal when they examined you or took tests or x-rays?
YES ..................................................................... 1
NO ...................................................................... 5 GO TO *N15 NO
EXAMINATION PERFORMED ................ 6 GO TO *N15 DON’T
KNOW .................................................. 8
GO TO *N15
REFUSED .......................................................... 9
GO TO *N15

*N14.

Was your frequent tiredness always the result of a physical illness or injury [such as (MENTIONS IN *N8)]?
YES ................................... 1
NO ..................................... 5
DON’T KNOW ................. 8
REFUSED ......................... 9

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*N15.

Do you think that psychological factors ever played an important part in your frequent tiredness and other related
problems?
PSYCHOLOGICAL FACTORS IMPORTANT .......................... 1
PSYCHOLOGICAL FACTORS NOT IMPORTANT ................. 2
DON'T KNOW .............................................................................. 8
REFUSED ................................................................................. 9

*N16.

Can you remember your exact age the very first time in your life you had a period lasting several months or longer
when you were easily tired and had any of the other related problems that we just reviewed?
YES .................................... 1
NO ...................................... 5 GO TO *N16b
DON’T KNOW ................. 8 GO TO *N16b
REFUSED.......................... 9 GO TO *N16b

*N16a.

(IF NEC: How old were you?)
YEARS OLD

GO TO *N17

DON’T KNOW ................ 998
REFUSED ...................... 999

*N16b.

About how old were you (the first time you had a period of this sort)?
YEARS OLD
DON’T KNOW
....... 998
REFUSED ...................... 999

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*N17.

Did you have a period of a month or longer when you had these problems in the past 12 months?
YES ................................... 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9
*N17a.

GO TO *N17c
GO TO *N17c
GO TO *N17c

How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH..................................... 1
2-6 MONTHS AGO ............................. 2
MORE THAN 6 MONTHS AGO ........ 3
DON’T KNOW .................................... 8
REFUSED ............................................ 9

*N17b.

How many months in the past 12 months did you have frequent tiredness and any of the other problems
we reviewed?
MONTHS

GO TO *N18

DON’T KNOW ....................... 98
REFUSED ............................... 99
*N17c.

GO TO *N18
GO TO *N18

How old were you the last time you had frequent tiredness and any of the other problems we reviewed?
YEARS OLD
DON’T KNOW ....................... 998
REFUSED ............................... 999

*N18.

How many episodes of frequent tiredness lasting several months or longer have you had in your life?
EPISODES
DON’T KNOW .................... 998
REFUSED ............................ 999

*N19.

INTERVIEWER CHECKPOINT: (SEE *N18)
ONE EPISODE .............................................................................. 1
ALL OTHERS ............................................................................... 2

*N20.

GO TO *N21

How many months or years did that episode last?

_NUMBER
CIRCLE UNIT OF TIME:

GO TO *N25
MONTHS...............1

DON’T KNOW .....................998
REFUSED..............................999

YEARS ................ 2

GO TO *N25
GO TO *N25

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*N21.

How many months or years did the longest of these episodes last?

NUMBER
CIRCLE UNIT OF TIME:

MONTHS...............1

YEARS................ 2

DON’T KNOW ..................... 998
REFUSED ............................. 999

*N22.

How many different years in your life did you have at least one episode?
YEARS
DON’T KNOW .................... 998
REFUSED ............................ 999

*N25.

INTERVIEWER QUERY: (SEE *N17)
R HAD AN EPISODE IN THE PAST 12 MONTHS ................ 1
ALL OTHERS ........................................................................... 2

GO TO *N30

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No
Interference
0
*N26.

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

(RB, PG 9) Think about the month or longer in the past 12 when your tiredness and related problems were most
severe. Using a 0 to 10 scale on page 9 of your booklet, where 0 means no interference and 10 means very severe
interference, what number describes how much your tiredness and related problems interfered with each of the
following activities during that time?

(IF NEC: How much did your tiredness and related problems interfere with (ACTIVITY) during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)
NUMBER (0-10)

*N26a.

Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY ............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*N26b.

Your ability to work?
DOES NOT APPLY ............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*N26c.

Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY ............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*N26d.

Your social life?
DOES NOT APPLY ............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*N27.

INTERVIEWER CHECKPOINT: (SEE *N26a - *N26d)
ALL FOUR RESPONSES TO *N26a - *N26d SERIES EQUAL ‘0’ OR ‘97’................... 1
ALL OTHERS ...................................................................................................................... 2

GO TO *N30

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*N28.

About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your tiredness?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999

*N30.

INTERVIEWER CHECKPOINT: (SEE *N7)
“YES” RESPONSE IN *N7 ..........................1
ALL OTHERS ...............................................2

*N31.

How old were you the first time you ever talked to a medical doctor or other professional about your tiredness? (By
other professional we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other
healing professionals.)
YEARS OLD

DON’T KNOW .............. 998
REFUSED ...................... 999

*N32.

GO TO *N31
GO TO *N32

GO TO *N33 (GO TO *N44) **

(15h)

GO TO *N33 (GO TO *N44) **
GO TO *N33 (GO TO *N44) **

Did you ever in your life talk to a professional about your tiredness? (By professional we mean psychologists,
counselors, spiritual advisors, herbalists, acupuncturists, and other healing professionals.)
YES .................................................... 1
NO ..................................................... 5
DON’T KNOW ................................ 8
REFUSED......................................... 9
*N32a.

GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION

How old were you the first time (you talked to a professional about your tiredness)?
YEARS OLD
DON’T KNOW ............................. 998
REFUSED ..................................... 999

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*N44.

Did you ever get treatment for your tiredness that you considered helpful or effective?
YES ...................................1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *N44c
GO TO *N44c
GO TO *N44c

*N44a. How old were you the first time (you got helpful treatment for your tiredness)?
YEARS OLD
DON’T KNOW................. 998
REFUSED ........................ 999
*N44b. How many professionals did you ever talk to about your tiredness, up to and including the first
time you got helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW................ 98
REFUSED........................ 99

GO TO *N46

GO TO *N46
GO TO *N46

*N44c. How many professionals did you ever talk to about your tiredness?
NUMBER OF PROFESSIONALS
DON’T KNOW................. 98
REFUSED ........................ 99

*N46.

Did you receive professional treatment for your tiredness at any time in the past 12 months?
YES ...................................1
NO.....................................5
DON’T KNOW .................8
REFUSED .........................9

*N47.

Were you ever hospitalized overnight for your tiredness?
YES.................................................... 1
NO ..................................................... 5
DON’T KNOW ................................ 8
REFUSED......................................... 9

GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION
GO TO *FD1, NEXT SECTION

*N47a. How old were you the first time (you were hospitalized overnight because of your tiredness)?
YEARS OLD
DON’T KNOW................. 998
REFUSED ........................ 999
GO TO *OCD, NEXT SECTION

END OF SECTION
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O1.

O1a.

O1b.

O1c.

O1d.

O1e.

O2.

OBSESSIVE-COMPULSIVE DISORDER SECTION
Some people have repeated unpleasant thoughts, images, or impulses that they can’t get out of their heads.
For example, some people have the idea that their hands are dirty no matter how much they wash them. Did
you ever have a time in your life when you were bothered by any of the following:
YES NO
DK RF
(1)
(5)
(8)
(9)
A recurrent, persistent concern about dirt, germs, or contamination?
1
5
8
9
(KEY PHRASE: concerns about germs or contamination)
A recurrent, persistent concern about harming someone, or being
responsible for things going wrong?
(KEY PHRASE: concerns about causing harm)
A recurrent, persistent concern about having things symmetrical, lined
up, or ordered in exactly the right way, or a recurrent urge to count or
touch things?
(KEY PHRASE: concerns about symmetry and order)
A recurrent, persistent concern about having to save or keep things, even
if they have little monetary or sentimental value?
(KEY PHRASE: concerns about saving things)
Any another disturbing thought that kept entering your mind, such as
concerns about doing something terrible or morally wrong, sexual
thoughts that you found disturbing and unpleasant, or some other
repeated, upsetting thought, image, or impulse?
(KEY PHRASE: [and some other] recurrent, disturbing thoughts)

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

INTERVIEWER CHECKPOINT: (SEE O1a - O1e)
ONE OR MORE RESPONSES CODED ‘1’.......... 1
ALL OTHERS......................................................... 2

O3.

1

GO TO O21

You mentioned (KEY PHRASES OF ALL ‘YES’ RESPONSES IN O1a - O1e). I will use the phrase
“unpleasant thoughts” to refer to these thoughts, images, and impulses. The next questions focus only on these
thoughts, not on anything you might have done when the thoughts came to mind.
Sometimes unpleasant thoughts of this sort are related to day-to-day problems in areas like finances, work,
personal relationships, or planning for the future. How often did your unpleasant thoughts focus on day-to-day
problems – all the time, most of the time, sometimes, rarely, or never?
ALL ........................................ 1
MOST......................................2
SOME......................................3
RARELY ............................4
NEVER...............................5

GO TO O4
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DON’T KNOW ................. 8
REFUSED ....................... 9

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O3a.

How often did your unpleasant thoughts focus on things other than day-to-day problems – all the
time, most of the time, sometimes, rarely, or never?
ALL......................................... 1
MOST ..................................... 2
SOME ..................................... 3
RARELY ............................4
NEVER ...............................5
DON’T KNOW ..................8
REFUSED ........................9

O4.

Please give me a brief example of your unpleasant thoughts (that did not focus on day-to-day problems):
(PROBE FOR UP TO 3 EXAMPLES: Any other examples of unpleasant thoughts?)

O5.

How much did these unpleasant thoughts ever upset you or cause you emotional distress – extremely, a lot,
some, a little, or not at all?
EXTREMELY ....................1
A LOT.................................2
SOME .................................3
A LITTLE ...........................4
NOT AT ALL .....................5
DON’T KNOW ..................8
REFUSED ..........................9

O6.

During the time in your life when you had these unpleasant thoughts, how often did any of them seem
excessive or unreasonable to you – all the time, most of the time, sometimes, rarely, or never?
ALL.....................................1
MOST .................................2
SOME ................................3
RARELY ...........................4
NEVER ...............................5
DON’T KNOW ..................8
REFUSED ....................... 9
O6a.

GO TO O8
GO TO O8
GO TO O8
GO TO O8

Did you ever pay more attention to these unpleasant thoughts than they deserved?
YES.....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED .............................. 9

GO TO O8

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O7.

INTERVIEWER CHECKPOINT: (SEE O5):
O5 CODED ‘1’, ‘2’ OR ‘3’ ............................................................... 1
ALL OTHERS................................................................................... 2

O8.

GO TO O21

OFTEN
(1)

SOMETIMES
(2)

RARELY
(3)

NEVER
(4)

DK
(8)

RF
(9)

O8a. How often did you try to resist
the unpleasant thoughts or push
them out of your mind?

1
GO TO O9

2
GO TO O9

3

4

8

9

O8b. How often did you try to ignore
these unpleasant thoughts or
think about other things?

1
GO TO O9

2
GO TO O9

3

4

8

9

1

2

3

4

8

9

O8c. Some people react to unpleasant
thoughts by thinking or doing
something over and over. For
example, a person who worries
about leaving the door unlocked
might check the lock again and
again. Or a person who has a
terrible thought might pray,
count, or repeat words in his
mind over and over. How often
did you react to your unpleasant
thoughts by thinking or doing
something over and over?

O9. INTERVIEWER CHECKPOINT: (SEE O8a – O8c)
ONE OR MORE RESPONSES CODED ‘1’, ‘2’ OR ‘3’..............1
ALL OTHERS................................................................................2

O10.

GO TO O21

How often were these thoughts so strong that you could not get them out of your mind no matter how hard
you tried – often, sometimes, rarely, or never?
OFTEN ...............................1
SOMETIMES .....................2
RARELY ............................3
NEVER ...............................4
DON’T KNOW ..................8
REFUSED ....................... 9

O11.

How much did these thoughts ever interfere with either your work, your social life, or your personal
relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL .....................1
A LITTLE ...........................2
SOME......................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
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REFUSED ....................... 9

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O12.

Did you have any of these unpleasant thoughts in the past 12 months?
YES .....................................1
NO.......................................5
DON’T KNOW .................8
REFUSED .........................9

O12a.

GO TO O12c
GO TO O12c
GO TO O12c

How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH......................................... 1
2-6 MONTHS AGO ................................. 2
MORE THAN 6 MONTHS AGO ........... 3
DON’T KNOW ........................................ 8
REFUSED ................................................ 9

O12b.

About how many weeks altogether in the past 12 months did you have any of these unpleasant
thoughts?
WEEKS
DON’T KNOW ..................998
REFUSED ..........................999

O12c.

GO TO O13
GO TO O13

How old were you the last time you had any of these unpleasant thoughts?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

O13.

GO TO O13

GO TO O14
GO TO O14
GO TO O14

In the past 12 months, was there a time lasting two weeks or longer when you had any of these unpleasant
thoughts most days?
YES .....................................1
NO.......................................5
DON’T KNOW .................8
REFUSED .........................9
O13a.

GO TO O14
GO TO O14
GO TO O14

How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH......................................... 1
2-6 MONTHS AGO ................................. 2
MORE THAN 6 MONTHS AGO ........... 3
DON’T KNOW ........................................ 8
REFUSED ................................................ 9

O13b.

About how many weeks altogether in the past 12 months did you have any of these unpleasant
thoughts most days?
WEEKS
DON’T KNOW ..................998
REFUSED ..........................999

GO TO O15
GO TO O15
GO TO O15

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O14.

Was there ever a time in your life lasting two weeks or longer when you had any of these unpleasant
thoughts most days?
YES .....................................1
NO.......................................5
DON’T KNOW .................8
REFUSED .........................9
O14a.

GO TO O15
GO TO O15
GO TO O15

How old were you the last time you had any of these unpleasant thoughts most days for two weeks or
longer?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

O15.

INTERVIEWER CHECKPOINT (SEE O12):
O12 CODED ‘1’.................................................. 1
ALL OTHERS..................................................... 2

GO TO O21

O16. The next questions ask about your experiences with these unpleasant thoughts in the past 12 months. In the past
12 months, on average, how much of your time was occupied by these thoughts – less than 1 hour a day,
1 to 3 hours a day, more than 3 hours and up to 8 hours a day, or more than 8 hours a day?
LESS THAN 1 HOUR ............................. 1
1 TO 3 HOURS........................................... 2
MORE THAN 3, UP TO 8 HOURS. ........ 3
MORE THAN 8 HOURS......................... 4
DON’T KNOW ........................................ 8
REFUSED ............................................. 9

O17.

In the past 12 months, how much did these unpleasant thoughts interfere with your work, your social life, or
your personal relationships – not at all, a little, somewhat, a lot, extremely?
NOT AT ALL .....................1
A LITTLE ...........................2
SOME......................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ....................... 9

O18.

In the past 12 months, how much did these unpleasant thoughts upset you or make you anxious – not at all,
a little, somewhat, a lot, extremely?
NOT AT ALL .....................1
A LITTLE ...........................2
SOME .................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ..........................9

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O19.

In the past 12 months, how much of an effort did you make to resist these unpleasant thoughts or to turn your
attention away from them as they entered your mind – none, a little, some, a lot, or an extreme effort?
NONE..................................... 1
A LITTLE ...........................2
SOME......................................3
A LOT ................................ 4
EXTREME .............................5
DON’T KNOW ................. 8
REFUSED ....................... 9

O20.

How much control did you have over these unpleasant thoughts in the past 12 months – no control, little
control, moderate control, much control, or complete control?
NONE .................................1
LITTLE ...............................2
MODERATE ......................3
MUCH ................................4
COMPLETE .......................5
DON’T KNOW ..................8
REFUSED ..........................9

O21.

O21a.

O21b.

O21c.

O21d.

O21e.

O22.

Some people feel driven to do certain behaviors over and over, either physically or in their mind. For
example, some people check the stove in their home again and again, many times a day, no matter how
many times they see that the stove is turned off. Did you ever have a time in your life when you repeatedly
carried out any of the following behaviors:
YES NO
DK
RF
(1)
(5)
(8)
(9)
Repeatedly washing, cleaning, or decontaminating?
1
5
8
9
(KEY PHRASE: washing or cleaning)
Repeatedly checking things like locks or stoves, or repeatedly making
sure that no harm or injury was done to yourself or someone else?
(KEY PHRASE: checking things)
Repeatedly straightening, lining up, arranging, counting, or touching
things, or doing things in an exactly defined order?
(KEY PHRASE: ordering or touching things)
Always having to save things, to the point where you could not throw
away things that you no longer needed or cared about?
(KEY PHRASE: saving things)
Any other repetitive behaviors that you felt driven to do, such as going
over and over a moral argument in your mind, or praying over and over
for forgiveness, or some other physical or mental act you felt you had to
do repeatedly?
(KEY PHRASE: [and some other] behaviors you did over and over)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

INTERVIEWER CHECKPOINT (SEE O21a – O21e):
ONE OR MORE RESPONSES CODED ‘1’...............................................1
ALL OTHERS .............................................................................................. 2

GO TO O24

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O23.

INTERVIEWER CHECKPOINT (SEE O9):
O9 CODED ‘1’ .................................1
ALL OTHERS...................................2

O24.

GO TO O43
GO TO O74

You mentioned (KEY PHRASES OF ALL ‘YES’ RESPONSES IN O21a – O21e). I will use the phrase
“repeated behaviors” to refer to these repeated physical or mental acts. The next questions focus just on these
repeated behaviors, not the thoughts I asked about earlier.
During the time in your life when you were doing these repeated behaviors, how often did any of them
seem excessive or unreasonable to you – all the time, most of the time, sometimes, rarely, or never?
ALL.....................................1
MOST .................................2
SOME ................................3
RARELY ...........................4
NEVER ...............................5
DON’T KNOW ..................8
REFUSED ....................... 9
O24a.

GO TO O26
GO TO O26
GO TO O26
GO TO O26

Did you ever think these behaviors were useless or unnecessary, or that you overdid them?
YES.....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ........................9

O25.

INTERVIEWER CHECKPOINT (SEE O9):
O9 CODED ‘1’ .................................1
ALL OTHERS...................................2

O26.
O26a.

O26b.

O26c.

GO TO O26

GO TO O43
GO TO O74

OFTEN
(1)

SOMETIMES
(2)

RARELY
(3)

NEVER
(4)

DK
(8)

RF
(9)

How often did doing these
repeated behaviors make
you feel less anxious or
upset?

1
GO TO
O27

2
GO TO O27

3

4

8

9

How often did doing these
repeated behaviors keep you
from becoming anxious or
upset?

1
GO TO
O27

2
GO TO O27

3

4

8

9

1

2

3

4

8

9

How often did you ever feel
that something bad might
happen if you did not do
these repeated behaviors?

O27. INTERVIEWER CHECKPOINT: (SEE O26a – O26c)
ONE OR MORE RESPONSES CODED ‘1’, ‘2’ OR ‘3’..............1
ALL OTHERS................................................................................2

GO TO *O29
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O28.

How often did you try to resist doing these repeated behaviors – often, sometimes, rarely, or never?
OFTEN ...............................1
SOMETIMES .....................2
RARELY ............................3
NEVER .............................. 4
DON’T KNOW ..................8
REFUSED ....................... 9

O28a.

How often were the urges to carry out these behaviors ever so strong that you could not resist them
no matter how hard you tried – often, sometimes, rarely, or never?
OFTEN ..............................................1
SOMETIMES ....................................2
RARELY ...........................................3
NEVER ..............................................4
DON’T KNOW .................................8
REFUSED ...................................... 9

O28b.

Some people not only feel some relief when they do these behaviors, but also find them pleasurable
or enjoyable. How often did you find these repeated behaviors pleasurable – often, sometimes,
rarely, or never?
OFTEN ..............................................1
SOMETIMES ....................................2
RARELY ...........................................3
NEVER ..............................................4
DON’T KNOW .................................8
REFUSED ...................................... 9

O29. INTERVIEWER CHECKPOINT: (SEE O27, O28a)
O27 CODED ‘1’ .............................................................1
O28a CODED ‘1’, ‘2’ OR ‘3’ ........................................2
ALL OTHERS .................................................................3

O30.

INTERVIEWER CHECKPOINT (SEE O9):
O9 CODED ‘1’.................................................1
ALL OTHERS ..................................................2

O31.

GO TO O31
GO TO O31

GO TO O43
GO TO O74

How much did these repeated behaviors ever upset you or cause you emotional distress – extremely, a lot,
some, a little, or not at all?
EXTREMELY ....................1
A LOT.................................2
SOME .................................3
A LITTLE ...........................4
NOT AT ALL .....................5
DON’T KNOW ..................8
REFUSED ..........................9

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O32.

How much did these repeated behaviors ever interfere with either your work, your social life, or your
personal relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL .....................1
A LITTLE ...........................2
SOME......................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ....................... 9

O33.

Did you carry out any of these repeated behaviors in the past 12 months?
YES .....................................1
NO.......................................5
DON’T KNOW .................8
REFUSED .........................9
O33a.

GO TO O33c
GO TO O33c
GO TO O33c

How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH......................................... 1
2-6 MONTHS AGO ................................. 2
MORE THAN 6 MONTHS AGO ........... 3
DON’T KNOW ........................................ 8
REFUSED ................................................ 9

O33b.

About how many weeks altogether in the past 12 months did you carry out any of these repeated
behaviors?
WEEKS
DON’T KNOW ..................998
REFUSED ..........................999

O33c.

GO TO O34
GO TO O34

How old were you the last time you carried out any of these repeated behaviors?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

O34.

GO TO O34

GO TO O35
GO TO O35
GO TO O35

In the past 12 months, was there a time lasting two weeks or longer when you carried out any of these
repeated behaviors most days?
YES .....................................1
NO.......................................5
DON’T KNOW .................8
REFUSED .........................9
O34a.

GO TO O35
GO TO O35
GO TO O35

How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH......................................... 1
2-6 MONTHS AGO ................................. 2
MORE THAN 6 MONTHS AGO ........... 3
DON’T KNOW ........................................ 8
REFUSED ................................................ 9
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
O34b.

About how many weeks altogether in the past 12 months did you carry out any of these repeated
behaviors most days?
WEEKS

GO TO O36

DON’T KNOW ..................998
REFUSED ..........................999

O35.

GO TO O36
GO TO O36

Was there ever a time in your life lasting two weeks or longer when you carried out any of these repeated
behaviors most days?
YES .....................................1
NO.......................................5
DON’T KNOW .................8
REFUSED .........................9
O35a.

GO TO O36
GO TO O36
GO TO O36

How old were you the last time you carried out any of these repeated behaviors most days for two
weeks or longer?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

O36.

INTERVIEWER CHECKPOINT (SEE O33):
O33 CODED ‘1’.................................................. 1
ALL OTHERS..................................................... 2

O37.

GO TO O43

The next questions ask about your experiences with these repeated behaviors in the past 12 months. In the
past 12 months, on average, how much time did you spend performing these behaviors – less than 1 hour a
day, 1 to 3 hours a day, more than 3 hours and up to 8 hours a day, or more than 8 hours a day?
LESS THAN 1 HOUR ............................. 1
1 TO 3 HOURS........................................... 2
MORE THAN 3, UP TO 8 HOURS. ........ 3
MORE THAN 8 HOURS......................... 4
DON’T KNOW ........................................ 8
REFUSED ............................................. 9

O38.

In the past 12 months, how much did these repeated behaviors interfere with your work, your social life, or
your personal relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL .....................1
A LITTLE ...........................2
SOME......................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ....................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
O39.

In the past 12 months, how anxious would you have felt if you were prevented from performing these
repeated behaviors – not at all, mildly, moderately, severely, or extremely?
NOT AT ALL .....................1
MILDLY .............................2
MODERATELY ................3
SEVERELY ........................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ..........................9

O40.

In the past 12 months, how much of an effort did you make to resist doing these repeated behaviors – none, a
little, some, a lot, or an extreme effort?
NONE......................................1
A LITTLE ...........................2
SOME......................................3
A LOT.................................4
EXTREME .............................5
DON’T KNOW ..................8
REFUSED ....................... 9

O41.

How much control did you have over these repeated behaviors in the past 12 months – no control, little
control, moderate control, much control, or complete control?
NONE .................................1
LITTLE ...............................2
MODERATE ......................3
MUCH ................................4
COMPLETE .......................5
DON’T KNOW ..................8
REFUSED ..........................9

O42.

In the past 12 months, how much did these repeated behaviors upset or bother you – not at all, a little,
some, a lot, or extremely?
NOT AT ALL .....................1
A LITTLE ...........................2
SOME......................................3
A LOT.................................4
EXTREMELY ....................5
DON’T KNOW ..................8
REFUSED ....................... 9

O43.

INTERVIEWER CHECKPOINT: (SEE O12, O33)
O12 CODED ‘1’..............................................................1
O33 CODED ‘1’..............................................................2
ALL OTHERS .................................................................3

O44.

GO TO O53

INTERVIEWER CHECKPOINT (SEE O9):
O9 CODED ‘1’....................................................................... 1
ALL OTHERS........................................................................ 2

GO TO O46
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O45.

INTERVIEWER CHECKPOINT: (SEE O29)
O29 CODED ‘1’ OR ‘2’ ........................................................ 1
ALL OTHERS ........................................................................ 2

GO TO O47
GO TO O48

INTERVIEWER INSTRUCTIONS: REFER TO “REPEATED BEHAVIORS” FOR THE REMAINDER
OF THE SECTION. DO NOT REFER TO THOUGHTS.

O46.

GO TO O49 INTRO1
INTERVIEWER INSTRUCTIONS: REFER TO “UNPLEASANT THOUGHTS OR REPEATED
BEHAVIORS” FOR THE REMAINDER OF THE SECTION.

O47.

GO TO O49 INTRO2

O48.

INTERVIEWER INSTRUCTIONS: REFER TO “UNPLEASANT THOUGHTS” FOR THE
REMAINDER OF THE SECTION. DO NOT REFER TO BEHAVIORS.
GO TO O49 INTRO3

O49 INTRO1
Think about the month or longer in
the past 12 months when your
repeated behaviors were most
severe.

No
Interference
0

O49.

O49 INTRO2
The next questions ask about these
repeated behaviors and the
unpleasant thoughts you mentioned
earlier. Think about the month or
longer in the past 12 months when
these thoughts or behaviors were
most severe.

Mild
1

2

O49 INTRO3
The next questions ask about the
unpleasant thoughts you mentioned
earlier. Think about the month or
longer in the past 12 months when
your unpleasant thoughts were most
severe.

Moderate
3

4

5

Severe
6

7

8

Very Severe
Interference
9 10

(RB, PG 9) Using a 0 to 10 scale on page 9 of your booklet, where 0 means no interference and 10 means
very severe interference, what number describes how much these (unpleasant thoughts/ unpleasant thoughts
or repeated behaviors/ repeated behaviors) interfered with each of the following activities during that time?
(IF NEC: How much did these (unpleasant thoughts/ unpleasant thoughts or repeated behaviors/ repeated
behaviors) interfere with (ACTIVITY) during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)
NUMBER (0-10)

O49a.

Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
REFUSED .............................. 99

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
O49b.

Your ability to work?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

O49c.

Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

O49d.

Your social life?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

O50.

INTERVIEWER CHECKPOINT: (SEE O49a - O49d)
ALL FOUR RESPONSES TO O49a-O49d CODED ‘0’ OR ‘97’ ............................. 1
ALL OTHERS............................................................................................................. 2

O51.

GO TO O52

About how many days out of 365 in the past 12 months were you totally unable to work or carry out your
normal activities because of these (unpleasant thoughts / unpleasant thoughts or repeated behaviors/
repeated behaviors)?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999

O52. The next questions ask about your experiences with these (unpleasant thoughts/ unpleasant thoughts or
repeated behaviors/ repeated behaviors) since they first began. Experiences of this sort sometimes occur as a
result of physical causes such as physical illness or injury or the use of medication, drugs, or alcohol. Do you
think your (unpleasant thoughts/ unpleasant thoughts or repeated behaviors/ repeated behaviors) ever occurred
as a result of such physical causes?
YES.....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO O58a
GO TO O59
GO TO O59
GO TO O59

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O53.

INTERVIEWER CHECKPOINT (SEE O9):
O9 CODED ‘1’....................................................................... 1
ALL OTHERS ........................................................................ 2

O54.

INTERVIEWER CHECKPOINT: (SEE O29)
O29 CODED ‘1’ OR ‘2’ ........................................................ 1
ALL OTHERS ........................................................................ 2

O55.

GO TO O55

GO TO O56
GO TO O57

INTERVIEWER INSTRUCTIONS: REFER TO “REPEATED BEHAVIORS” FOR THE REMAINDER
OF THE SECTION. DO NOT REFER TO THOUGHTS.
GO TO O58 INTRO1

O56.

INTERVIEWER INSTRUCTIONS: REFER TO “UNPLEASANT THOUGHTS OR REPEATED
BEHAVIORS” FOR THE REMAINDER OF THE SECTION.
GO TO O58 INTRO2

O57.

INTERVIEWER INSTRUCTIONS: REFER TO “UNPLEASANT THOUGHTS” FOR THE
REMAINDER OF THE SECTION. DO NOT REFER TO BEHAVIORS.
GO TO O58 INTRO3

O58 INTRO1
The next questions ask about your
experiences with these repeated
behaviors since they first began.

O58.

O58 INTRO2
The next questions ask about your
experiences with these repeated
behaviors, and the unpleasant
thoughts you mentioned earlier,
since they first began.

O58 INTRO3
The next questions ask about your
experiences with the unpleasant
thoughts you mentioned earlier,
since these thoughts first began.

Experiences of this sort sometimes occur as a result of physical causes such as physical illness or injury or the
use of medication, drugs, or alcohol. Do you think your (unpleasant thoughts/ unpleasant thoughts or repeated
behaviors/ repeated behaviors) ever occurred as a result of such physical causes?
YES .....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO O59
GO TO O59
GO TO O59

O58a. Do you think they were always the result of physical causes?
YES .....................................1
NO.......................................5 GO TO O59
DON’T KNOW ..................8 GO TO O59
REFUSED ..........................9 GO TO O59

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
O58b.

What were these physical causes?
CHECK ALL MENTIONS
PHYSICAL ILLNESS/INJURY
EXHAUSTION ..............................................................................1
MENSTRUAL CYCLE .................................................................2
PREGNANCY/POSTPARTUM ............................................................3
HEART DISEASE .........................................................................4
THYROID DISEASE ........................................................................ 5
CANCER .................................................................................................. 6
OVERWEIGHT .............................................................................7
INFECTION [FOR EXAMPLE: THROAT INFECTION] ..........8
OTHER PHYSICAL ILLNESS OR INJURY (SPECIFY) ...........9
MEDICATION/DRUGS/ALCOHOL
MEDICATION (SPECIFY BELOW) .......................................... 10
DRUGS (SPECIFY BELOW) ...................................................... 11
ALCOHOL ................................................................................ 12
OTHER
NO DEFINITIVE DIAGNOSIS ....................................................... 81
OTHER (SPECIFY BELOW)........................................................82
DON’T KNOW ............................................................................. 98
REFUSED ......................................................................................99
SPECIFY

O59.

Some people only have experiences like these when they are sad or depressed. Did the (unpleasant thoughts/
unpleasant thoughts or repeated behaviors/ repeated behaviors) usually occur during times when you were sad
or depressed?
YES ...................................... 1
NO.....................................5
DON’T KNOW ................8
REFUSED ........................9
O59a.

GO TO O60
GO TO O60
GO TO O60

Did you ever have these (unpleasant thoughts/ unpleasant thoughts or repeated behaviors/ repeated
behaviors) when you were not sad or depressed?
YES ............................. 1
NO............................... 5
DON’T KNOW .......... 8
REFUSED .................. 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
O60.

Think of the very first time in your life when you experienced (the unpleasant thoughts/ the unpleasant
thoughts or repeated behaviors/ the repeated behaviors). Can you remember your exact age?
YES ...................................... 1
NO.....................................5
DON’T KNOW ................8
REFUSED ........................9

O60a.

GO TO O60b
GO TO O60b
GO TO O60b

(IF NEC: How old were you?)
YEARS OLD
DON’T KNOW ..................998
REFUSED .........................999

O60b.

GO TO O61
GO TO O61
GO TO O61

About how old were you (the first time you had an experience of this sort)?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL .................... 4
BEFORE TEENS .......................................... 12
BEFORE 20s ................................................. 19
WHOLE LIFE OR DON’T KNOW .............. 998
REFUSED ..................................................... 999

O61.

How many different years in your life did you have these experiences?
YEARS
DON’T KNOW ................998
REFUSED ........................ 999

O62.

INTERVIEWER CHECKPOINT: (SEE O13, O14)
O13 CODED ‘1’..................................................................... 1
O14 CODED ‘1’..................................................................... 2
ALL OTHERS ........................................................................ 3

O63.

GO TO O64
GO TO O64

INTERVIEWER CHECKPOINT: (SEE O34, O35)
O34 CODED ‘1’..................................................................... 1
O35 CODED ‘1’..................................................................... 2
ALL OTHERS ........................................................................ 3

GO TO O66

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
O64. Now think of the very first time in your life you had two weeks or longer when most days you experienced
(unpleasant thoughts/ unpleasant thoughts or repeated behaviors/ repeated behaviors). Can you remember
your exact age?
YES ...................................1
NO.....................................5
DON’T KNOW ................8
REFUSED ........................9

O64a.

GO TO O64b
GO TO O64b
GO TO O64b

(IF NEC: How old were you?)
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

O64b.

GO TO O65
GO TO O65
GO TO O65

About how old were you (the first time you had two weeks of this sort)?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL .................... 4
BEFORE TEENS .......................................... 12
BEFORE 20s ................................................. 19
WHOLE LIFE OR DON’T KNOW .............. 998
REFUSED ..................................................... 999

O65.

How many different years in your life did you have a time lasting two weeks or longer when you had these
experiences most days?
YEARS
DON’T KNOW 998
REFUSED ........................ 999

O66.

Think of the time in your life when these (unpleasant thoughts/ unpleasant thoughts and repeated behaviors/
repeated behaviors) were most frequent. About how many minutes or hours each day did you spend (with
these unpleasant thoughts on your mind/ either with these unpleasant thoughts on your mind, or carrying out
repeated behaviors/ carrying out these repeated behaviors)?
PROBE FINAL DK: Was it more than 60 minutes a day?
NUMBER
CIRCLE UNIT OF TIME:

MINUTES….1

HOURS….2

DON’T KNOW
...... 98
REFUSED ......................................99

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O67.

INTERVIEWER CHECKPOINT: (SEE O45, O54)
O45 CODED ‘1’..................................................................... 1
O54 CODED ‘1’..................................................................... 2
ALL OTHERS ........................................................................ 3

O68.

GO TO O69

Were you bothered mainly by unpleasant thoughts, mainly by repeated behaviors, or about equally by both
the thoughts and behaviors?
THOUGHTS……………1
BEHAVIORS…………...2
EQUAL…………………3
DON’T KNOW…………8
REFUSED………………9

O69.

Did you ever in your life talk to a medical doctor or other professional about these (unpleasant thoughts/
unpleasant thoughts or repeated behaviors/ repeated behaviors)? (By other professional we mean
psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other healing professionals).
YES ...................................1
NO.....................................5
DON’T KNOW ................8
REFUSED ........................9

O70.

GO TO O74
GO TO O74
GO TO O74

How old were you the first time (you talked to a medical doctor or other professional about these
[unpleasant thoughts/ unpleasant thoughts or repeated behaviors/ repeated behaviors])?
YEARS OLD
DON’T KNOW .............. 998
REFUSED ...................... 999

O71.

Did you ever get treatment for these (unpleasant thoughts/ unpleasant thoughts or repeated behaviors/
repeated behaviors) that you considered helpful or effective?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9
O71a.

GO TO O71c
GO TO O71c
GO TO O71c

How old were you the first time (you got helpful treatment for these [unpleasant thoughts/
unpleasant thoughts or repeated behaviors/ repeated behaviors])?
YEARS OLD
DON’T KNOW .................998
REFUSED .........................999

O71b.

How many professionals did you ever talk to about these (unpleasant thoughts/ unpleasant
thoughts or repeated behaviors/ repeated behaviors), up to and including the first time you got
helpful treatment?
NUMBER OF PROFESSIONALS GO TO O72
DON’T KNOW.................98

GO TO O72
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
REFUSED.........................99

GO TO O72

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O71c.

How many professionals did you ever talk to about these (unpleasant thoughts/ unpleasant thoughts
or repeated behaviors/ repeated behaviors)?
NUMBER OF PROFESSIONALS
DON’T KNOW .................98
REFUSED .........................99

O72.

Did you receive professional treatment for these (unpleasant thoughts/ unpleasant thoughts or repeated
behaviors/ repeated behaviors) at any time in the past 12 months?
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW................................. 8
REFUSED ......................................9

O73.

Were you ever hospitalized overnight for these (unpleasant thoughts/ unpleasant thoughts or repeated
behaviors/ repeated behaviors)?
YES ................................................... 1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9
O73a.

GO TO O74
GO TO O74
GO TO O74

How old were you the first time (you were hospitalized overnight because of these [unpleasant thoughts/
unpleasant thoughts or repeated behaviors/ repeated behaviors])?
YEARS OLD
DON’T KNOW ................998
REFUSED ........................999

O73b. How many separate times were you ever hospitalized for these (unpleasant thoughts/ unpleasant thoughts
or repeated behaviors/ repeated behaviors)?
NUMBER OF TIMES DON’T
KNOW
...............998
REFUSED .........................999

O74.

INTERVIEWER CHECKPOINT: (SEE RESPONDENT’S ID NUMBER) RANDOM 30% OF
RESPONDENTS................................................. 1
ALL OTHERS .......................................................................................2

GO TO PS1

END OF SECTION

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PSYCHOSIS SCREEN (PS)
*PS1.

The next questions are about unusual things, like seeing visions or hearing voices. We believe that these things may be
quite common, but we don't know for sure because previous research has not done a good job asking about them. So
please take your time and think carefully before answering.
YES
NO
DK
RF
(1)
(5)
(8)
(9)
*PS1a. The first thing is seeing a vision -- that is, seeing something that other people who
5
8
9
were there could not see. Did you ever see a vision that other people could not
GO
GO
GO
see?
1
TO
TO
TO
*PS1b *PS1b *PS1b
(KEY PHRASE: saw a vision)
*PS1a.1. Did this every happen when you were not dreaming, not half-asleep, and not
5
8
9
under the influence of alcohol or drugs?
GO
GO
GO
1
TO
TO
TO
*PS1b *PS1b *PS1b
*PS1a.2. About how many times in your life did this ever happen (when you saw a vision when you were not dreaming, not
half-asleep, and not under the influence of alcohol or drugs)?
TIMES
DON’T KNOW ........................... 998
REFUSED ................................... 999
*PS1a.3. Could you give me a brief example of a time when this happened?

*PS1a.4. What do you think caused this to happen?

*PS1b. The second thing is hearing voices that other people could not hear. I don't mean
having good hearing, but rather hearing things that other people said did not exist,
like strange voices coming from inside your head talking to you or about you, or
voices coming out of the air when there was no one around. Did you ever hear
voices in this way?
(KEY PHRASE: heard voices)
*PS1b.1. Did this every happen when you were not dreaming, not half-asleep, and not
under the influence of alcohol or drugs?

1

5
GO
TO
*PS1c

8
GO
TO
*PS1c

9
GO
TO
*PS1c

1

5
GO
TO
*PS1c

8
GO
TO
*PS1c

9
GO
TO
*PS1c
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YES
NO
DK
RF
(1)
(5)
(8)
(9)
*PS1b.2. About how many times in your life did this ever happen (when you heard voices when you were not dreaming, not
half-asleep, and not under the influence of alcohol or drugs)?
TIMES
DON’T KNOW ............................................ 998
REFUSED .................................................... 999
*PS1b.3. Could you give me a brief example of a time when this happened?

*PS1b.4. What do you think caused this to happen?

*PS1c. The third thing is really two. One is believing that some mysterious force was
inserting many different strange thoughts -- that were definitely not your own
thoughts – directly into your head by means of x-rays or laser beams or other
methods. The other is believing that your own thoughts were being stolen out of
your mind by some strange force. Did you ever have either of these mind control
experiences?

1

5
GO
TO
*PS1d

8
GO
TO
*PS1d

9
GO
TO
*PS1d

(KEY PHRASE: experienced mind control)
*PS1c.1. Did this every happen when you were not dreaming, not half-asleep, and not
under the influence of alcohol or drugs?

5
8
9
GO
GO
GO
1
TO
TO
TO
*PS1d *PS1d *PS1d
*PS1c.2. About how many times in your life did this ever happen (when you experienced mind control when you were not
dreaming, not half-asleep, and not under the influence of alcohol or drugs)?
TIMES
DON’T KNOW ........................... 998
REFUSED ................................... 999

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YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5
GO
TO
*PS1e

8
GO
TO
*PS1e

9
GO
TO
*PS1e

*PS1c.3. Could you give me a brief example of a time when this happened?

*PS1c.4. What do you think caused this to happen?

*PS1d.

The fourth unusual thing is feeling that your mind was being taken over by
strange forces with laser beams or other methods that were making you do things
you did not choose to do. Did you ever have a time when you felt that your mind
was being taken over by strange forces?

(KEY PHRASE: felt that your mind was being taken over by strange forces)
*PS1d.1. Did this every happen when you were not dreaming, not half-asleep, and not
under the influence of alcohol or drugs?

5
8
9
GO
GO
GO
1
TO
TO
TO
*PS1e *PS1e *PS1e
*PS1d.2. About how many times in your life did this ever happen (when you felt that your mind was being taken over by
strange forces when you were not dreaming, not half-asleep, and not under the influence of alcohol or drugs)?
TIMES
DON’T KNOW ............................................ 998
REFUSED .................................................... 999
*PS1d.3. Could you give me a brief example of a time when this happened?

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YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5
GO
TO
*PS1f

8
GO
TO
*PS1f

9
GO
TO
*PS1f

*PS1d.4. What do you think caused this to happen?

*PS1e. The fifth thing is believing that some strange force was trying to communicate
directly with you by sending special signs or signals that you could understand
but that no one else could understand. Sometimes this happens by special signs
coming through the radio or television. Did you ever experience these kinds of
attempts at communication from strange forces?
(KEY PHRASE: experienced attempts at communication from strange forces)
*PS1e.1. Did this every happen when you were not dreaming, not half-asleep, and not
under the influence of alcohol or drugs?

5
8
9
GO
GO
GO
1
TO
TO
TO
*PS1f *PS1f *PS1f
*PS1e.2. About how many times in your life did this ever happen (when you experienced attempts at communication from
strange forces when you were not dreaming, not half-asleep, and not under the influence of alcohol or drugs)?
TIMES
DON’T KNOW ........................... 998
REFUSED ................................... 999
*PS1e.3. Could you give me a brief example of a time when this happened?

*PS1e.4. What do you think caused this to happen?

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YES
(1)

NO
DK
RF
(5)
(8)
(9)
5
8
9
*PS1f. Sixth, did you ever believe that there was an unjust plot going on to harm you or
to have people follow you that your family and friends did not believe was true?
GO
GO
GO
1
TO
TO
TO
(KEY PHRASE: believed there was a plot to harm you)
*PS2
*PS2
*PS2
*PS1f.1. Did this every happen when you were not dreaming, not half-asleep, and not
5
8
9
under the influence of alcohol or drugs?
GO
GO
GO
1
TO
TO
TO
*PS2
*PS2
*PS2
*PS1f.2. About how many times in your life did this ever happen (when you believed there was a plot to harm you when you
were not dreaming, not half-asleep, and not under the influence of alcohol or drugs)?
TIMES
DON’T KNOW ............................................ 998
REFUSED .................................................... 999
*PS1f.3. Could you give me a brief example of a time when this happened?

*PS1f.4. What do you think caused this to happen?

*PS2. INTERVIEWER CHECKPOINT: (SEE *PS1a.1, *PS1b.1, *PS1c.1, *PS1d.1, *PS1e.1, *PS1f.1)
ONE OR MORE RESPONSES CODED ‘1’ IN *PS1a.1, *PS1b.1, *PS1c.1,
*PS1d.1, *PS1e.1, *PS1f.1 ...................................................................................................... 1
ALL OTHERS.......................................................................................................................... 2

*PS3.

GO TO NEXT SECTION

Let me review. You (KEY PHRASE FOR ALL YES MENTIONS IN *PS1a - *PS1f). How old were you the
very first time (this/either of these things/any of these things) happened to you?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

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*PS4.

(Has/Have) (this/either of these things/any of these things) happened to you at any time in the past 12 months?
YES .........................................1
NO.......................................5
DON'T KNOW...................8
REFUSED ..........................9

*PS5.

GO TO *PS6
GO TO *PS6
GO TO *PS6

About how many different days did (this/either of these things/any of these things) happen to you in the past 12
months?
NUMBER OF TIMES
DON’T KNOW ..................998
REFUSED ..........................999

*PS6.

About how many different times have you had (this/either of these things/any of these things) happen to you in
your entire life?
NUMBER OF TIMES
DON’T KNOW ..................998
REFUSED ..............................999

*PS7.

Did you ever talk to a doctor or mental health professional for help in dealing with (this/these) experience(s)?
YES .........................................1
NO.......................................5
DON'T KNOW...................8
REFUSED ..........................9

*PS8.

GO TO *GM1, NEXT SECTION
GO TO *GM1, NEXT SECTION
GO TO *GM1, NEXT SECTION

What did the doctor say was causing (this/these) experience(s)?
INTERVIEWER: CIRCLE ALL MENTIONS
SCHIZOPHRENIA/PSYCHOSIS .................................................1
MANIC-DEPRESSION/MANIA ..................................................2
EMOTIONS/NERVES/MENTAL HEALTH ...............................3
PHYSICAL ILLNESS/ INJURY ...................................................4
MEDICATION/DRUGS/ALCOHOL ...........................................5
OTHER (SPECIFY) .......................................................................6

DON’T KNOW ..............................................................................8
REFUSED ......................................................................................9

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*PS9.

Were you ever hospitalized because of (this/these) experience(s)?
YES......................................... 1
NO........................................... 5
DON'T KNOW .................. 8
REFUSED .............................. 9

*PS10. (RB, PG 52) This is a list of medications commonly taken by people who have experiences like the (one/ones) you had.
Did you ever take any of these medications?
YES......................................... 1
NO.......................................5
DON'T KNOW...................8
REFUSED ..........................9

GO TO *GM1, NEXT SECTION
GO TO *GM1, NEXT SECTION
GO TO *GM1, NEXT SECTION

*PS10a. Did you take any of these medications in the past 12 months?
YES ....................................... 1
NO ......................................... 5
DON'T KNOW ................ 8
REFUSED ............................ 9
*SC24 EQUALS ‘1’…………………………………. GO TO *M1
*SC25a EQUALS ‘1’……………………………. GO TO *M5
[OTHERWISE, GO TO EATING DISORDER - *EA]

MANIA (M)
*M1.

Earlier in the interview you mentioned having an episode lasting four days or longer when you felt much more excited
and full of energy than usual and your mind went too fast. (READ SLOWLY) People who have episodes like this often
have changes in their thinking and behavior at the same time, like being more talkative, needing very little sleep, being
very restless, going on buying sprees, and behaving in ways they would normally think are inappropriate. Did you ever
have any of these changes during your episodes of being excited and full of energy?
YES................................................. 1
NO ................................................... 5
DON’T KNOW ............................... 8
REFUSED. ...................................... 9

*M1a.

GO TO *M3

INTERVIEWER CHECKPOINT: (SEE *SC25a)
*SC25a IS CHECKED .............................................................1
ALL OTHERS ............................................................................. 2

*M3.

GO TO *M5
GO TO *M54

Please think of the one episode when you were very excited and full of energy and you had the
largest number of changes like these at the same time. Is there one episode of this sort that stands
out in your mind?
YES ................................................. 1
NO .................................................. 5
DON’T KNOW............................... 8
REFUSED....................................... 9
*M3a.

GO TO *M3c
GO TO *M3c
GO TO *M3c

How old were you when that episode occurred?
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
YEARS OLD
DON’T KNOW ................. 998
REFUSED.......................... 999
*M3b. How long did that episode last?
NUMBER
CIRCLE UNIT OF TIME:

GO TO *M4
HOURS ... 1

DAYS.....2 WEEKS ...3

YEARS…5 DON’T KNOW ..................... 998
REFUSED ............................. 999
GO TO *M4

MONTHS ..... 4
GO TO *M4

*M3c. Then think of the most recent time you had an episode like this. How old were you when that most recent episode
occurred?
YEARS OLD
DON’T KNOW ................. 998
REFUSED.......................... 999
*M3d. How long did that episode last?
NUMBER
CIRCLE UNIT OF TIME: HOURS ... 1
DON’T KNOW ..................... 998
REFUSED ............................. 999

*M4.

DAYS.....2 WEEKS ...3

MONTHS ..... 4 YEARS…5

During that episode, which of the following behavior changes did you experience: were you so irritable or grouchy that
you started arguments, shouted at people, or hit people?
YES ...................................1
NO .....................................5
DON’T KNOW .................8
REFUSED .........................9
INTERVIEWER INSTRUCTION: USE THE PHRASE “EXCITED AND FULL OF ENERGY” THROUGHOUT
THIS SECTION
GO TO *M7a

*M5.

Earlier in the interview you mentioned having episodes lasting four days or longer when you became so irritable or
grouchy that you started arguments, shouted at people, or hit people.
(READ SLOWLY) People who have episodes of irritability like this often have changes in their thinking and
behavior at the same time, like being more talkative, needing very little sleep, being very restless, going on buying
sprees and behaving in ways they would normally think are inappropriate. Did you ever have any of these changes
during your episodes of being very irritable or grouchy?
YES ...................................1
NO ....................................5
DON’T KNOW.................8
REFUSED.........................9

GO TO *M54
GO TO *M54
GO TO *M54

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*M6.

Please think of the episode of four days or more when you were very irritable or grouchy and you had the largest
number of changes like these at the same time. Is there one episode of this sort that stands out in your mind?
YES ...................................1
NO ....................................5
DON’T KNOW.................8
REFUSED.........................9

*M6a.

GO TO *M6c
GO TO *M6c
GO TO *M6c

How old were you when that episode occurred?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999

*M6b. How long did that episode last?
NUMBER

CIRCLE UNIT OF TIME:

GO TO *M7

HOURS ... 1

DON’T KNOW ..................... 998
REFUSED ............................. 999

DAYS.....2 WEEKS ...3

MONTHS ..... 4 YEARS…5

GO TO *M7
GO TO *M7

INTERVIEWER INSTRUCTION: USE THE PHRASE “IRRITABLE OR GROUCHY” THROUGHOUT
THIS SECTION

*M6c. Then think of the most recent time you had an episode like this. How old were you when that most recent
episode occurred?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999
*M6d.

How long did that episode last?
NUMBER
CIRCLE UNIT OF TIME:

HOURS ... 1

DAYS.....2 WEEKS ...3

MONTHS ..... 4 YEARS…5

DON’T KNOW ..................... 998
REFUSED ............................. 999
INTERVIEWER INSTRUCTION: USE THE PHRASE “IRRITABLE OR GROUCHY” THROUGHOUT
THIS SECTION

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*M7.

During that episode, which of the following changes did you experience:

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*M7a. Did you become so restless or fidgety that you paced up and down or
couldn’t stand still?
(KEY PHRASE: being restless)
*M7b. Were you a lot more interested in sex than usual, or did you want to have
sexual encounters with people you wouldn’t ordinarily be interested in?
(KEY PHRASE: having a lot more interest in sex than usual)
*M7c.

Did you become overly friendly or outgoing with people?
(KEY PHRASE: being overly friendly or outgoing)

*M7d. Did you do anything else that wasn’t usual for you - - like talking about
things you would normally keep private, or acting in ways that you’d
usually find embarrassing?
(KEY PHRASE: behaving inappropriately)
*M7e.

Did you try to do things that were impossible to do, like taking on large
amounts of work?
(KEY PHRASE: trying to accomplish unrealistic goals)

*M7f.

Did you talk a lot more than usual or feel a need to keep talking all the
time?
(KEY PHRASE: talking a lot more than usual)

*M7g. Did you constantly keep changing your plans or activities?
(KEY PHRASE: constantly changing plans)
*M7h. Did you find it hard to keep your mind on what you were doing?
(KEY PHRASE: hard to keep your mind on things)
*M7i.

Did your thoughts seem to jump from one thing to another or race
through your head so fast you couldn’t keep track of them?
(KEY PHRASE: thoughts racing)

*M7j.

Did you sleep far less than usual and still not get tired or sleepy?
(KEY PHRASE: sleeping far less than usual)

*M7k. Did you get involved in foolish investments or schemes for making
money?
(KEY PHRASE: getting involved in foolish schemes)

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YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*M7l. Did you spend so much more money than usual that it caused you to have
financial trouble?
(KEY PHRASE: getting into financial trouble)
*M7m. Did you do reckless things like driving too fast, staying out all night, or
having casual or unsafe sex?
(KEY PHRASE: doing risky things)
*M7n. Did you have a greatly exaggerated sense of self-confidence or believe
you could do things you really couldn’t do?
(KEY PHRASE: having too much self-confidence)
*M7o. Did you have the idea that you were actually someone else, or that you
had a special connection with a famous person that you really didn’t
have?
(KEY PHRASE: believing you were someone else or somehow
connected to a famous person)

*M8.

INTERVIEWER CHECK POINT: (SEE *M7a-o)
THREE OR MORE RESPONSES CODED ‘1’..................1
ALL OTHERS ....................................................................2

GO TO *M54

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*M9.

Let me review. You had episodes when you were very (excited and full of energy/irritable or grouchy) and also had
some problems like (KEY PHRASE OF 3 “YES” RESPONSES IN *M7 SERIES). How much did these episodes
ever interfere with either your work, your social life, or your personal relationships – not at all, a little, some, a lot, or
extremely?
NOT AT ALL ................................. 1
A LITTLE ...................................... 2
SOME ............................................. 3
A LOT ............................................. 4
EXTREMELY................................. 5
DON’T KNOW ............................... 8
REFUSED....................................... 9
*M9a.

GO TO M10a
GO TO M10a

GO TO M10a

How often during these episodes were you unable to carry out your normal daily activities – often,
sometimes, rarely, or never?
OFTEN ........................................... 1
SOMETIMES ................................. 2
RARELY ........................................ 3
NEVER ........................................... 4
DON’T KNOW .............................. 8
REFUSED ...................................... 9

*M9b. Did other people say anything or worry about the way you were acting?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

*M10a. Episodes of this sort sometimes occur as a result of physical causes such as physical illness or injury or the
use of medication, drugs, or alcohol. Do you think your episodes ever occurred as the result of such
physical causes?
YES ................................. 1
NO .................................. 5 GO TO *M18
DON’T KNOW .............. 8 GO TO *M18
REFUSED....................... 9 GO TO *M18
*M10b. Do you think all of your episodes were the result of physical causes?
YES ................................. 1
NO .................................. 5 GO TO *M18
DON’T KNOW .............. 8 GO TO *M18
REFUSED....................... 9 GO TO *M18
*M10c. Briefly, what were the physical causes?

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*M18. Think of the very first time in your life you had an episode lasting four days or longer when you became very
(excited and full of energy/irritable or grouchy) and also had some of the behavior changes you just reported. Can you
remember your exact age?
YES ................................................. 1
NO .................................................. 5
DON’T KNOW............................... 8
REFUSED....................................... 9

GO TO *M18b
GO TO *M18b
GO TO *M18b

*M18a. (IF NEC: How old were you?)
YEARS OLD

GO TO *M18c

DON’T KNOW ..................998
REFUSED ..........................999

*M18b. About how old were you the first time you had an episode of this sort?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?
YEARS OLD
BEFORE STARTED SCHOOL.................. 4
BEFORE TEENAGER ............................... 12
NOT BEFORE TEENAGER ...................... 13
WHOLE LIFE OR DON’T KNOW ............ 998
REFUSED................................................... 999
*M18c. Was that episode brought on by some stressful experience? Or did it happen out of the blue?
BROUGHT ON BY STRESS ..............................................................1
OUT OF THE BLUE ...........................................................................2
DON’T REMEMBER ..........................................................................5
DON’T KNOW ....................................................................................998
REFUSED ............................................................................................999
*M18d. About how long did that episode go on?
NUMBER
CIRCLE UNIT OF TIME:

HOURS ... 1

DAYS.....2 WEEKS ...3

MONTHS ..... 4 YEARS…5

DON’T KNOW
........... 98
REFUSED ........................................................................ 99

*M19. Did you have one of these episodes at any time in the past 12 months?
YES ....................................................1
NO ....................................5
DON’T KNOW.................8
REFUSED.........................9

GO TO *M19d
GO TO *M19d
GO TO *M19d

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*M19a. How recently – in the past month, two to six months ago, or more than six months ago?
PAST MONTH ....................................................................... 1
2-6 MONTHS AGO ................................................................ 2
MORE THAN 6 MONTHS AGO ........................................... 3
DON’T KNOW ....................................................................... 8
REFUSED ............................................................................... 9
*M19b. How many episodes did you have in the past 12 months?
NUMBER
DON’T KNOW
998
REFUSED ........................................................ 999

*M19c. How many weeks in the past 12 months were you in (this episode/one of these episodes)
NUMBER
DON’T KNOW .................. 998
REFUSED .......................... 999

GO TO *M20
GO TO *M20
GO TO *M20

*M19d. How old were you the last time you had one of these episodes?
YEARS OLD
DON’T KNOW ................................................ 998
REFUSED ........................................................ 999

*M20. How many episodes lasting a full week or longer have you ever had in your life?
NUMBER
DON’T KNOW
998
REFUSED ..........................................999

*M21. How many episodes lasting less than one week have you ever had in your life?
NUMBER
DON’T KNOW
998
REFUSED ..........................................999

*M21a. Interviewer Checkpoint: (SEE *M20, *M21)
SUM OF EPISODES IN *M20 AND *M21 EQUALS ONE ..................... 1
ALL OTHERS ............................................................................................................ 2

GO TO *M26

*M21.1. How many of your episodes were brought on by some stressful experience?
NUMBER
DON’T KNOW ..................................998
REFUSED ..........................................999
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*M22. How long was the longest episode you ever had?
NUMBER
HOURS ....... 1 DAYS ........ 2 WEEKS........ 3 MONTHS ........ 4 YEARS…5

CIRCLE UNIT OF TIME:
DON’T KNOW ................................998
REFUSED........................................999

*M23. How many different years in your life did you have at least one episode?
YEARS
DON’T KNOW...................998
REFUSED........................... 999

*M26. INTERVIEWER CHECKPOINT: (SEE *M19)
*M19 EQUALS ‘1’ ..................................................................... 1
ALL OTHERS ............................................................................. 5 GO TO *M33

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No
Interference
0

Mild
1

Moderate
2

3

4

Very Severe
Interference

Severe
5

6

7

8

9

10

*M27. (RB, PG 9) Think about the month or longer in the past 12 when your episode(s) of being very (excited and full of
energy/ irritable or grouchy) (was/were) most severe. Using the 0 to 10 scale on page 9 of your booklet, where 0 means no
interference and 10 means very severe interference, what number describes how much your episode(s) of being very (excited and
full of energy/ irritable or grouchy) interfered with each of the following activities during that time?
(IF NEC: How much did your episode(s) of being very (excited and full of energy/ irritable or grouchy) interfere with (ACTIVITY)
during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)
NUMBER (0-10)

*M27a. Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY ......................................................................................................................................... 97
DON’T KNOW ................................................................................................................................................ 98
REFUSED ........................................................................................................................................................ 99
*M27b.

Your ability to work?

*M27c.
Your ability to form and maintain close
relationships with other people?

*M27d.

Your social life?

____________ DOES NOT APPLY.............. 97
DON’T KNOW....................................... 98
REFUSED............................................... 99
____________ DOES NOT APPLY.............. 97
DON’T KNOW....................................... 98
REFUSED............................................... 99
____________ DOES NOT
APPLY.............. 97
DON’T KNOW....................................... 98
REFUSED............................................... 99

*M28. INTERVIEWER CHECKPOINT: (SEE *M27a - *M27d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’......................................................................... 1
ALL OTHERS ..................................................................................................................................... 2

GO TO *M29.1

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*M29. About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your episode(s) of being very (excited and full of energy/ irritable or grouchy)?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ..................................998
REFUSED ..........................................999

*M29.1. INTERVIEWER CHECKPOINT
R CAN READ .................................................... 1
ALL OTHERS...................................2

GO TO *M30

*M29.2. (RB, PG 10-13) For the next questions I need you to think about the episode of four days or more during the past 12
months when you were in the most severe episode of being very (excited and full of energy/ irritable or grouchy).
Please read each of the eleven sets of statements on pages 10-13 in your booklet and circle the one response for each of the
eleven that best describes your experience during the worst four days. As you finish each set, please tell me the number of the
statement you have circled.
GO TO *M30a

*M30. (RB, PG 10-13) For the next questions I need you to think about the episode during the past 12 months when you
were in the most severe episode of being very (excited and full of energy/ irritable or grouchy). I’m going to read eleven series
of statements. Please pick the one statement in each series that comes closest to your experience during that worst four days.
*M30a. Here’s the first series, which deals with your mood during those four days:
One:
Your mood was no more high than usual in terms of things like being happy, self-confident, or optimistic
Two:
Your mood was a little more high than usual.
Three: Your mood was quite a bit more high than usual, but never over the edge or inappropriate.
Four: Your mood was over the edge in terms of things like being unrealistically self-confident or optimistic or very happy
even when bad things were happening.
Five:
You were uncontrollably high in terms of things like laughing out loud without cause or singing
loudly in public places.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ........................................................ 999

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*M30b. Here’s the next series, which deals with physical arousal:
One:
You had no increase in physical arousal in terms of things like energy or restlessness or difficulty sitting still.
Two:
You had some increase in arousal, but not enough for most people to notice.
Three: You had a big enough increase in arousal for most people to notice, with things like increases in hand gestures,
loudness, or being a lot more animated than usual.
Four: You were so highly aroused that you felt agitated or restless or hyper, but not enough to be out of control. Five:
You were uncontrollably agitated or restless or hyper.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999
*M30c. Here’s the next series, which deals with sexual interest:
One:
You had no increase in sexual interest.
Two:
You had a mild increase in sexual interest.
Three: You had a strong increase in sexual thoughts without talking about it or doing anything. Four: You
talked a lot more about sex than usual without doing anything about it.
Five:
You inappropriately propositioned people or touched people sexually or engaged in other sexual
behaviors you wouldn’t normally do.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999
*M30d. Here’s the next series, which deals with how much sleep you got:
One:
You experienced no decrease in sleep.
Two:
You slept less than normal by up to one hour.
Three: You slept less than normal by more than one hour.
Four: You slept less than usual and didn’t feel the need for more sleep. Five:
You didn’t feel the need for any sleep at all.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999

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*M30e. Here’s the next series, which deals with how irritable you were:
One:
You experienced no increase in irritability, in terms of things like feeling grumpy or acting annoyed or angry.
Two:
You experienced some increase in irritability, but not enough for most people to notice.
Three: You experienced a big enough increase in irritability for most people to notice, with things like sometimes being short or
snappy with people or having occasional outbursts of anger.
Four: You were very irritable most of the time.
Five:
You were so hostile or uncooperative that it was impossible for people to be around you.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999
*M30f. Here’s the next series, which deals with how talkative you were:
One:
You experienced no increase in talkativeness.
Two:
You wanted to be more talkative, but didn’t actually talk a lot more than usual.
Three: At times you talked a lot more than usual or a lot more than the situation required.
Four: You often talked a lot more than the situation required or talked so much that it was hard for other people to interrupt
you.
Five:
You talked nonstop or so much that no one could interrupt you even when they tried.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999
*M30g. Here’s the next series, which deals with racing thoughts or disorganized thinking:
One:
Your thoughts did not come more quickly or seem more confused or escape you more than usual.
Two:
Your thoughts came somewhat more quickly than usual, or seemed a bit more confused than usual, or
you lost your train of thought somewhat more than usual.
Three: Your thoughts raced through your mind, or you easily lost your train of thought, or your mind kept jumping from one
topic to another.
Four: Your thoughts jumped around so much that people had a hard time following you or you couldn’t keep yourself on
track in a conversation.
Five:
Your thoughts were going so fast or you were so confused that it was impossible for anyone to
follow you or for you to make yourself understood.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999

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*M30h. Here’s the next series, which deals with thinking about impractical or unrealistic things:
One:
You didn’t think or talk about anything different than usual
Two:
You thought a lot about new interests or new plans that were not very practical or realistic.
Three: You thought a lot about really strange unrealistic things like hyper-religious ideas or totally unrealistic plans.
Four: You had a lot of grandiose ideas about being able to do things you can’t really do, or paranoid ideas about plots or
conspiracies that don’t really exist, or ideas about you being at the center of things that really don’t have much to do with you.
Five:
Your mind was so confused that you were having delusions or hearing voices or seeing things.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)
NUMBER
DON’T KNOW ............................................... 998
REFUSED ....................................................... 999
*M30i. Here’s the next series, which deals with disruptive or aggressive behavior:
One:
You were no more disruptive or aggressive in your behavior than usual.
Two:
You were often loud or sarcastic with people, but never threatened or got physical.
Three: You sometimes threatened people or made hostile demands, but never got physical. Four:
You frequently threatened or shouted at people, but without getting physical.
Five:
You physically assaulted someone or destroyed property.
(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999
*M30j. Here’s the next series, which deals with your appearance:
One:
You dressed the same as always.
Two:
You had a big reduction in neatness of dressing or grooming, but not so much that most people would get
worried about you.
Three: You had a big change in dressing and grooming, either due to looking like a mess in terms of clothes and grooming or
due to being very overdressed.
Four: You had an extreme change in dressing or grooming, like being only partly clothed or wearing wild make-up or
looking like a total mess.
Five:
You were completely un-groomed or disorganized in clothing or wore bizarre clothes.

(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ....................................................... 999

135

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*M30k. Here’s the next series, which deals with whether you thought you had a problem:
One:
You recognized that you were sick and needed help.
Two:
You realized that you might have a problem.
Three: You recognized that your behavior had changed a great deal, but didn’t think it was a problem.
Four: You realized that there had been some change in your behavior, but didn’t really appreciate how great it had been.
Five:
You had times when you were totally unaware that your behavior was different from normal.

(IF NEC: Which of these five statements was most true of you during your worst episode of being very (excited and full of
energy/irritable or grouchy) in the past 12 months?)

NUMBER
DON’T KNOW
998
REFUSED ........................................................ 999

*M33. Did you ever in your life talk to a medical doctor or other professional about your episode(s) of being very (excited
and full of energy/irritable or grouchy)? (By professional we mean psychologists, counselors, spiritual advisors, herbalists,
acupuncturists, and other healing professionals.)
YES .................................................................. 1
NO .................................................. 5
DON’T KNOW............................... 8
REFUSED....................................... 9

GO TO *M48.1
GO TO *M48.1
GO TO *M48.1

*M33a. How old were you the first time [you talked to a professional about your episode(s) of being very (excited
and full of energy/ irritable or grouchy)]?
YEARS OLD
DON’T KNOW ................................................ 998
REFUSED ........................................................ 999
M33b. IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,” PROBE: Was it before your
teens?
IF NO/DK, PROBE: Was it before your twenties?
YEARS OLD
BEFORE TEENS. ................................................... 12
BEFORE 20s............................................................ 19
AFTER 20s. ............................................................. 20
(IF VOL): "NEVER". ............................................... 997
DON’T KNOW ...................................................... 998
REFUSED................................................................ 999

136

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*M45. Did you ever get treatment for your episode(s) of being very (excited and full of energy/ irritable or grouchy) that you
considered helpful or effective?
YES .................................................................. 1
NO .................................................. 5
DON’T KNOW............................... 8
REFUSED....................................... 9

GO TO *M45c
GO TO *M45c
GO TO *M45c

*M45a. How old were you the first time [you got helpful treatment for your episode(s) of being very (excited and full
of energy/ irritable or grouchy)]?
YEARS OLD
DON’T KNOW ................................................ 998
REFUSED ........................................................ 999

*M45b. How many professionals did you ever talk to about your episode(s) of being very (excited and full of energy/ irritable or
grouchy), up to and including the first time you got helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW ................ 98
REFUSED ........................ 99

GO TO *M47

GO TO *M47
GO TO *M47

*M45c. How many professionals did you ever talk to about your episode(s) of being very (excited and full of energy/ irritable or
grouchy)?
NUMBER OF PROFESSIONALS
DON’T KNOW ................................................ 98
REFUSED ........................................................ 99

*M47. Did you receive professional treatment for your episode(s) of being very (excited and full of energy/ irritable or
grouchy) at any time in the past 12 months?
YES .................................................................. 1
NO .................................................................... 5
DON’T KNOW ................................................ 8
REFUSED ........................................................ 9

*M48. Were you ever hospitalized overnight for your episode(s) of being very (excited and full of energy/irritable or
grouchy)?
YES .................................................................. 1
NO .................................................. 5
DON’T KNOW............................... 8
REFUSED....................................... 9

GO TO *M48.1
GO TO *M48.1
GO TO *M48.1

*M48a. How old were you the first time [you were hospitalized overnight because of your episode(s) of being very
(excited and full of energy/ irritable or grouchy)]?
YEARS OLD
DON’T KNOW ................................................ 998
REFUSED ........................................................ 999
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*M48.1. How many of your close relatives – including your biological parents, brothers and sisters, and children – ever had
episodes of being very (excited and full of energy/ irritable or grouchy)?
NUMBER DON’T
KNOW
998
REFUSED ......................................... 999

EATING DISORDERS (EA)

*EA1.

This part of the interview is about problems you might have had either with eating or with your weight. Was there ever a
time in your life when you had a great deal of concern about or strongly feared being too fat or overweight?
YES ........................................................1
NO ..........................................................5
DON’T KNOW ......................................8
REFUSED ..............................................9

GO TO *EA16
GO TO *EA16
GO TO *EA16

*EA1a. Did you ever have this strong worry or fear at a time when you really weighed less than most other people?
YES ..........................................1
NO ............................................5
DON’T KNOW ........................8
REFUSED ................................9

GO TO *EA16
GO TO *EA16
GO TO *EA16

*EA2.1 INTERVIEWER CHECKPOINT: UNIT OF MEASUREMENT FOR WEIGHT
IMPERIAL/US ................. 1
METRIC........................... 2

*EA2. What was the lowest body weight you ever purposefully had after the age of twelve?
BODY WEIGHT (POUNDS or KILOGRAMS)
DON’T KNOW ..................................... 998
REFUSED ..............................................999

*EA3.1. INTERVIEWER CHECKPOINT: UNIT OF MEASUREMENT FOR HEIGHT
IMPERIAL/US ............................. 1
METRIC.......................................2

GO TO *EA3c.

*EA3a. How tall were you at that time?
138

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
BODY HEIGHT

(FEET/ INCHES)

DON’T KNOW ......................................998
REFUSED ..............................................999
*EA3c. How tall were you at that time?
BODY HEIGHT

(CENTIMETERS)

DON’T KNOW ..................................... 998
REFUSED ..............................................999

139

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA4.

INTERVIEWER CHECKPOINT: (SEE *EA2, *EA3 AND MINIMUM WEIGHT TABLE, BELOW)
WEIGHT RECORDED IN *EA2 IS LESS THAN MINIMUM WEIGHT IN TABLE FOR
HEIGHT RECORDED IN *EA3 .................................................................................................. 1
ALL OTHERS....................................................................................................................... ........ 2 GO TO *EA16

MINIMUM WEIGHTS FOR WOMEN

Height (feet)
Weight (lbs)
4’10” or less ............ 111
4’11”........................ 114
5’0” ......................... 116
5’1”.......................... 119
5’2”.......................... 122
5’3”.......................... 125
5’4”.......................... 128
5’5”.......................... 132
5’6”.......................... 135
5’7”.......................... 139
5’8”.......................... 142
5’9”.......................... 145
5’10”........................ 147
5’11”........................ 150
6’0” or more ............ 152

Height (meters)
Weight (kg)
1.47 or less .................... 50
1.50 ............................... 52
1.52 ............................... 53
1.55 ............................... 54
1.57 ............................... 55
1.60 ............................... 57
1.62 ............................... 58
1.65 ............................... 60
1.68 ............................... 61
1.70 ............................... 63
1.73 ............................... 64
1.75 ............................... 66
1.78 ............................... 67
1.8 ................................. 68
1.83 or more .................. 69

MINIMUM WEIGHTS FOR MEN

Height (feet)
Weight (lbs)
5’2” or less .............. 128
5’3”.......................... 130
5’4”.......................... 133
5’5”.......................... 136
5’6”.......................... 139
5’7”.......................... 143
5’8”.......................... 146
5’9”.......................... 150
5’10”........................ 153
5’11”........................ 156
6’0”.......................... 160
6’1” ......................... 163
6’2” ......................... 167
6’3” ......................... 172
6’4” or more ............ 176

Height (meters)
Weight (kg)
1.57 or less .................... 58
1.60 ............................... 59
1.62 ............................... 60
1.65 ............................... 62
1.68 ............................... 63
1.70 ............................... 65
1.73 ............................... 66
1.75 ............................... 68
1.78 ............................... 69
1.80 ............................... 71
1.83 ............................... 73
1.85 ............................... 74
1.88 ............................... 76
1.90 ............................... 78
1.93 or more .................. 80

*EA6. At the time you weighed (WEIGHT REPORTED IN *EA2) were you very afraid that you might gain weight?
YES ....................................................... 1
NO ..........................................................5
DON’T KNOW ......................................8
REFUSED ..............................................9

GO TO *EA16
GO TO *EA16
GO TO *EA16

140

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA7.

Did you do things to keep your weight low, such as dieting or exercising?
YES ........................................................1
NO ..........................................................5
DON’T KNOW ......................................8
REFUSED ..............................................9

*EA8.

GO TO *EA10

Around the time you weighed (WEIGHT REPORTED IN *EA2) did you ever have three months or more in a row when
you stopped having your menstrual periods?
YES ....................................................... 1
NOT APPLICABLE ...............................3
NO ..........................................................5
DON’T KNOW ......................................8
REFUSED ..............................................9

*EA10.

(17b)

INTERVIEWER CHECKPOINT: (R’S GENDER)
R IS MALE ............................................1
R IS FEMALE ....................................... 2

*EA9.

(GO TO *EA16) **
(GO TO *EA16) **
(GO TO *EA16) **

(GO TO *EA16) **
(GO TO *EA16) **
(GO TO *EA16) **

Did you feel like you were heavier than you should have
been or heavier than you wanted to be?

(17c)

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

(KEY PHRASE: feeling you were too heavy)
*EA10b. Did you think that some parts of your body were too fat?
(KEY PHRASE: thinking that parts of your body were
too fat)
*EA10c. Did you feel like your self-esteem or confidence
depended on your ability to stay thin or to lose even
more weight?
(KEY PHRASE: feeling like your self-esteem depended
on being thin)
*EA10d. Did anyone tell you that your low weight was bad for
your health?
(KEY PHRASE: hearing from others that your low
weight was bad for your health)
*EA11. INTERVIEWER CHECKPOINT: (SEE *EA10 SERIES (*EA10, *EA10b, *EA10c, *EA10d) **)
AT LEAST ONE “YES” RESPONSE IN *EA 10 SERIES (*EA10, *EA10b, OR *EA10c, OR
*EA10d) ................................................................................................................................................ 1
ALL OTHERS....................................................................................................................... ................. 2

(17e)

GO TO
*EA16

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA12. Think of the very first time in your life you weighed around (WEIGHT REPORTED IN *EA2) and you had problems
like (KEY PHRASES FROM “YES” RESPONSES IN *EA10 SERIES). Can you remember your exact age?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *EA12b
GO TO *EA12b
GO TO *EA12b

*EA12a. (IF NEC: How old were you?)
YEARS OLD

GO TO *EA13

DON’T KNOW ................ 998
REFUSED ........................ 999
*EA12b. About how old were you the first time?
IF DK, PROBE: Was it before your twenties?
YEARS OLD
BEFORE TWENTIES ................................... 19
DON’T KNOW ........................................... 998
REFUSED ................................................... 999

*EA13. About how many different years in your life did you weigh around (WEIGHT REPORTED IN *EA2) and have problems
like the ones we just reviewed?
YEARS
DON’T KNOW .................. 998
REFUSED .......................... 999

*EA14. INTERVIEWER CHECKPOINT: (SEE *EA13)
*EA13 IS CODED 1 YEAR OR LESS ......................... 1
ALL OTHERS ................................................................ 2

GO TO *EA16

*EA15. How recently did you weigh around (WEIGHT REPORTED IN *EA2) and have problems like the ones we just reviewed –
in the past month, two to six months ago, seven to twelve months ago, or more than twelve months ago?
PAST MONTH................................................ 1
2-6 MONTHS AGO ........................................ 2
7-12 MONTHS AGO ...................................... 3
MORE THAN 12 MONTHS AGO ................. 4
DON’T KNOW ................................................ 8
REFUSED ........................................................ 9

GO TO *EA16
GO TO *EA16
GO TO *EA16

*EA15a. How old were you the last time?
YEARS OLD
DON’T KNOW .............. 998
REFUSED ...................... 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA16. The next question is about “eating binges” where a person eats a large amount of food during a short period like two hours.
By “a large amount” I mean eating so much food that it would be like eating two or more entire meals in one sitting, or
eating so much of one particular food -- like candy or ice cream -- that it would make most people feel sick. With that
definition in mind, did you ever have a time in your life when you went on eating binges (READ SLOWLY) at least twice a
week for several months or longer?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *EA 23 (GO TO *EA30) *
GO TO *EA 23 (GO TO *EA30) *
GO TO *EA 23 (GO TO *EA30) *

(17f)

YES
(1)

NO
(5)

DK
(8)

RF
(9)

During the binges did you usually eat much more quickly
than usual?

1

5

8

9

Did you usually eat until you felt uncomfortably full?

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

Around the time you were binge eating, were you very
afraid that you would gain weight?

1

5

8

9

Did you feel like your self-esteem and confidence depended
on your weight or body shape?

1

5

8

9

*EA17g. Did you worry about the long term effects of binging on
your health, on your weight, or on your body shape?

1

5

8

9

*EA17h. Did you often get upset both during and after the binges
that your eating was out of your control?

1

5

8

9

*EA17.

*EA17a.

*EA17b. Did you usually continue to eat even when you didn’t feel
hungry?

*EA17c.

Did you usually eat alone because you were embarrassed by
how much you ate?

*EA17d. Did you feel guilty, very upset with yourself, or depressed
after you binged?
*EA17e.

*EA17f.

*EA18. INTERVIEWER CHECKPOINT: (SEE *EA17 SERIES)
AT LEAST ONE “YES” RESPONSE IN *EA17 SERIES .................... 1
ALL OTHERS..........................................................................................2 GO TO *EA23

143

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA19. Can you remember your exact age the very first time in your life you began binging at least two times a week for three
months or longer?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *EA19b
GO TO *EA19b
GO TO *EA19b

*EA19a. (IF NEC: How old were you?)
YEARS OLD

GO TO *EA20

DON’T KNOW ................ 998
REFUSED ........................ 999
*EA19b. About how old were you the first time?
IF DK, PROBE: Was it before your twenties?
YEARS OLD
BEFORE TWENTIES ................................... 19
DON’T KNOW ........................................... 998
REFUSED ................................................... 999

*EA20. About how many different years in your life did you go through periods when you binged at least two times a week for
three months or longer?
YEARS
DON’T KNOW .................. 998
REFUSED .......................... 999

*EA21. INTERVIEWER CHECKPOINT: (SEE *EA20)
*EA20 IS CODED 1 YEAR OR LESS ........................ 1
ALL OTHERS ................................................................ 2

GO TO *EA23a

*EA22. How recently did you binge at least two times a week – in the past month, two to six months ago, seven to twelve months
ago, or more than twelve months ago?
PAST MONTH................................................ 1
2-6 MONTHS AGO ........................................ 2
7-12 MONTHS AGO ...................................... 3
MORE THAN 12 MONTHS AGO ................. 4
DON’T KNOW ................................................ 8
REFUSED ........................................................ 9
*EA22a.

GO TO *EA23a
GO TO *EA23a
GO TO *EA23a

How old were you the last time?
YEARS OLD
DON’T KNOW.............. 998
REFUSED ...................... 999

GO TO *EA23a
GO TO *EA23a
GO TO *EA23a

144

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO
*EA23b

5
GO TO
*EA23b

8
GO TO
*EA23b

9
GO TO
*EA23b

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*EA23. Did you ever do any of the following things regularly in
order to control your weight:
Did you fast by not eating at all or only taking liquids
for 8 hours or longer?
(KEY PHRASE: fasted or took only a liquid diet)
*EA23a. Did you ever do any of the following things regularly after
binging in order to control your weight:
Did you fast by not eating at all or only taking liquids
for 8 hours or longer?
(KEY PHRASE: fasted or took only a liquid diet)
*EA23b. Did you take water pills, diuretics, or weight control
medicines?
(KEY PHRASE: took weight loss medicine or pills)
*EA23c. Did you make yourself vomit?
(KEY PHRASE: vomited)
*EA23d. Did you take laxatives or enemas?
(KEY PHRASE: took laxatives or enemas)
*EA23e. Did you exercise excessively?
(KEY PHRASE: exercised excessively)
*EA23f. Did you chew and then spit out your food?
(KEY PHRASE: spit out your food)

*EA24. INTERVIEWER CHECKPOINT: (SEE *EA23 SERIES)
AT LEAST ONE “YES’ RESPONSE IN *EA23 SERIES .................................................. 1
ALL OTHERS ........................................................................................................................ 2

GO TO *EA30

*EA25. You (KEY PHRASES FROM “YES” RESPONSES IN *EA23 SERIES). Did you ever do (this/ either of these things/
any of these things) at least two times a week for three months or longer?
YES ..................................... 1
NO....................................... 5
DON’T KNOW .................. 8
REFUSED........................... 9

GO TO *EA30
GO TO *EA30
GO TO *EA30

145

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA26. Can you remember your exact age the very first time you used (this/ any of these) weight control (strategy/ strategies) at
least two times a week for three months?
YES ..................................... 1
NO....................................... 5
DON’T KNOW .................. 8
REFUSED........................... 9

GO TO *EA26b
GO TO *EA26b
GO TO *EA26b

*EA26a. (IF NEC: How old were you?)
YEARS OLD

GO TO *EA27

DON’T KNOW ................ 998
REFUSED ........................ 999
*EA26b. About how old were you the first time?
IF DK, PROBE: Was it before your twenties?
YEARS OLD
BEFORE TWENTIES ................................... 19
DON’T KNOW ........................................... 998
REFUSED ................................................... 999

*EA27. About how many different years in your life did you do any of these things at least twice a week for three months or longer?
YEARS
DON’T KNOW ..........................998
REFUSED ..................................999

*EA28. INTERVIEWER CHECKPOINT: (SEE *EA27)
*EA27 IS CODED 1 YEAR OR LESS ......................... 1
ALL OTHERS ................................................................ 2

GO TO *EA30

*EA29. How recently did you use (this strategy/these strategies) this often – in the past month, two to six months ago, seven to
twelve months ago, or more than twelve months ago?
PAST MONTH................................................ 1
2-6 MONTHS AGO ........................................ 2
7-12 MONTHS AGO ...................................... 3
MORE THAN 12 MONTHS AGO ................. 4
DON’T KNOW ................................................ 8
REFUSED ........................................................ 9

GO TO *EA30
GO TO *EA30
GO TO *EA30

*EA29a. How old were you the last time?
YEARS OLD
DON’T KNOW ................. 998
REFUSED ......................... 999

146

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA30. INTERVIEWER CHECKPOINT: (SEE *EA11, *EA18, *EA24)
RESPONSE CODED “1,” IN AT LEAST ONE OF THE
FOLLOWING: *EA11, *EA18 OR *EA24 ................................................. 1
ALL OTHERS ..................................................................................................2

GO TO *PR1, NEXT SECTION

*EA31. INTERVIEWER CHECKPOINT: (SEE *EA15, *EA22, *EA29)
RESPONSE CODED “1,” “2,” OR “3” IN AT LEAST ONE OF THE
FOLLOWING: *EA15, *EA22 OR *EA29 ................................................... 1
ALL OTHERS ..................................................................................................2

GO TO *EA35

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
No
Interference
0

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

*EA32. (RB, PG 9) Think about the month or longer in the past 12 when your problems with your eating or weight were most
severe. Using a 0 to 10 scale on page 9 of your booklet, where 0 means no interference and 10 means very severe
interference, what number describes how much problems with your eating or weight interfered with each of the
following activities during that time?
(IF NEC: How much did problems with your eating or weight interfere with (ACTIVITY) during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)
NUMBER (0-10)

*EA32a. Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*EA32b. Your ability to work?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*EA32c. Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY ............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*EA32d. Your social life?
DOES NOT APPLY ............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*EA33. INTERVIEWER CHECKPOINT: (SEE *EA32 SERIES)
ALL FOUR RESPONSES TO *EA32 SERIES EQUAL ‘0’ OR ‘97’ ..........1
ALL OTHERS .................................................................................................2

GO TO *EA35

*EA34. About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of problems with your eating or weight?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*EA35. Did you ever in your life talk to a medical doctor or other professional about problems with your eating or weight? (By
other professional we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other healing
professionals.)
YES.......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................ 8
REFUSED......................................... 9

GO TO *PR1, NEXT SECTION
GO TO *PR1, NEXT SECTION
GO TO *PR1, NEXT SECTION

*EA35a. How old were you the first time (you talked to a professional about problems with your eating or weight)?
YEARS OLD
DON’T KNOW ................998
REFUSED.........................999

*EA37. Did you ever get treatment for problems with your eating or weight that you considered helpful or effective?
YES ..........................................................1
NO ..................................................... 5
DON’T KNOW ................................ 8
REFUSED......................................... 9

GO TO *EA37c
GO TO *EA37c
GO TO *EA37c

*EA37a. How old were you the first time (you got helpful treatment for problems with your eating or weight)?
YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999
*EA37b.How many professionals did you ever talk to about problems with your eating or weight, up to and
including the first time you got helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW ................. 998
REFUSED.......................... 999

GO TO *EA38

GO TO *EA38
GO TO *EA38

*EA37c.How many professionals did you ever talk to about problems with your eating or weight?
NUMBER OF PROFESSIONALS
DON’T KNOW ..................998
REFUSED ..........................999

*EA38. Did you receive professional treatment for problems with your eating or weight at any time in the past 12
months?
YES ......................................... 1
NO...................................... 5
DON’T KNOW ................. 8
REFUSED ........................ 9

149

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
END OF SECTION

INTERMITTENT EXPLOSIVE DISORDER (IED)
*IED1. INTERVIEWER CHECKPOINT: (SEE *SC20.1, *SC20.2, *SC20.3)
*SC20.1 IS CHECKED ............................................... 1

GO TO *IED2

*SC20.2 IS CHECKED ............................................... 2

GO TO *IED3 INTRO 4

*SC20.3 IS CHECKED ............................................... 3

GO TO *IED3 INTRO 5

ALL OTHERS ............................................................. 4

GO TO NEXT SECTION

*IED2. INTERVIEWER CHECKPOINT: (SEE *SC20.2, *SC20.3)
*SC20.2 IS CHECKED ............................................... 1

GO TO *IED3 INTRO 1

*SC20.3 IS CHECKED ............................................... 2

GO TO *IED3 INTRO 2

ALL OTHERS ............................................................. 3

GO TO *IED3 INTRO 3

*IED3 INTRO 1.
Earlier in the interview
you mentioned having
attacks of anger when
all of a sudden you lost
control and either
broke or smashed
something of value or
you hit or hurt
someone. The next few
questions are about
those attacks.
Approximately how
many times in your life
have you had an attack
of this sort, (READ
SLOWLY) when you
lost control and either
broke something, hurt
someone, or threatened
to hurt someone?
*IED3.

*IED3 INTRO 2.
Earlier in the interview
you mentioned having
attacks of anger when
all of a sudden you lost
control and either
broke or smashed
something of value or
you threatened to hit or
hurt someone. The next
few questions are about
those attacks.
Approximately how
many times in your life
have you had an attack
of this sort, (READ
SLOWLY) when you
lost control and either
broke something or
threatened to hurt
someone?

*IED3 INTRO 3.
Earlier in the interview
you mentioned having
attacks of anger when
all of a sudden you lost
control and broke or
smashed something of
value. The next few
questions are about
those attacks.
Approximately how
many times in your
life have you had an
attack of this sort,
(READ SLOWLY)
when you lost control
and either broke or
smashed something?

*IED3 INTRO 4.
Earlier in the interview
you mentioned having
attacks of anger when
all of a sudden you
lost control and hit or
hurt someone. The
next few questions are
about those attacks.
Approximately how
many times in your
life have you had an
attack of this sort,
(READ SLOWLY)
when you lost control
and either hurt
someone or threatened
to hurt someone?

*IED3 INTRO 5.
Earlier in the
interview you
mentioned having
attacks of anger when
all of a sudden you
lost control and
threatened to hit or
hurt someone. The
next few questions are
about those attacks.
Approximately how
many times in your
life have you had an
attack of this sort,
(READ SLOWLY)
when you lost control
and threatened to hurt
someone?

CODE RESPONSES GREATER THAN 9997 AS 9997
ATTACKS
DON’T KNOW .............................9998
REFUSED .....................................9999

*IED4. INTERVIEWER CHECKPOINT: (SEE *IED3)

150

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED3 CODED ‘0’-‘2’ ................................................ 1
ALL OTHERS ................................................................ 2

GO TO NEXT SECTION

151

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED5. As you look back on it now, did these anger attacks sometimes occur without a good reason?
YES .................................. 1
NO ........................................ 5
DON’T KNOW ................ 8
REFUSED ............................ 9

GO TO *IED6

*IED5a. Did the attacks sometimes occur in situations where most people would not have had an anger attack?
YES ..........................................1
NO ................................................ 5
DON’T KNOW ........................8
REFUSED .................................... 9

GO TO *IED6

*IED5b. During those attacks, did you sometimes get a lot more angry than most people would have been in the
same situation.
YES .............................................. 1
NO............................................5
DON’T KNOW .......................8
REFUSED ...............................9

GO TO NEXT SECTION
GO TO NEXT SECTION
GO TO NEXT SECTION

*IED6. Did you have times before these attacks when you felt such a strong impulse to let loose or blow-up that you couldn't
resist it no matter how hard you tried?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

*IED7. How often was your anger out of control during your typical attacks -- all of the time, most of the time, sometimes,
rarely, or never?
ALL OF THE TIME .................................. 1
MOST OF THE TIME ............................... 2
SOMETIMES .................................................. 3
RARELY.......................................................... 4
NEVER ............................................................ 5
DON’T KNOW ......................................... 8
REFUSED ........................................................ 9

*IED8. INTERVIEWER CHECKPOINT: (SEE *IED6, *IED7)
*IED6 CODED ‘1’ ...................................................... 1
*IED7 CODED ‘1’-‘4’ ................................................ 2
ALL OTHERS ............................................................. 3

GO TO NEXT SECTION

*IED8.1. INTERVIEWER CHECKPOINT: (SEE *IED3)
*IED3 EQUALS ‘3’ – ‘9997’ ...................................... 1
ALL OTHERS ........................................................... 2
GO TO *IED9
*IED8.2. INTERVIEWER INSTRUCTION: CIRCLE LETTER ‘I’ IN LONG/SHORT GROUP OF REFERENCE
CARD (SIDE TWO). THEN GO TO *IED 9.

152

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED9. Some people only have anger attacks when they drink alcohol or use drugs. Did your anger attacks usually occur when
you had been drinking or using drugs?
YES ...................................... 1
NO .................................... 5 GO TO *IED10
DON’T KNOW ............... 8 GO TO *IED10
REFUSED ....................... 9 GO TO *IED10

*IED9a. Did you ever have anger attacks when you had not been drinking or using drugs?
YES ............................................... 1
NO................................................. 5
DON’T KNOW ............................ 8
REFUSED .................................... 9

GO TO NEXT SECTION
GO TO NEXT SECTION
GO TO NEXT SECTION

*IED10. Anger attacks can sometimes be caused by physical illnesses such as epilepsy or head injury or by the use of
medications. Were your anger attacks ever caused by physical illness or the use of medications?
YES ............................................ 1
NO ......................................... 5
DON’T KNOW .................... 8
REFUSED ............................ 9

GO TO *IED11
GO TO *IED11
GO TO *IED11

*IED10a. What was the cause?

*IED10b. Did you ever have anger attacks that were not caused by physical causes such as (CAUSE DESCRIBED IN
*IED10a) or by the use of alcohol or drugs?
YES ............................................. 1
NO ............................................... 5
DON’T KNOW ........................... 8
REFUSED ................................... 9

*IED11.Some people only have anger attacks when they are sad or depressed. Did your anger attacks usually occur during
periods of time when you were sad or depressed?
YES ...................................... 1
NO .................................... 5 GO TO *IED12
DON’T KNOW ............... 8 GO TO *IED12
REFUSED ....................... 9 GO TO *IED12

*IED11a. Did you ever have anger attacks at times you were not sad or depressed?
YES .................................................. 1
NO .................................................... 5
DON’T KNOW ................................ 8
REFUSED ........................................ 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*IED12. INTERVIEWER CHECKPOINT: (SEE REFERENCE CARD, SCREENING SECTION)
*SC 20.1 IS CHECKED .............................. 1
*SC 20.2 IS CHECKED ............................ 2
ALL OTHERS ........................................... 3

GO TO *IED15
GO TO *IED16

*IED13. Think about all the things you ever damaged or broke during your anger attacks. What is the approximate combined
repair cost or replacement value of all these things?
CODE RESPONSES GREATER THAN $9,997 AS $9,997
$
DON’T KNOW .............................. 9998
REFUSED ...................................... 9999

*IED15.About how many times during your anger attacks did you ever hurt someone badly enough that they needed medical
attention?
CODE RESPONSES GREATER THAN 997 AS 997
TIMES
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*IED16.How much did your anger attacks ever interfere with either your work, your social life, or your personal relationships -not at all, a little, some, a lot, or extremely?
NOT AT ALL............................................ 1
A LITTLE.................................................. 2
SOME............................................................... 3
A LOT ....................................................... 4
EXTREMELY ................................................. 5
DON’T KNOW ......................................... 8
REFUSED ................................................. 9

GO TO *IED17
GO TO *IED17

GO TO *IED17

*IED16a. How often were you unable to carry out your daily activities because of your attacks -- often, sometimes,
rarely, or never?
OFTEN ............................................................... 1
SOMETIMES .................................................... 2
RARELY ............................................................ 3
NEVER .............................................................. 4
DON’T KNOW ........................................... 8
REFUSED .......................................................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED17. How often did you feel guilty or embarrassed or regretful in the days or weeks after your attacks -- all of the time, most
of the time, sometimes, rarely, or never?
ALL OF THE TIME .................................. 1
MOST OF THE TIME .............................. 2
SOMETIMES ............................................ 3
RARELY ................................................... 4
NEVER...................................................... 5
DON’T KNOW ......................................... 8
REFUSED ................................................. 9

*IED18. Think of the very first time in your life you had an anger attack. Can you remember your exact age when that attack
occurred?
YES ...................................... 1
NO .................................... 5 GO TO *IED18b
DON’T KNOW ............... 8 GO TO *IED18b
REFUSED ....................... 9 GO TO *IED18b
*IED18a. (IF NEC: How old were you)?
YEARS OLD

GO TO *IED19

DON’T KNOW .............................. 998
REFUSED ...................................... 999

*IED18b. About how old were you?
YEARS OLD
IF "ALL MY LIFE" OR "AS LONG AS I CAN REMEMBER," PROBE:
*IED18b1. Was it before you first started school?
IF NO, PROBE: Was it before you were a teenager?
BEFORE STARTED SCHOOL ................................. 4
BEFORE TEENAGER .............................................. 12
NOT BEFORE TEENAGER ..................................... 13
WHOLE LIFE OR DON’T KNOW ......................... 998
REFUSED ........................................................................... 999

*IED19.During about how many different years in your life did you have at least one attack?
YEARS
DON’T KNOW .............................. 998
REFUSED ...................................... 999
*IED20. What is the largest number of anger attacks you ever had during a single month?
CODE RESPONSES GREATER THAN 997 AS 997
ATTACKS
DON’T KNOW 998
REFUSED ...................................... 999

155

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED21. What is the largest number of anger attacks you ever had during a single year?
CODE RESPONSES GREATER THAN 997 AS 997
ATTACKS
DON’T KNOW 998
REFUSED ...................................... 999

*IED22. How recently did you have an anger attack -- in the past month, two to six months ago, seven to twelve months ago, or
more than twelve months ago?
PAST MONTH............................................................ 1
2-6 MONTHS AGO .................................................... 2
7-12 MONTHS AGO .................................................. 3
MORE THAN 12 MONTHS AGO .............................. 4
DON’T KNOW ........................................................... 8
REFUSED ............................................................................ 9

GO TO *IED23
GO TO *IED23
GO TO *IED23

*IED22a. How old were you the last time (you had an attack)?
YEARS OLD

GO TO *IED29

DON’T KNOW .............................. 998 GO TO *IED29
REFUSED ...................................... 999 GO TO *IED29

*IED23.How many weeks out of 52 in the past twelve months did you have at least one attack?
WEEKS
DON’T KNOW .............................. 998
REFUSED ...................................... 999

*IED24. And how many attacks in total did you have during the past twelve months?
CODE RESPONSES GREATER THAN 997 AS 997
ATTACKS
DON’T KNOW 998
REFUSED ...................................... 999

156

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED25. In answering the next few questions, think about the week
during the past twelve months when you (had the attack/had the
most violent attack). During that one week, how many times did
you do each of the following things:
DON’T KNOW
(998)

REFUSED
(999)

TIMES

998

999

TIMES

998

999

TIMES

998

999

TIMES

998

999

TIMES

998

999

TIMES

998

999

TIMES

998

999

TIMES

998

999

NUMBER OF TIMES
*IED25a. slam a door, kick a chair, or throw clothes in anger?

*IED25b. break something in anger?

*IED25c. break several things in anger?

*IED25d. purposefully set a fire or destroy someone else’s property?

*IED25e. purposefully injure or torture an animal?

*IED25f. threaten someone?

*IED25g. hurt someone so badly that they needed medical attention?

*IED25h. hurt someone badly, but not enough to need medical attention?

157

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
No
Interference
0

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

*IED26. (RB, PG 9) Using the 0 to 10 scale on page 9 of your booklet, where 0 means no interference and 10 means very
severe interference, what number describes how much your anger attacks interfered with each of the following
activities during the past 12 months?
[IF NEC: How much did your anger attacks interfere with (ACTIVITY) during that period?]
(IF NEC: You can use any number between 0 and 10 to answer.)
NUMBER (0-10)

*IED26a. Your home management, like cleaning, shopping, and
working around the (house/ apartment) (or yard)?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*IED26b. Your ability to work?
DOES NOT APPLY............... 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*IED26c. Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*IED26d. Your social life?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*IED27. INTERVIEWER CHECKPOINT: (SEE *IED26a - *IED26d)
ALL RESPONSES CODED ‘0’ OR ‘97’.................................................................................1
ALL OTHERS .......................................................................................................................... 2

GO TO *IED29

*IED28. About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your anger attacks?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED29. Did you ever in your life talk to a medical doctor or other professional about your anger attacks? (By professional
we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other healing professionals.)
YES .......................................................... 1
NO ..................................................... 5
DON’T KNOW ................................ 8
REFUSED......................................... 9

GO TO *IED33.1
GO TO *IED33.1
GO TO *IED33.1

*IED29a. How old were you the first time [you talked to a professional about your anger attacks]?
YEARS OLD
DON’T KNOW ......................998
REFUSED ..............................999
*IED30. Did you ever get treatment for your anger attacks that you considered helpful or effective?
YES ............................................ 1
NO ......................................... 5
DON’T KNOW ..................... 8
REFUSED ............................. 9

GO TO *IED30c
GO TO *IED30c
GO TO *IED30c

*IED30a. How old were you the first time [you got helpful treatment for your anger attacks]?
YEARS OLD
DON’T KNOW ............ 998
REFUSED .................... 999

*IED30b. How many professionals did you ever talk to about your anger attacks, up to and including the first time
you got helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW ............ 998
REFUSED .................... 999

GO TO *IED32

GO TO *IED32
GO TO *IED32

*IED30c. How many professionals did you ever talk to about your anger attacks?
NUMBER OF PROFESSIONALS
DON’T KNOW........... 998
REFUSED................... 999

159

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*IED32. Did you receive professional treatment for your anger attacks at any time in the past 12 months?
YES ............................................... 1
NO ................................................. 5
DON’T KNOW ........................8
REFUSED .................................... 9

*IED33. Were you ever hospitalized overnight for your anger attacks?
YES ................................................. 1
NO ................................................... 5
DON’T KNOW............................... 8
REFUSED....................................... 9

GO TO *IED33.1
GO TO *IED33.1
GO TO *IED33.1

*IED33a. How old were you the first time [you were hospitalized overnight because of your anger attacks]?
YEARS OLD
DON’T KNOW ............. 998
REFUSED ..................... 999
*IED33.1. How many of your close relatives -- including your biological parents, brothers and sisters, and children
-- ever had repeated attacks of anger?

NUMBE
R DON’T KNOW ......... 998
REFUSED ..................... 999

PERSONALITY DISORDERS SCREEN (P)
*P1.

Now, I am going to read a series of statements that people use to describe themselves. Answer true or false for
each statement. The best answer is usually the one that comes to your mind first, so don’t take too much time
thinking before you answer. Here’s the first statement.
(IF NEC: Would you say this is true or false for you?)

*P1.

I show my feelings for everyone to see.
Would you say this is true or false for you?

TRUE
(1)

FALSE
(5)

DK
(8)

RF
(9)

1

5

8

9

*P2.

I get into very intense relationships that don’t last.

1

5

8

9

*P3.

I often feel “empty” inside.

1

5

8

9

*P4.

I’m very moody.

1

5

8

9

160

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*P5.

Giving in to some of my urges gets me into trouble.

1

5

8

9

*P6.

I have tantrums or angry outbursts.

1

5

8

9

*P7.

When I’m under stress, things around me don’t seem real.

1

5

8

9

*P8.

I go to extremes to try to keep people from leaving me.

1

5

8

9

*P9.

I can’t decide what kind of person I want to be.

1

5

8

9

*P10.

I’ve never been arrested.

1

5

8

9

*P11.

At times I’ve done things that could get a person arrested.

1

5

8

9

*P12.

I usually feel bad when I hurt or upset someone.

1

5

8

9

*P13.

At times I’ve refused to hold a job, even when I was expected to.

1

5

8

9

*P14.

I will lie or con someone if it serves my purpose.

1

5

8

9

*P15.

I lose my temper and get into physical fights.

1

5

8

9

*P16.

I take chances and do reckless things.

1

5

8

9

*P17.

It’s hard for me to stay out of trouble.

1

5

8

9

(IF NEC: Would you say this statement is true or false for
you?)

TRUE
(1)

FALSE
(5)

DK
(8)

RF
(9)

*P18.

At times I fail to meet my financial obligations.

1

5

8

9

*P19.

At times I’ve intentionally damaged things that weren’t mine.

1

5

8

9

*P20.

I will give false information about myself if it will help me get
a job or impress someone.

1

5

8

9

161

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*P21.

I argue or fight when people try to stop me from doing what I
want.

1

5

8

9

*P22.

My feelings are like the weather, they’re always changing.

1

5

8

9

*P23.

Sometimes I get so angry I break or smash things.

1

5

8

9

*P24.

I let others make my big decisions for me.

1

5

8

9

*P25.

I usually feel uncomfortable or helpless when I’m alone.

1

5

8

9

*P26.

I often seek advice or reassurance about everyday decisions.

1

5

8

9

*P27.

I keep to myself even when there are other people around.

1

5

8

9

*P28.

People think I’m too strict about rules and regulations.

1

5

8

9

*P29.

People think I‘m too stiff or formal.

1

5

8

9

*P30.

I feel awkward or out of place in social situations.

1

5

8

9

*P31.

People often make fun of me behind my back.

1

5

8

9

*P32.

I prefer activities that I can do by myself.

1

5

8

9

*P33.

I’ve held grudges against people for years.

1

5

8

9

*P34.

I’m convinced there’s a conspiracy behind many things in the
world.

1

5

8

9

162

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
PERSONALITY
*PEA1. Now I am going to read a series of statements that people use to describe themselves. Answer “true” or
“false” for each statement. The best answer is usually the one that comes to your mind first, so don’t take
too much time thinking before you answer. Here’s the first statement.
(IF NEC: Would you say this is true or false for you?)

TRU
E
(1)

FALSE
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PEA54. Giving in to some of my urges gets me into trouble.

1

5

8

9

*PEA55. I have tantrums or angry outbursts.

1

5

8

9

*PEA56. When I’m under stress, things around me don’t seem real.

1

5

8

9

*PEA57. I go to extremes to try to keep people from leaving me.

1

5

8

9

*PEA40. I never met a person that I didn’t like.
*PEA41. I have always told the truth.
*PEA42. I always win at games.
*PEA43. I have never been bored.
*PEA44. I never get lost, even in unfamiliar places.
*PEA45. I never get annoyed when people cut ahead of me in line.
*PEA46. My table manners at home are as good as when I eat out in a
restaurant.
*PEA47. I have never lost anything.
*PEA48. No matter how hot or cold it gets, I am always quite
comfortable.
*PEA49. It doesn’t bother me if someone takes advantage of me.

*PEA50. I show my feelings for everyone to see.
*PEA51. I get into very intense relationships that don’t last.
*PEA52. I often feel “empty” inside.

*PEA53.

I’m very moody.

163

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

TRUE
(1)

FALSE
(5)

DK
(8)

RF
(9)

*PEA58. I can’t decide what kind of person I want to be.

1

5

8

9

*PEA59. I’ve never been arrested.

1

5
GO TO
*PEA 61

8

9

*PEA60. At times I’ve done things that could get a person arrested.

1

5

8

9

*PEA61. I usually feel bad when I hurt or upset someone.

1

5

8

9

*PEA62. At times I’ve refused to hold a job, even when I was expected
to.

1

5

8

9

*PEA63. I will lie or con someone if it serves my purpose.

1

5

8

9

*PEA64. I lose my temper and get into physical fights.

1

5

8

9

*PEA65. I take chances and do reckless things.

1

5

8

9

*PEA66. It’s hard for me to stay out of trouble.

1

5

8

9

*PEA67. At times I fail to meet my financial obligations.

1

5

8

9

*PEA68. At times I’ve intentionally damaged things that weren’t mine.

1

5

8

9

*PEA69. I will give false information about myself if it will help me
get a job or impress someone.

1

5

8

9

*PEA70. I argue or fight when people try to stop me from doing what I
want.

1

5

8

9

*PEA71. My feelings are like the weather, they’re always changing.

1

5

8

9

*PEA72. Sometimes I get so angry I break or smash things.

1

5

8

9

*PEA73. I let others make my big decisions for me.

1

5

8

9

*PEA74. I usually feel uncomfortable or helpless when I’m alone.

1

5

8

9

*PEA75. I often seek advice or reassurance about everyday decisions.

1

5

8

9

(IF NEC: Would you say this statement is true or false for you?)

164

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
TRUE
(1)

FALSE
(5)

DK
(8)

RF
(9)

*PEA76. I keep to myself even when there are other people around.

1

5

8

9

*PEA77. People think I’m too strict about rules and regulations.

1

5

8

9

*PEA78. People think I‘m too stiff or formal.

1

5

8

9

*PEA79. I feel awkward or out of place in social situations.

1

5

8

9

*PEA80. People often make fun of me behind my back.

1

5

8

9

*PEA81. I prefer activities that I can do by myself.

1

5

8

9

*PEA82. I’ve held grudges against people for years.

1

5

8

9

*PEA83. I’m convinced there’s a conspiracy behind many things in the
world.

1

5

8

9

(IF NEC: Would you say this statement is true or false for you?)

SPECIFIC PHOBIA (SP)
*SP1. INTERVIEWER: (SEE *SC27a-f)
CIRCLE # IF GROUP WAS ENDORSED

Group 1: ANIMALS

1

Group 2: STILL WATER OR WEATHER EVENTS

2

Group 3: BLOOD, INJURIES, OR MEDICAL
EXPERIENCES

3

Group 4: CLOSED SPACES

4

Group 5: HIGH PLACES

5

Group 6: FLYING

6

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SP1a. INTERVIEWER CHECKPOINT: (SEE *SC27a-*SC27f)
EXACTLY ONE CATEGORY CODED ‘1’ IN *SC27a-*SC27f ............................................ 1
MORE THAN ONE CATEGORY CODED ‘1’ IN *SC27a-*SC27f ....................................... 2

*SP2.

INTERVIEWER CHECKPOINT: (SEE *SP1)

GO TO FIRST CIRCLED GROUP ON GRID *SP1 AND FOLLOW SKIP GROUP 1
........................ 1
GROUP 2 ......................... 2
GROUP 3 ......................... 3
GROUP 4 ......................... 4
GROUP 5 ......................... 5
GROUP 6 ......................... 6

GO TO *SP3
GO TO *SP5
GO TO *SP7
GO TO *SP9
GO TO *SP11
GO TO *SP13

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GROUP 1
[KEY PHRASE = ANIMALS]
*SP3.
Earlier you mentioned being a lot more afraid than most people of bugs,
snakes or other animals. How old were you the very first time you had a fear of
some type of animal?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YEARS OLD
BEFORE STARTED SCHOOL ....... 4
BEFORE TEENAGER ....................12
NOT BEFORE
TEENAGER.....................................13
DON'T KNOW ................................998
REFUSED ........................................999

*SP3.1. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SC27.2, *SC27.3)
*SP1a EQUALS ‘2’ AND *SC27.2 EQUALS ‘1’ ...1
*SP1a EQUALS ‘2’ AND *SC27.3 EQUALS ‘1’ ...2 GO TO *SP3b
*SC27.3 EQUALS ‘1’ ..................................................3 GO TO *SP3c
ALL OTHERS...............................................................4 GO TO *SP4
*SP3a. Was there ever a time when you almost always became very upset or
anxious whenever you were faced with (ANIMAL/the type of animal that scared
you most)?

YES .................................. 1
NO .................................... 5
DON'T KNOW ................ 8
REFUSED ........................ 9

*SP3a.1 INTERVIEWER CHECKPOINT: (SEE *SC27.3)
*SC27.3 EQUALS ‘1’ ...................................................................1
ALL OTHERS........................................................... 2 GO TO *SP4
*SP3b. Did you ever avoid situations where you might have even a small
chance of seeing (ANIMAL/this type of animal) whenever you could because
of your fear?

*SP3c. How old were you when you first avoided situations where you might
see (ANIMAL/animals)?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

*SP4.

YES .................................. 1
NO.................................. 5 GO TO *SP4
DON'T KNOW .............. 8 GO TO *SP4
REFUSED...................... 9 GO TO *SP4
YEARS OLD
BEFORE STARTED
SCHOOL..........................................4
BEFORE TEENAGER ....................12
NOT BEFORE
TEENAGER.....................................13
DON'T KNOW ................................998
REFUSED ........................................999

INTERVIEWER CHECKPOINT: (SEE *SP1)

GO TO NEXT CIRCLED GROUP ON GRID *SP1, PAGE 69 AND FOLLOW SKIP GROUP 2
......................... 2
GROUP 3 ......................... 3
GROUP 4 ......................... 4
GROUP 5 ......................... 5
GROUP 6 ......................... 6
ALL OTHERS ................. 7

GO TO *SP5
GO TO *SP7
GO TO *SP9
GO TO *SP11
GO TO *SP13
GO TO *SP14

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GROUP 2
[KEY PHRASE = STORMS OR STILL WATER]
*SP5.
(Earlier you/ You also) mentioned being a lot more afraid than most
people of either being in storms or in still water. How old were you the very first
time you had this fear?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YEARS OLD
BEFORE STARTED SCHOOL ... 4
BEFORE TEENAGER ................... 12
NOT BEFORE
TEENAGER .................................. 13
DON'T KNOW .............................. 998
REFUSED...................................... 999

*SP5.1. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SC27.2, *SC27.3)
*SP1a EQUALS ‘2’ AND *SC27.2 EQUALS ‘1’ ...................... 1
*SP1a EQUALS ‘2’ AND *SC27.3 EQUALS ‘1’ .... 2 GO TO *SP5b
*SC27.3 EQUALS ‘1’................................................ 3 GO TO *SP5c
ALL OTHERS ............................................................. 4 GO TO *SP6
*SP5a. Was there ever a time when you almost always became very upset or
anxious whenever you were faced with the situation like this that scared you
most?

YES ...................................1
NO ....................................5
DON'T KNOW .................8
REFUSED.........................9

*SP5a.1 INTERVIEWER CHECKPOINT: (SEE *SC27.3)
*SC27.3 EQUALS ‘1’ .................................................................. 1
ALL OTHERS ..........................................................2 GO TO *SP6
*SP5b. Did you ever avoid situations where you could be in a storm or still
water whenever you could because of your fear?

*SP5c. How old were you when you first started avoiding these situations?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YES .......................... 1
NO ......................... 5 GO TO *SP6
DON'T KNOW ...... 8 GO TO *SP6
REFUSED.............. 9 GO TO *SP6
YEARS OLD
BEFORE STARTED
SCHOOL ..........................4
BEFORE TEENAGER .. 12
NOT BEFORE TEENAGER
......................................... 13
DON'T KNOW ...............998
REFUSED.......................999

*SP6.
INTERVIEWER CHECKPOINT: (SEE *SP1)
GO TO NEXT CIRCLED GROUP ON GRID *SP1, PAGE 69 AND FOLLOW SKIP
GROUP 3 ......................... 3
GROUP 4 ......................... 4
GROUP 5 ......................... 5
GROUP 6 ......................... 6
ALL OTHERS ................. 7

GO TO *SP7
GO TO *SP9
GO TO *SP11
GO TO *SP13
GO TO *SP14

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GROUP 3
[KEY PHRASE = BLOOD, INJURIES, OR MEDICAL EXPERIENCES]
*SP7.
(Earlier you/ You also) mentioned being a lot more afraid than most
people of going to a doctor or a dentist or a hospital, getting a shot or injection,
or seeing blood or injury. How old were you the very first time you had this
fear?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YEARS OLD
BEFORE STARTED
SCHOOL .......................... 4
BEFORE TEENAGER...12
NOT BEFORE TEENAGER
.......................................... 13
DON'T KNOW ............... 998
REFUSED ...................... 999

*SP7.1. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SC27.2, *SC27.3)
*SP1a EQUALS ‘2’ AND *SC27.2 EQUALS ‘1’ ... 1
*SP1a EQUALS ‘2’ AND *SC27.3 EQUALS ‘1’ ... 2 GO TO *SP7b
*SC27.3 EQUALS ‘1’................................................ 3 GO TO *SP7c
ALL OTHERS ............................................................ 4 GO TO *SP7f
*SP7a. Was there ever a time when you almost always became very upset or
anxious whenever you were faced with the thing in this group that scared you
most?

YES .................................. 1
NO .................................... 5
DON'T KNOW ................. 8
REFUSED ........................ 9

*SP7a.1 INTERVIEWER CHECKPOINT: (SEE *SC27.3)
*SC27.3 EQUALS ‘1’ .................................................................. 1
ALL OTHERS.......................................................... 2 GO TO *SP7f
*SP7b. Did you ever avoid any of these things whenever you could because of
your fear?

*SP7c. How old were you when you first avoided any of these situations?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YES ......................... 1
NO ......................... 5 GO TO *SP7f
DON'T KNOW...... 8 GO TO *SP7f
REFUSED ............. 9 GO TO *SP7f
YEARS OLD
BEFORE STARTED
SCHOOL .......................... 4
BEFORE TEENAGER...12
NOT BEFORE TEENAGER
.......................................... 13
DON'T KNOW .................998
REFUSED ........................ 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SP7f. How often did you faint when you saw blood – all of the time, most of the time, sometimes, rarely, or
never?
ALL OF THE TIME ....................... 1
MOST OF THE TIME .................... 2
SOMETIMES .................................. 3
RARELY .........................................4
NEVER ...........................................5
DON'T KNOW................................ 8
REFUSED ....................................... 9
*SP8.

INTERVIEWER CHECKPOINT: (SEE *SP1)

GO TO NEXT CIRCLED GROUP ON GRID *SP1, PAGE 69 AND FOLLOW SKIP GROUP 4
......................... 4
GROUP 5 ......................... 5
GROUP 6 ......................... 6
ALL OTHERS ................. 7

GO TO *SP9
GO TO *SP11
GO TO *SP13
GO TO *SP14

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GROUP 4
[KEY PHRASE = CLOSED SPACES]
*SP9.
(Earlier you/ You also) mentioned being a lot more afraid than most
people of closed spaces, like caves, tunnels, closets, or elevators. How old were
you the very first time you had this fear?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YEARS OLD
BEFORE STARTED SCHOOL ....... 4
BEFORE TEENAGER...12
NOT BEFORE TEENAGER
.......................................... 13
DON'T KNOW ............... 998
REFUSED ...................... 999

*SP9.1. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SC27.2, *SC27.3)
*SP1a EQUALS ‘2’ AND *SC27.2 EQUALS ‘1’ ...................... 1
*SP1a EQUALS ‘2’ AND *SC27.3 EQUALS ‘1’..... 2 GO TO *SP9b
*SC27.3 EQUALS ‘1’ ................................................. 3 GO TO *SP9c
ALL OTHERS.............................................................. 4 GO TO *SP9d
*SP9a. Was there ever a time when you almost always became very upset or
anxious whenever you were faced with closed spaces?
(IF VOL: “IT DEPENDS WHICH CLOSED SPACE,” PROBE:
What if you were faced with the closed space that you feared most – in that
case, did you almost always become very upset or anxious?)

YES .................................. 1
NO .................................... 5
DON'T KNOW ................. 8
REFUSED ........................ 9

*SP9a.1 INTERVIEWER CHECKPOINT: (SEE *SC27.3)
*SC27.3 EQUALS ‘1’................................................ 1 ALL OTHERS
ALL OTHERS ......................................................... 2 GO TO *SP9d
*SP9b. Did you ever avoid any of these closed spaces whenever you could
because of your fear?

*SP9c. How old were you when you first avoided closed spaces?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YES ....................... 1
NO ....................... 5 GO TO *SP9d
DON'T KNOW.... 8 GO TO *SP9d
REFUSED ........... 9 GO TO *SP9d
YEARS OLD
BEFORE STARTED
SCHOOL ........................... 4
BEFORE TEENAGER...12
NOT BEFORE TEENAGER
.......................................... 13
DON'T KNOW ............... 998
REFUSED ...................... 999

*SP9d. INTERVIEWER CHECKPOINT: (SEE *SP9.1, *SP9a, *SP9b)
*SP9.1 EQUALS ‘2’ OR *SP9.1 EQUALS ‘3’ .......................... 1
*SP9a EQUALS ‘1’ OR *SP9b EQUALS ‘1’ ............................ 2
ALL OTHERS ........................................................... 3 GO TO *SP10

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Which of the following things did you strongly fear about closed spaces:
YES
(1)

(IF NEC: Were you afraid…)
*SP9f.

That you might be trapped and unable to escape?

*SP9g.

That you might have a panic attack and be unable to get help?

*SP9h.

That you might become physically ill and be unable to get help?

*SP9i.

That you might not be able to breathe?

*SP9j.

[INTERVIEWER CHECKPOINT: (SEE *SP9f-*SP9i SERIES)]

AT LEAST ONE RESPONSE CODED ‘1’....1
ALL OTHERS ................................................................. 5

*SP9k.

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

GO TO *SP10

What was it, then, that you feared most about closed spaces?

DON'T KNOW.................................. 8
REFUSED ......................................... 9

SP10.

INTERVIEWER CHECKPOINT: (SEE *SP1)

GO TO NEXT CIRCLED GROUP ON GRID *SP1, PAGE 69 AND FOLLOW SKIP GROUP 5
......................... 5
GROUP 6 ......................... 6
ALL OTHERS ................. 7

GO TO *SP11
GO TO *SP13
GO TO *SP14

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GROUP 5
[KEY PHRASE = HIGH PLACES]
*SP11. (Earlier you/ You also) mentioned being a lot more afraid than most
people of high places. How old were you the very first time you had this fear?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YEARS OLD
BEFORE STARTED
SCHOOL ........................... 4
BEFORE TEENAGER .. 12
NOT BEFORE TEENAGER
.......................................... 13
DON'T KNOW ............... 998
REFUSED ...................... 999

*SP11.1. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SC27.2, *SC27.3)
*SP1a EQUALS ‘2’ AND *SC27.2 EQUALS ‘1’ ... 1
*SP1a EQUALS ‘2’ AND *SC27.3 EQUALS ‘1’ ... 2 GO TO *SP11b
*SC27.3 EQUALS ‘1’................................................ 3 GO TO *SP11c
ALL OTHERS ............................................................ 4 GO TO *SP11d
*SP11a. Was there ever a time when you almost always became very upset or
anxious whenever you were faced with being in a high place?
(IF VOL: “IT DEPENDS WHICH HIGH PLACE,” PROBE: What if
you were faced with the high place that you feared most – in that case, did you
almost always become very upset or anxious?)

YES .................................. 1
NO .................................... 5
DON'T KNOW ................. 8
REFUSED ........................ 9

*SP11a.1 INTERVIEWER CHECKPOINT: (SEE *SC27.3)
*SC27.3 EQUALS ‘1’ .................................................................. 1
ALL OTHERS ........................................................2 GO TO *SP11d
*SP11b. Did you ever avoid high places whenever you could because of your
fear?

*SP11c. How old were you when you first avoided high places?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YES ............................. 1
NO............................. 5 GO TO *SP11d
DON'T KNOW ......998 GO TO *SP11d
REFUSED..............999 GO TO *SP11d
YEARS OLD
BEFORE STARTED
SCHOOL .......................... 4
BEFORE TEENAGER .. 12
NOT BEFORE TEENAGER
.......................................... 13
DON'T KNOW ............... 998
REFUSED ...................... 999

*SP11d. INTERVIEWER CHECKPOINT: (SEE *SP11.1, *SP11a, *SP11b)
*SP11.1 EQUALS ‘2’ OR *SP11.1 EQUALS ‘3’ ...................... 1
*SP11a EQUALS ‘1’ OR *SP11b EQUALS ‘1’ ........................ 2
ALL OTHERS ...........................................................3 GO TO *SP12

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Which of the following things did you strongly fear about high places:

YES
(1)

NO
(5)

DK
(8)

RF
(9)

(IF NEC: Were you afraid…)
*SP11f. That you might get dizzy and fall?
*SP11g. That you might jump?
*SP11h. That you might have a panic attack and be unable to get help?
*SP11i. That you might become physically ill and be unable to get help?

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*SP11j. INTERVIEWER CHECKPOINT: (SEE*SP11f -*SP11i SERIES)
AT LEAST ONE RESPONSE CODED ‘1’....1
ALL OTHERS ................................................................. 5

GO TO *SP12

*SP11k. What was it, then, that you feared most about high places?

DON'T KNOW.................................. 8
REFUSED ......................................... 9

SP12.

INTERVIEWER CHECKPOINT: (SEE *SP1)

GO TO NEXT CIRCLED GROUP ON GRID *SP1, PAGE 69 AND FOLLOW SKIP GROUP 6
......................... 6
ALL OTHERS ................. 7

GO TO *SP13
GO TO *SP14

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GROUP 6
[KEY PHRASE = FLYING]
*SP13. (Earlier you/ You also) mentioned being a lot more afraid than most
people of flying or airplanes. How old were you the very first time you had this
fear?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YEARS OLD
BEFORE STARTED
SCHOOL .......................... 4
BEFORE TEENAGER .. 12
NOT BEFORE TEENAGER
......................................... 13
DON'T KNOW............... 998
REFUSED .......................999

*SP13.1. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SC27.2, *SC27.3)
*SP1a EQUALS ‘2’ AND *SC27.2 EQUALS ‘1’ ..................... 1
*SP1a EQUALS ‘2’ AND *SC27.3 EQUALS ‘1’....2 GO TO *SP13b
*SC27.3 EQUALS ‘1’ ................................................3 GO TO *SP13c
ALL OTHERS.............................................................4 GO TO *SP13d
*SP13a. Was there ever a time when you almost always became very upset or
anxious whenever you were faced with flying?

YES .................................. 1
NO .................................... 5
DON'T KNOW................. 8
REFUSED ........................ 9

*SP13a.1 INTERVIEWER CHECKPOINT: (SEE *SC27.3)
*SC27.3 EQUALS ‘1’ ..................................................................1
ALL OTHERS .........................................................2 GO TO *SP13d
*SP13b. Did you ever avoid flying whenever you could because of your fear?

*SP13c. How old were you when you first avoided flying?
IF “ALL MY LIFE” OR “AS LONG AS I CAN REMEMBER,”
PROBE: Was it before you first started school?
IF NOT YES, PROBE: Was it before you were a teenager?

YES ............................ 1
NO............................5 GO TO *SP13d
DON'T KNOW ........8 GO TO *SP13d
REFUSED................9 GO TO *SP13d
YEARS OLD
BEFORE STARTED
SCHOOL .......................... 4
BEFORE TEENAGER .. 12
NOT BEFORE TEENAGER
......................................... 13
DON'T KNOW............... 998
REFUSED .......................999

*SP13d. INTERVIEWER CHECKPOINT: (SEE *SP13.1, *SP13a, *SP13b)
*SP13.1 EQUALS ‘2’ OR *SP13.1 EQUALS ‘3’ .......................1
*SP13a EQUALS ‘1’ OR *SP13b EQUALS ‘1’.........................2
ALL OTHERS........................................................... 3 GO TO *SP14

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Which of the following things did you strongly fear about flying:
YES
(1)

(IF NEC: Were you afraid of…)
*SP13f. Being high in the air?
*SP13g. Being in a closed space?
*SP13h. That you might have a panic attack and be unable to get help?
*SP13i. That you might become physically ill and be unable to get help?
*SP13j. That the plane might crash?

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*SP13k. INTERVIEWER QUERY: DID R ANSWER “YES” TO AT LEAST ONE QUESTION IN THE *SP13f*SP13j SERIES?
YES .................................. 1
NO ....................................................... 5

GO TO *SP14

*SP13l. What was it, then, that you feared most about flying?

DON'T KNOW ..................................8
REFUSED .........................................9
*SP14. INTERVIEWER CHECKPOINT: (SEE *SP1a, *SP3a, *SP3b, *SP5a, *SP5b, *SP7a, *SP7b, *SP9a,
*SP9b, *SP11a, *SP11b, *SP13a, *SP13b)
*SP1a EQUALS ‘1’ OR *SP3a EQUALS ‘1’ OR *SP3b EQUALS ‘1’ OR *SP5a EQUALS ‘1’ OR
*SP5b EQUALS ‘1’ OR *SP7a EQUALS ‘1’ OR *SP7b EQUALS ‘1’ OR *SP9a EQUALS ‘1’ OR
*SP9b EQUALS ‘1’ OR *SP11a EQUALS ‘1’ OR *SP11b EQUALS ‘1’ OR
*SP13a EQUALS ‘1’ *SP13b EQUALS ‘1’ ............................................................................................. 1
ALL OTHERS ........................................................................................................................ 2

GO TO *SP42

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*SP16. You had fears of (KEY PHRASES LISTED IN *SP1 GRID OF ALL CIRCLED GROUPS IN *SP1). How
much did your fear or avoidance of these things ever interfere with either your work, your social life, or your personal
relationships – not at all, a little, some, a lot, or extremely?
NOT AT ALL ................................... 1
A LITTLE .......................................2
SOME..........................................................................3
A LOT................................................................. 4
EXTREMELY .................................................... 5
DON'T KNOW ................................................ 8
REFUSED.......................................9

GO TO *SP17
GO TO *SP17

GO TO *SP17

SP16.1. How often during that time were you unable to carry out your daily activities or to take care of yourself
because your fears of (KEY PHRASES LISTED IN *SP1 GRID OF ALL CIRCLED GROUPS IN *SP1) – often,
sometimes, not very often, never?
OFTEN........................................................................... 1
SOMETIMES ................................................................ 2
NOT VERY OFTEN...................................................... 3
NEVER .......................................................................... 4
DON’T KNOW .............................................................. 8
REFUSED...................................................................... 9

*SP17. Was there ever a time in your life when you felt very emotionally upset, worried, or disappointed with
yourself because of your fear or avoidance of these things?
YES..............................................................................1
NO....................................................................... 5
DON’T KNOW .................................................. 8
REFUSED ....................................................... 9

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*SP18. (RB, PG 14) Think of the time in your life when the fear was most severe. When you were faced with these
things or thought you would have to be, did you ever have two or more of the problems on Page 14?
READ LIST BELOW STARTING WITH SP18a ONLY IF R PREFERS TO HAVE QUESTIONS READ YES
.................................................................... 1
NO ....................................................... 5
DON’T KNOW................................... 8
REFUSED ........................................9
GO TO *SP19
GO TO *SP19 AFTER TWO “YES” RESPONSES
*SP18a. Did your heart ever pound or race?
*SP18b. Did you sweat?
*SP18c. Did you tremble?
*SP18d. Did you feel sick to your stomach?
*SP18e. Did you have a dry mouth?
*SP18f. Did you have chills or hot flushes?
*SP18g. Did you feel numbness or have tingling sensations?
*SP18h. Did you have trouble breathing normally?
*SP18i. Did you feel like you were choking?
*SP18j. Did you have pain or discomfort in your chest?
*SP18k. Did you feel dizzy or faint?

YES
(1)

NO
(5)

DK
(8)

RF (9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

5

8

9

*SP18l. Were you afraid that you might die?

*SP18m. Did you ever fear that you might lose control, go crazy, or
pass out?
*SP18n. Did you feel like you were “not really there”, like you were
watching a movie of yourself?

GO TO
*SP19
*SP18o. Did you feel that things around you were unreal or like a
dream?

1

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*SP19. When was the last time you either strongly feared or avoided any of these things - within the past one month,
between two and six months ago, between seven and twelve months ago, or more than twelve months ago?
WITHIN PAST MONTH .............................. 1
2 AND 6 MONTHS AGO ............................. 2
7 AND 12 MONTHS AGO ........................... 3
MORE THAN 12 MONTHS AGO ................................... 4
DON’T KNOW.................................................................. 8
REFUSED .......................................................................... 9

GO TO *SP21
GO TO *SP21
GO TO *SP21

*SP20. How old were you the last time (you either strongly feared or avoided any of these things)?
YEARS OLD
DON'T KNOW
998
REFUSED ......................................... 999
*SP21. What if you were faced with one of these things today: How strong would your fear be – not at all, mild,
moderate, severe, or very severe?
(IF VOL “IT DEPENDS ON WHICH THING,” PROBE: What if you were faced with the thing that scares you most:
How strong would your fear be - not at all, mild, moderate, severe, or very severe?)
NOT AT ALL .................................1
MILD ..............................................2
MODERATE....................................................3
SEVERE...........................................................4
VERY SEVERE ...............................................5
DON’T KNOW ................................................8
REFUSED ........................................................ 9

GO TO *SP27
GO TO *SP27

*SP22. During the past 12 months, how often did you avoid these feared things - - all the time, most of the time,
sometimes, rarely, or never?
(IF VOL “IT DEPENDS ON WHICH THING,” PROBE: How about for the thing that you avoided most: Did you
avoid it all the time, most of the time, sometimes, rarely, or never?)
ALL THE TIME ................................................. 1
MOST OF THE TIME........................................ 2
SOMETIMES ..................................................... 3
RARELY............................................................. 4
NEVER ............................................................... 5
DON’T KNOW................................................... 8
REFUSED ........................................................... 9

179

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No
Interference

Mild

0

1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

*SP23. (RB, PG 9) Think about the month or longer in the past 12 when your fear (or avoidance) was most severe. Using the 0
to 10 scale on page 9 of your booklet, where 0 means no interference and 10 means very severe interference, what number
describes how much your fear (or avoidance) interfered with each of the following activities during that time?
[IF NEC: How much did the fear (or avoidance) interfere with (ACTIVITY) during that time?] [IF NEC: You can
use any number between 0 and 10 to answer.]
NUMBER (0-10)
*SP23a. Your home management, like cleaning, shopping,
and taking care of the (house/ apartment)?
DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99
*SP23b. Your ability to work?
DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99

*SP23c. Your ability to form and maintain close relationships with
other people?
DOES NOT APPLY ..........................................97
DON’T KNOW .............................................. 98
REFUSED........................................................99
*SP23d. Your social life

DOES NOT APPLY .......97
DON’T KNOW ..............98
REFUSED.......................99

*SP24. INTERVIEWER CHECKPOINT: (SEE *SP23a - *SP23d)
ALL RESPONSES EQUAL ‘0’ OR ‘97’.............1
ALL OTHERS ....................................................................... 2

GO TO *SP27

*SP25. About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your fear (or avoidance)?
(IF NEC: You can use any number between 0 and 365 to answer)
NUMBER OF DAYS
DON'T KNOW .......................................................... 998
REFUSED ................................................................. 999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SP27. Did you ever in your life talk to a medical doctor or other professional about your fear (or avoidance)? (By other
professional we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists, and other healing
professionals.)
YES...............................................................................................1
NO .................................................................... 5
DON’T KNOW ............................................... 8
REFUSED........................................................ 9

GO TO *SP41.1
GO TO *SP41.1
GO TO *SP41.1

*SP27a. How old were you the first time (you talked to a professional about your fear)?
YEARS OLD
DON’T KNOW..........................................................................998
REFUSED ............................................................................. 999

*SP38. Did you ever get treatment for your fear that you considered helpful or effective?
YES ................................................................. 1
NO .................................................. 5
DON’T KNOW .............................. 8
REFUSED ...................................... 9
*SP38a.

GO TO *SP38c
GO TO *SP38c
GO TO *SP38c

How old were you the first time (you got helpful treatment for your fear)?

YEARS OLD
DON’T KNOW
998
REFUSED ...................................................................... 999
*SP38b.
How many professionals did you ever talk to about your fear, up to and including the first time
you got helpful treatment?
NUMBER OF PROFESSIONALS

GO TO *SP40

DON’T KNOW ...........................98 GO TO *SP40
REFUSED ...................................99 GO TO *SP40

*SP38c.

How many professionals did you ever talk to about your fear?
NUMBER OF PROFESSIONALS

DON’T KNOW .............................................................. 98
REFUSED ...................................................................... 99

181

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*SP40. Did you receive professional treatment for your fear at any time in the past 12 months?
YES ............................................................................. 1
NO ....................................................................... 5
DON’T KNOW .................................................. 8
REFUSED ....................................................... 9

*SP41. Were you ever hospitalized overnight for your fear?
YES .................................................................................... 1
NO .................................................................. 5
DON’T KNOW.............................................. 8
REFUSED...................................................... 9

GO TO *SP41.1
GO TO *SP41.1
GO TO *SP41.1

*SP41a. How old were you the first time (you were hospitalized overnight because of your fear)?
YEARS OLD
DON’T KNOW .............................................................. 998
REFUSED ...................................................................... 999

*SP41.1. How many of your close relatives – including your biological parents, brothers and sisters, and children – ever had a strong
fear of something like animals or closed spaces or heights or blood?
NUMBER
DON'T KNOW........................................................... 998
REFUSED .................................................................. 999

*SP42. INTERVIEWER CHECKPOINT (SEE *SC26, *SC26a, *SC26b, *SC29.4, *SC30.4): FOLLOW SKIP FOR FIRST
ENDORSED ITEM.
*SC29.4 EQUALS’1’.............................................................. 1

GO TO *SO1, NEXT SECTION

*SC30.4 EQUALS’1’.............................................................. 2

GO TO *AG1

*SC26 EQUALS’1’................................................................. 3

GO TO *G1 INTRO 1

*SC26a EQUALS’1’............................................................... 4

GO TO *G1 INTRO 2

*SC26b EQUALS’1’ .............................................................. 5

GO TO *G1 INTRO 3

ALL OTHERS...................................................................... 6

GO TO *IED1

182

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POST-TRAUMATIC STRESS DISORDER (PT)
YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO *PT29
AND CODE “1”

5

8

9

1
GO TO *PT30
AND CODE “1”

5

8

9

1
GO TO *PT31
AND CODE “1”

5

8

9

1
GO TO *PT32
AND CODE “1”

5

8

9

1
GO TO *PT33
AND CODE “1”

5

8

9

1
GO TO *PT34
AND CODE “1”

5

8

9

1
GO TO *PT35
AND CODE “1”

5

8

9

1
GO TO *PT36
AND CODE “1”

5

8

9

1
GO TO *PT37
AND CODE “1”

5

8

9

*PT1. (RB, PG 42) In the next part of the interview, we ask about very
stressful events that might have happened in your life. (Some of
these events are listed on the card.) First, did you ever
participate in combat, either as a member of a military, or as a
member of an organized non-military group?
*PT2.

*PT3.

*PT4.

*PT5.

*PT6.

*PT7.

*PT8.

Did you ever serve as a peacekeeper or relief worker in a war zone
or in a place where there was ongoing terror of people because of
political, ethnic, religious or other conflicts?

Were you ever an unarmed civilian in a place where there was a
war, revolution, military coup or invasion?

Did you ever live as a civilian in a place where there was
ongoing terror of civilians for political, ethnic, religious or other
reasons?

Were you ever a refugee – that is, did you ever flee from your
home to a foreign country or place to escape danger or
persecution?

Were you ever kidnapped or held captive?

Were you ever exposed to a toxic chemical or substance that could
cause you serious harm?

Were you ever involved in a life-threatening automobile accident?

*PT9. Did you ever have any other life- threatening accident, including on
your job?

183

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO *PT38
AND CODE “1”

5

8

9

1
GO TO *PT39
AND CODE “1”

5

8

9

1
GO TO *PT40
AND CODE “1”

5

8

9

1
GO TO *PT41
AND CODE “1”

5

8

9

1
GO TO *PT42
AND CODE “1”

5

8

9

1
GO TO *PT43
AND CODE “1”

5

8

9

1
GO TO *PT44
AND CODE “1”

5

8

9

1
GO TO *PT45
AND CODE “1”

5

8

9

1
GO TO *PT46
AND CODE “1”

5

8

9

1
GO TO *PT47
AND CODE “1”

5

8

9

*PT10. Were you ever involved in a major natural disaster, like a
devastating flood, hurricane, or earthquake?

*PT11. Were you ever in a man-made disaster, like a fire started by a
cigarette, or a bomb explosion?

*PT12. Did you ever have a life-threatening illness?

*PT13. As a child, were you ever badly beaten up by your parents or the
people who raised you?

*PT14. Were you ever badly beaten up by a spouse or romantic partner?

*PT15.

Were you ever badly beaten up by anyone else?

*PT16. Were you ever mugged, held up, or threatened with a weapon?

*PT17. The next question is about rape. We define this as an event during
which one person has sexual intercourse with or penetrates the
body of another person without their consent, or when they were
too young to know what was happening.
Did you ever experience an event like the one I just described?
*PT18. The next question is about sexual assault. We define this as an
event during which one person touches another person
inappropriately, or without that person’s consent.
Other than rape, did you ever experience an event like the one I
just described?
*PT19. Has someone ever stalked you – that is, followed you or kept track
of your activities in a way that made you feel you were in serious
danger?

184

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*PT20. Did someone very close to you ever die unexpectedly; for
example, they were killed in an accident, murdered, committed
suicide, or had a fatal heart attack at a young age?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO *PT48
AND CODE “1”

5

8

9

1
GO TO *PT49
AND CODE “1”

5

8

9

1
GO TO *PT50
AND CODE “1”

5

8

9

1
GO TO *PT50.1
AND CODE “1”

5

8

9

1
GO TO *PT51
AND CODE “1”

5

8

9

1
GO TO *PT52
AND CODE “1”

5

8

9

1
GO TO *PT53
AND CODE “1”

5

8

9

1
GO TO *PT54
AND CODE “1”

5

8

9

1
GO TO *PT55
AND CODE “1”

5

8

9

1
GO TO *PT57
AND
CODE “YES”

5

8

9

*PT21. Did you ever have a son or daughter who had a life-threatening
illness or injury?

*PT22. Did anyone very close to you ever have an extremely traumatic
experience, like being kidnapped, tortured or raped?

*PT22.1. When you were a child, did you ever witness serious physical
fights at home, like when your father beat up your mother?

*PT23. Did you ever see someone being badly injured or killed, or
unexpectedly see a dead body?

*PT24. Did you ever do something that accidentally led to the serious
injury or death of another person?

*PT25. Did you ever on purpose either seriously injure, torture, or kill
another person?

*PT26. Did you ever see atrocities or carnage such as mutilated bodies or
mass killings?

*PT27. Did you ever experience any other extremely traumatic or lifethreatening event that I haven’t asked about yet?

*PT28. Sometimes people have experiences they don’t want to
talk about in interviews. I won’t ask you to describe anything like
this, but, without telling me what it was, did you ever have a
traumatic event that you didn’t tell me about because you didn’t
want to talk about it?

GO TO *CC1,
NEXT SECTION

185

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INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

NO
(5)

*PT29. (KEY PHRASE: combat experience)

AGE
How old were
you when you
had your first
combat
experience?
*PT29a.

DURATION
How long did
you serve?

*PT29b.

1
CHECK

YEARS

OFF
EVENT
ON
REF.
CARD

DK ........... 998
RF ............. 999

*PT29c.
INTERVIEWER: IF RESPONDENT VOLUNTEERS INFORMATION ON
MULTIPLE OCCURRENCES OF THIS EVENT TYPE, ENTER AGE AND
DURATION FOR THE SECOND OCCURRENCE.

DAYS ........... 1
WEEKS ....... 2
MONTHS .. 3
YEARS ........ 4
DK ................ 98
RF.................. 99
*PT29d.

YEARS
DK ........... 998
RF ............. 999

DAYS............1
WEEKS ....... 2
MONTHS .. 3
YEARS........ 4
DK ................98
RF .................99

186

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INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

NO
(5)

*PT30. (KEY PHRASE: relief worker in war zone)
[Other than the time (s) you participated in
combat,] Did you ever serve as a peacekeeper or
relief worker in a war zone or in a place where
there was ongoing terror of people because of
political, ethnic, religious or other conflicts?
DK................ 8 GO TO *PT31
RF................. 9 GO TO *PT31
(IF NEC: A peacekeeper is a person who works for an
international organization, a government, or a military
organization to supervise and enforce a truce between
hostile groups.)

AGE
How old were
you the first time
you did this?

DURATION
How long did
you serve in that
capacity?

*PT30a.

*PT30b.

YEARS

1

5

CHECK

GO
TO
*PT31

OFF
EVENT
ON
REF.
CARD

DK ........... 998
RF ............. 999

*PT30c.
INTERVIEWER: IF RESPONDENT VOLUNTEERS INFORMATION ON
MULTIPLE OCCURRENCES OF THIS EVENT TYPE, ENTER AGE AND
DURATION FOR THE SECOND OCCURRENCE.

DAYS ........... 1
WEEKS ....... 2
MONTHS .. 3
YEARS ........ 4
DK ................ 98
RF ................. 99

*PT30d.

YEARS
DK ........... 998
RF ............. 999

DAYS............1
WEEKS ....... 2
MONTHS .. 3
YEARS........ 4
DK ................98
RF .................99

187

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

AGE
INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

NO
(5)

*PT31. (KEY PHRASE: civilian in war zone)
(Other than when you served as a relief worker,)
Were you ever an unarmed civilian in a place
where there was a war, revolution, military coup
or invasion?
DK................ 8 GO TO *PT32
RF................. 9 GO TO *PT32
(IF NEC: By this we mean a civilian not directly
involved in the armed conflict.)

1

5

CHECK

GO
TO
*PT32

OFF
EVENT
ON
REF.
CARD

How old were
you when you
were first in this
situation?
*PT31a.

YEARS
DK ...........998
RF ............ 999

*PT31c.

DURATION
How long were
you in this
situation?
*PT31b.

DAYS ........... 1
WEEKS ....... 2
MONTHS .. 3
YEARS ........ 4
DK ................ 98
RF ................. 99

*PT31d.

INTERVIEWER: IF RESPONDENT VOLUNTEERS INFORMATION ON
MULTIPLE OCCURRENCES OF THIS EVENT TYPE, ENTER AGE AND
DURATION FOR THE SECOND OCCURRENCE.
YEARS
DK ........... 998
RF ............. 999

DAYS............1
WEEKS ....... 2
MONTHS .. 3
YEARS........ 4
DK ................98
RF .................99

188

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INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

NO
(5)

1

5

CHECK

GO
TO
*PT33

*PT32. (KEY PHRASE: civilian in region of terror)
(Other than what you have already told me
about,) Did you ever live as a civilian in a place
where there was ongoing terror of civilians for
political, ethnic, religious or other reasons?
DK................ 8 GO TO *PT33
RF................. 9 GO TO *PT33

OFF
EVENT
ON
REF.
CARD

AGE
How old were
you when you
were first in this
situation?
*PT32a.

YEARS
DK ........... 998
RF ............. 999

*PT32c.

DURATION
How long were
you in this
situation?
*PT32b.

DAYS ........... 1
WEEKS ....... 2
MONTHS .. 3
YEARS ........ 4
DK ................ 98
RF ................. 99
*PT32d.

INTERVIEWER: IF RESPONDENT VOLUNTEERS INFORMATION ON
MULTIPLE OCCURRENCES OF THIS EVENT TYPE, ENTER AGE AND
DURATION FOR THE SECOND OCCURRENCE.
YEARS
DK ........... 998
RF ............. 999

DAYS............1
WEEKS ....... 2
MONTHS .. 3
YEARS........ 4
DK ................98
RF .................99

189

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INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

NO
(5)

*PT33. (KEY PHRASE: refugee)
Were you ever a refugee – that is, did you ever
flee from your own home to a foreign country or
place to escape danger or persecution?
DK................ 8 GO TO *PT34
RF................. 9 GO TO *PT34

1

5

CHECK

GO
TO

EVENT
ON
REF.
CARD

*PT34

OFF

INTERVIEWER: IF RESPONDENT VOLUNTEERS INFORMATION ON
MULTIPLE OCCURRENCES OF THIS EVENT TYPE, ENTER AGE AND
DURATION FOR THE SECOND OCCURRENCE.

AGE
How old were
you when you
were first in this
situation?
*PT33a.

YES
(1)

NO
(5)

*PT34. (KEY PHRASE: kidnapped)
Were you ever kidnapped or held captive?

DK................ 8 GO TO *PT35
RF................. 9 GO TO *PT35

1

DK ........... 998
RF ............. 999

*PT33c.

*PT33d.

YEARS

DAYS ............1
WEEKS ....... 2
MONTHS...3
YEARS ........ 4
DK ................98
RF .................. 99

AGE
How old were
you when you
were first in this
situation?
*PT34a.

DURATION
How long were
you in captivity?

*PT34b.

5

DK ........... 998
RF ............. 999

DAYS ........... 1
WEEKS ....... 2
MONTHS...3
YEARS ........ 4
DK................ 98
RF .................. 99

*PT34c.

*PT34d.

YEARS

CHECK

OFF
EVENT
ON
REF.
CARD

*PT33b.

DAYS ........... 1
WEEKS ....... 2
MONTHS...3
YEARS ........ 4
DK................ 98
RF ................. 99

YEARS

DK ........... 998
RF ............. 999

INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.

DURATION
How long were
you a refugee?

GO
TO
*PT35

INTERVIEWER: IF RESPONDENT VOLUNTEERS INFORMATION ON
MULTIPLE OCCURRENCES OF THIS EVENT TYPE, ENTER AGE AND
DURATION FOR THE SECOND OCCURRENCE.
YEARS
DK ........... 998
RF ............. 999

DAYS ............1
WEEKS ....... 2
MONTHS...3
YEARS ........ 4
DK ................98
RF .................. 99

190

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INTERVIEWER: IF EVENT IS ENDORSED, ASK
THE FOLLOW-UP QUESTIONS AT RIGHT.
YES
(1)

NO
(5)

*PT35. (KEY PHRASE: toxic chemical exposure)
Were you ever exposed to a toxic chemical or
substance that could cause you serious harm?
DK................ 8 GO TO *PT36
RF................. 9 GO TO *PT36
IF VOL “MAYBE, NOT SURE,” CODE DK.

1

5

CHECK

GO
TO
*PT36

OFF
EVENT
ON
REF.
CARD

AGE
How old were
you when you
first found out
about (this
exposure/ one
of these
exposures)?
*P35a.

YEARS
DK ........... 998
RF ............. 999

#TIMES
How many times
(did that happen
in your life)?

*PT35b.

TIMES
DK ............ 998
RF ............. 999

191

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INTERVIEWER: FOR EACH ENDORSED EVENT,
ASK THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

NO
(5)

1

5

CHECK

GO
TO
*PT37

*PT36. (KEY PHRASE: automobile accident)
Were you ever involved in a life-threatening
automobile accident?
DK................ 8 GO TO *PT37
RF................. 9 GO TO *PT37

OFF
EVENT
ON
REF.
CARD

*PT37. (KEY PHRASE: life-threatening accident)
5

Were you in any other life- threatening accident,
including on your job?

CHECK

DK................ 8 GO TO *PT38
RF................. 9 GO TO *PT38

OFF
EVENT
ON
REF.
CARD

GO
TO
*PT38

Were you ever involved in a major natural
disaster, like a devastating flood, hurricane, or
earthquake?
DK................ 8 GO TO *PT39
RF................. 9 GO TO *PT39

1

5

CHECK

GO
TO
*PT39

OFF
EVENT
ON
REF.
CARD

*PT39. (KEY PHRASE: man-made disaster)
[Other than the time(s) you’ve already told me
about,] Were you ever in a man-made disaster,
like a fire started by a cigarette, or a bomb
explosion?
DK................ 8 GO TO *PT40
RF................. 9 GO TO *PT40

YEARS
DK ........... 998
RF ............. 999

*PT37a.
1

*PT38. (KEY PHRASE: natural disaster)

AGE
How old were
you the first
time?
*PT36a.

YEARS
DK ........... 998
RF ............. 999

*PT38a.

YEARS
DK ........... 998
RF ............. 999

*PT39a.
1

5

CHECK

GO
TO
*PT40

OFF
EVENT
ON
REF.
CARD

INTERVIEWER: DO NOT RECORD TOXIC
CHEMICAL EXPOSURE.
*PT40. (KEY PHRASE: life-threatening illness)
5

CHECK

GO
TO
*PT41

TIMES
DK ............ 998
RF ............. 999

*PT37b.

TIMES
DK ............ 998
RF ............. 999

*PT38b.

TIMES
DK ............ 998
RF ............. 999

*PT39b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

*PT40a.
1

# TIMES
How many times
(did that happen
in your life)?
*PT36b.

*PT40b.

Did you ever have a life-threatening illness?
DK................ 8 GO TO *PT41
RF................. 9 GO TO *PT41

OFF
EVENT
ON
REF.
CARD

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

192

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
AGE
How old were
you the first
time?

INTERVIEWER: FOR EACH ENDORSED EVENT,
ASK THE FOLLOW-UP QUESTIONS AT RIGHT.

*PT41. (KEY PHRASE: beaten up as a child by
caregiver)
As a child, were you ever badly beaten up by
your parents or the people who raised you?
DK................ 8 GO TO *PT42
RF................. 9 GO TO *PT42
*PT42. (KEY PHRASE: beaten up by a spouse or
romantic partner)
Were you ever badly beaten up by a spouse or
romantic partner?
DK................ 8 GO TO *PT43
RF................. 9 GO TO *PT43
*PT43. (KEY PHRASE: beaten by somebody else)
Were you ever badly beaten up by anyone
else?
DK................ 8 GO TO *PT44
RF................. 9 GO TO *PT44

*PT44. (KEY PHRASE: mugged or threatened with a
weapon)
Were you ever mugged, held up, or threatened
with a weapon?
DK................ 8 GO TO *PT45
RF................. 9 GO TO *PT45

YES
(1)

NO
(5)

1

5

CHECK

GO
TO
*PT42

OFF
EVENT
ON
REF.
CARD
1

5

CHECK

GO
TO
*PT43

OFF
EVENT
ON
REF.
CARD
1

5

CHECK

GO
TO
*PT44

OFF
EVENT
ON
REF.
CARD
1

5

CHECK

GO
TO
*PT45

OFF
EVENT
ON
REF.
CARD

# TIMES
How many
times (did that
happen in your
life)?
IF “ONGOING”
FOR A PERIOD
IN R’S LIFE,
CODE 995.

*PT41a.

*PT41b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

*PT42a.

*PT42b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

*PT43a.

*PT43b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

*PT44a.

*PT44b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK.............. 998
RF ................. 999

193

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT45. (KEY PHRASE: rape)
The next question is about rape. We define this
as an event during which one person has sexual
intercourse with or penetrates the body of
another person without their consent, or when
they were too young to know what was
happening.
Did you ever experience an event like the one I
just described?

*PT45a.

1

5

CHECK

GO
TO
*PT46

OFF
EVENT
ON
REF.
CARD

*PT45b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

DK................ 8 GO TO *PT46
RF................. 9 GO TO *PT46

194

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
AGE
How old were
you the first
time?

INTERVIEWER: FOR EACH ENDORSED EVENT,
ASK THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)

The next question is about sexual assault. We
define this as an event during which one person
touches another person inappropriately, or
without that person’s consent.
Other than rape, did you ever experience an
event like the one I just described?

*PT46a.
1

5

CHECK

GO
TO
*PT47

OFF
EVENT
ON
REF.
CARD

DK................ 8 GO TO *PT47
RF................. 9 GO TO *PT47
*PT47. (KEY PHRASE: stalked)
Has someone ever stalked you – that is,
followed you or kept track of your activities in a
way that made you feel you were in serious
danger?
DK................ 8 GO TO *PT48
RF................. 9 GO TO *PT48

IF “ONGOING”
FOR A PERIOD
IN R’S LIFE,
CODE 995.

NO
(5)

*PT46. (KEY PHRASE: sexual assault)

5

CHECK

GO
TO
*PT48

OFF
EVENT
ON
REF.
CARD

*PT46b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

*PT47a.
1

# TIMES
How many
times (did that
happen in your
life)?

*PT47b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

195

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
AGE
How old were
you the first
time?

INTERVIEWER: FOR EACH ENDORSED EVENT,
ASK THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)
*PT48. (KEY PHRASE: unexpected death of a
loved one)
Did someone very close to you ever die
unexpectedly; for example, they were killed
in an accident, murdered, committed suicide,
or had a fatal heart attack at a young age?
DK................ 8 GO TO *PT49
RF................. 9 GO TO *PT49

CHECK

OFF
EVENT
ON
REF.
CARD

GO TO
*PT49

DK................ 8 GO TO *PT50
RF................. 9 GO TO *PT50
*PT50. (KEY PHRASE: traumatic event to love
one)
Did anyone very close to you ever have an
extremely traumatic experience, like being
kidnapped, tortured or raped?
DK................ 8 GO TO *PT50.1
RF................. 9 GO TO *PT50.1
*PT50. 1. (KEY PHRASE: witnessed physical fights
at home)
When you were a child, did you ever
witness serious physical fights at home,
like when your father beat up your
mother?
DK............ 8 GO TO *PT51
RF............. 9 GO TO *PT51

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

*PT49a.
1
CHECK

OFF
EVENT
ON
REF.
CARD

CHECK

OFF
EVENT
ON
REF.
CARD

GO TO
*PT50

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............ 998
RF ............. 999

CHECK

OFF
EVENT
ON
REF.
CARD

*PT50b.

5
GO TO
*PT50.1

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............... 998
RF ................. 999

*PT50.1a.
1

*PT49b.

5

*PT50a.
1

*PT48b.

5

*PT49. (KEY PHRASE: child’s serious illness)
(Other than the death of your child you just
mentioned) Did you ever have a son or
daughter who had a life-threatening illness or
injury?

IF “ONGOING”
FOR A PERIOD
IN R’S LIFE,
CODE 995.

NO
(5)
*PT48a.

1

# TIMES
How many
times (has that
happened in
your life)?

*PT50.1b.

5
GO TO
*PT51

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............... 998
RF ................. 999

196

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT51. (KEY PHRASE: witnessed death or dead
body or saw someone seriously hurt)
Did you ever see someone being badly
injured or killed, or unexpectedly see a dead
body?
DK................ 8 GO TO *PT52
RF................. 9 GO TO *PT52

*PT51a.
1
CHECK

OFF
EVENT
ON
REF.
CARD

*PT51b.

5
GO TO
*PT52

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............. 998
RF............... 999

197

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
AGE
How old were
you the first
time?

INTERVIEWER: FOR EACH ENDORSED EVENT,
ASK THE FOLLOW-UP QUESTIONS AT RIGHT.

YES
(1)
*PT52. (KEY PHRASE: accidentally caused serious
injury or death)
Did you ever do something that accidentally led
to the serious injury or death of another person?
IF VOL “MAYBE, NOT SURE,” CODE NO.
DK................ 8 GO TO *PT53
RF................. 9 GO TO *PT53
*PT53. (KEY PHRASE: purposely injured, tortured or
killed someone)
(Other than what you already told me about,)
Did you ever on purpose either seriously injure,
torture, or kill another person?
DK................ 8 GO TO *PT54
RF................. 9 GO TO *PT54
*PT54. (KEY PHRASE: saw atrocities)
Did you ever see atrocities or carnage such as
mutilated bodies or mass killings?
DK................ 8 GO TO *PT55
RF................. 9 GO TO *PT55

IF “ONGOING”
FOR A PERIOD
IN R’S LIFE,
CODE 995.

NO
(5)
*PT52a.

1

5

CHECK

GO
TO
*PT53

OFF
EVENT
ON
REF.
CARD

5

CHECK

GO
TO
*PT54

OFF
EVENT
ON
REF.
CARD
1

5

CHECK

GO
TO
*PT55

OFF
EVENT
ON
REF.
CARD

*PT52b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............. 998
RF ............... 999

*PT53a.
1

# TIMES
How many
times (has that
happened in
your life)?

*PT53b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............. 998
RF............... 999

*PT54a.

*PT54b.

YEARS

TIMES

DK .......... 998
RF ............ 999

DK ............. 998
RF ............... 999

198

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PT55. Did you ever experience any other
extremely traumatic or life-threatening
event that I haven’t asked about yet?
DK................ 8 GO TO *PT57
RF................. 9 GO TO *PT57

YES
(1)

NO
(5)

1

5

CHECK

GO TO
*PT57

OFF
EVENT
ON
REF.
CARD

*PT55a. Briefly, what was the one most traumatic event that you have not told me about?
DON’T KNOW…………………8 GO TO *PT57
REFUSED....................................9 GO TO *PT57

RECORD BRIEF DESCRIPTION OF EVENT:

*PT55b. (IF NEC: Was this a one-time event or was it ongoing over a period of days, weeks, months, or
even years?)
ONE-TIME EVENT .......1 GO TO *PT55c
ONGOING EVENT ........2 GO TO *PT55d
DON’T KNOW .............. 8
REFUSED .......................... 9
*PT55c. [IF NEC: How old were you when (EVENT IN *PT55a / this happened)?]
(IF NEC: How old were you when you first learned about it?)

199

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
YEARS OLD GO TO *PT56
DON’T KNOW...............998
REFUSED .......................999

GO TO *PT56
GO TO *PT56

*PT55d. (IF NEC: For how long were you in this situation / For how long did this continue)?
DURATION NUMBER
CIRCLE UNIT
OF TIME: DAYS ................ 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

DON’T KNOW ...............98
REFUSED .......................99

*PT56. INTERVIEWER QUERY: (SEE *PT55a) DID EVENT IN *PT55a INVOLVE THREAT OF DEATH OR
SERIOUS INJURY TO R OR TO A CLOSE LOVED ONE?
(IF NEC, PROBE: Did this event involve threat of death or serious injury to you or to a close loved one?)
YES .................................................................................. 1
NO .................................................................................... 5
DON’T KNOW ........................................................8
REFUSED ........................................................................ 9

*PT57. Sometimes people have experiences they don’t want to talk about in interviews. I won’t ask you to describe
anything like this, but, without telling me what it was, did you ever have a traumatic event that you didn’t tell
me about because you didn’t want to talk about it?
CHECK OFF “PRIVATE EVENT” ON REFERENCE
CARD, THEN GO TO *PT57a
GO TO *PT58
GO TO *PT58
GO TO *PT58

YES ...............................................1
NO .................................................5
DON’T KNOW .............................8
REFUSED .....................................9

*PT57a. How old were you when your most upsetting event like this happened? Or, if it was an ongoing
event, how old were you when it started and for how long were you in this situation?
If I ask you any further questions about this event, I will refer to it as your “private event.”
YEARS OLD
DURATION NUMBER FOR ONGOING EVENTS
CIRCLE UNIT OF TIME:
DAYS ........ 1

WEEKS ....... 2

MONTHS ...... 3

YEARS ........4

DON’T KNOW ..........98
REFUSED .................... 99
*PT58.0.

You reported the following events: (LIST ALL ENDORSED EVENTS). Is that correct?
YES ............................................1
ALL OTHERS............................

GO TO *PT58
MANUALLY CORRECT INCORRECT EVENT(S)
200

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT58.

INTERVIEWER CHECKPOINT: (SEE REFERENCE CARD)

STEP 1.

ON REFERENCE CARD, WRITE A NUMBER ON THE LINE TO THE RIGHT OF
EACH ENDORSED EVENT TYPE. START WITH THE NUMBER ONE
(1, 2, 3, 4, …).

STEP 2.

IN LEFT-HAND COLUMN BELOW, CIRCLE TOTAL NUMBER OF EVENT TYPES
REPORTED. THE RIGHT-HAND COLUMN GIVES THE NUMBER THAT
CORRESPONDS TO THE NUMBER LABEL YOU’VE WRITTEN BY R’S
RANDOMLY ASSIGNED EVENT TYPE.

TOTAL EVENT
TYPES REPORTED
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

RANDOMLYASSIGNED
EVENT TYPE
GO TO *CC1,
NEXT SECTION
1
(random b/w 1-2)
(random b/w 1-3)
(random b/w 1-4)
(random b/w 1-5)
(random b/w 1-6)
(random b/w 1-7)
(random b/w 1-8)
(random b/w 1-9)
(random b/w 1-10)
(random b/w 1-11)
(random b/w 1-12)
(random b/w 1-13)
(random b/w 1-14)
(random b/w 1-15)
(random b/w 1-16)
(random b/w 1-17)
(random b/w 1-18)
(random b/w 1-19)
(random b/w 1-20)
(random b/w 1-21)
(random b/w 1-22)
(random b/w 1-23)
(random b/w 1-24)
(random b/w 1-25)
(random b/w 1-26)
(random b/w 1-27)
(random b/w 1-28)
(random b/w 1-29)

201

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
STEP 3. CIRCLE RANDOMLY-ASSIGNED EVENT TYPE IN LEFT COLUMN AND FOLLOW
INSTRUCTION AT RIGHT:

RANDOMLY-ASSIGNED EVENT TYPE
COMBAT EXPERIENCE

GO TO *PT59,
ASK ABOUT FIRST OCCURRENCE

RELIEF WORKER IN A WAR ZONE

GO TO *PT59,
ASK ABOUT FIRST OCCURRENCE

CIVILIAN IN A WAR ZONE

GO TO *PT59,
ASK ABOUT FIRST OCCURRENCE

CIVILIAN IN A REGION OF TERROR

GO TO *PT59,
ASK ABOUT FIRST OCCURRENCE

REFUGEE

GO TO *PT59,
ASK ABOUT FIRST OCCURRENCE

KIDNAPPED

GO TO *PT59,
ASK ABOUT FIRST OCCURRENCE

ALL OTHERS

GO TO STEP 4

STEP 4. REFER TO THE QUESTION WHERE R ORIGINALLY REPORTED THE RANDOM
EVENT (REFERENCE CARD SHOWS SOURCE QUESTION). NOTE THE TOTAL
NUMBER OF TIMES RANDOM EVENT HAS OCCURRED IN R’S LIFE. IN THE
LEFT-HAND COLUMN BELOW, CIRCLE NUMBER THAT NUMBER. THE RIGHTHAND COLUMN SHOWS WHICH OCCURRENCE OF THE RANDOM EVENT WILL
BE PROBED.
TOTAL TIMES

OCCURRENCE TO BE PROBED

1 OR “ONGOING”

ONLY OCCURRENCE OR
“ONGOING” OCCURRENCE
(random b/w 1-2)
(random b/w 1-3)
MOST RECENT OCCURRENCE

2
3
4 OR MORE

202

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*PT59. INTERVIEWER: RECORD RANDOM EVENT

PT59a. NOTE OCCURRENCE TO BE PROBED: (SEE *PT58, STEP 4)
(E.G., “FIRST TIME,” “ONLY TIME,” “ONGOING,” ETC.)

OCCURRENCE:
PT59b. NOTE AGE AT TIME OF RANDOM EVENT:
[IF NEC: How old were you (when/ the first time/ the second time/ the third time/ the most recent
time) (RANDOM EVENT) (happened/ started)?

YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999
INTERVIEWER: THIS EVENT WILL NOW BE REFERRED TO AS “RANDOM EVENT.”

*PT60. INTERVIEWER CHECKPOINT: (SEE *PT58)
R REPORTED ONLY ONE EVENT TYPE,
*PT1 THROUGH *PT6 OR *PT29 THROUGH *PT34 .............................. 1
R REPORTED ONLY ONE EVENT TYPE,
AND THAT EVENT OCCURRED ONLY ONCE............................................ 2
ALL OTHERS ..................................................................................................... 3

GO TO *PT118
GO TO *PT118

*PT61. INTERVIEWER CHECKPOINT: (SEE *PT58)
R REPORTED ONLY ONE EVENT TYPE,
AND THAT EVENT OCCURRED MORE THAN ONCE....................1 GO TO *PT62 INTRO 2
R REPORTED TWO OR THREE DIFFERENT EVENT TYPES ........2 GO TO *PT62 INTRO 3
ALL OTHERS...........................................................................................3 GO TO *PT62 INTRO 4

203

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*PT62 INTRO 2.
Let me review. You experienced
(NUMBER) (KEY PHRASE OF EVENT
TYPE). After an experience like this,
people sometimes have problems like
upsetting memories or dreams, feeling
emotionally distant or depressed, trouble
sleeping or concentrating, and feeling
jumpy or easily startled. Did you have any
of these reactions after [(either/any)
[EVENT TYPE]/ of these experiences]?

*PT62 INTRO 3.
Let me review. You had (two/ three)
different types of traumatic events: [KEY
PHRASES OF ALL EVENT TYPES] (and
a private event). After experiences like
these, people sometimes have problems like
upsetting memories or dreams, feeling
emotionally distant or depressed, trouble
sleeping or concentrating, and feeling
jumpy or easily startled. Did you have any
of these reactions after any of the traumatic
experiences you have gone through?

YES .................................... 1
NO ...................................... 5
DON’T KNOW.................. 8
REFUSED.......................... 9

*PT62.2

*PT62 INTRO 4.
Let me review. You had quite a few
different traumatic experiences, like: [KEY
PHRASES OF 3 EVENT TYPES] (and a
private event). After experiences like these,
people sometimes have problems like
upsetting memories or dreams, feeling
emotionally distant from or depressed,
trouble sleeping or concentrating, and
feeling jumpy or easily startled. Did you
have any of these reactions after any of the
traumatic experiences you have gone
through?

GO TO *PT63
GO TO *PT63
GO TO *PT63

Did you ever in your life talk to a medical doctor or other professional about (this problem/any of these
problems)? (By professional we mean psychologists, counselors, spiritual advisors, herbalists,
acupuncturists, and other healing professionals.)
YES ................................................... 1
NO......................................................5
DON’T KNOW .................................8
REFUSED .........................................9
*PT62.2a.

GO TO *PT64
GO TO *PT64
GO TO *PT64

How old were you the first time [you talked to a professional about (this problem/any of these
problems)?
YEARS OLD
DON’T KNOW .........998
REFUSED .................999

100% GO TO *PT64 AT THE END OF *PT62.2a

204

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*PT63. INTERVIEWER CHECKPOINT: (SEE REFERENCE CARD)
USING THE NUMBERING SCHEME FROM REFERENCE CARD, THE
RANDOM EVENT IS OF ONE OF THE FOLLOWING
TYPES: 1,2,3,4,5,8,10,11,17,18 or 20...................................................................1

RANDOM 10% GO TO *PT119

USING THE NUMBERING SCHEME FROM REFERENCE CARD, THE
RANDOM EVENT IS OF ONE OF THE FOLLOWING
TYPES: 1,2,3,4,5,8,10,11,17,18 or 20' ..................................................................2

RANDOM 90% GO TO *CC1

ALL OTHERS .......................................................................................................3

GO TO *CC1

*PT64. Of the [experiences you mentioned to me/ (NUMBER) times (EVENT TYPE)s happened] which one caused
you the most problems like upsetting memories or dreams, feeling emotionally distant, trouble sleeping or
concentrating, or feeling jumpy or easily startled. That is, which one experience caused the largest number
or most severe problems?
IF NEC: REVIEW ENDORSED EVENTS.
(IF “DON’T KNOW,” PROBE: Which of these very upsetting events happened most recently?)
DON’T KNOW .................................998
REFUSED .........................................999
RECORD WORST EVENT:

NUMBER OF EVENT

PT64a. NOTE AGE AT TIME OF WORST EVENT:
[IF NEC: How old were you when that (happened/ started)?]

YEARS OLD
DON’T KNOW ..................998
REFUSED ..........................999
PT64b. [IF NEC: Which occurrence was this (-- the first time, the second time…)?]
NOTE OCCURRENCE (E.G., “FIRST TIME,” “ONLY TIME,” “ONGOING,” ETC.):
OCCURRENCE:
INTERVIEWER: THIS EVENT WILL NOW BE REFERRED TO AS “WORST EVENT.”

*PT65. INTERVIEWER CHECKPOINT: (SEE *PT59 AND *PT64)
RANDOM EVENT AND WORST EVENT ARE THE SAME TYPE OF EVENT............. 1
205

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
ALL OTHERS ........................................................................................................................5 GO TO *PT67

206

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT66. INTERVIEWER CHECKPOINT: (SEE *PT59a AND *PT64b)
RANDOM EVENT AND WORST EVENT ARE THE SAME
OCCURRENCE OF THE SAME EVENT .................................................................1
THIS EVENT WILL NOW BE REFERRED TO AS “RANDOM EVENT.”
ALL OTHERS ..............................................................................................................5

GO TO *PT122

*PT66.1. (RB, PG 42. FOR EACH EVENT ENDORSED, ASK R TO MARK IT IN THE RB.) INTERVIEWER
CHECKPOINT: (SEE REFERENCE CARD, *PT SECTION): PROBE TO FIND WHETHER ANY OTHER
REPORTED EVENTS ARE LINKED TO THE RANDOM EVENT. PROBE ONLY FOR PLAUSIBLE
COMBINATIONS. IF THERE ARE NO PLAUSIBLE COMBINATIONS OR NO LINKED EVENTS, CODE 29.
SUGGESTED PROBE: You reported [RANDOM EVENT RECORDED IN *PT59] when you were [AGE].
The next question is about that experience. I need to ask whether this was linked in any way to any of the
other events you reported. When I say, “linked” I mean whether (RANDOM EVENT) and other events were
either part of the same experience or one caused the other. Look at page 20 in your booklet.
Considering (all) the events you reported, were any of these linked to (RANDOM EVENT)?
[IF NEC: If you believe that (EVENT) happened in part because (OTHER EVENT) made it much more
likely to happen, we will consider those events to be linked.]
INTERVIEWER: CIRCLE ALL THAT APPLY.
COMBAT EXPERIENCE ........................................................................................................1
RELIEF WORKER IN WAR ZONE ........................................................................................2
CIVILIAN IN WAR ZONE ......................................................................................................3
CIVILIAN IN REGION OF TERROR ......................................................................................... 4
REFUGEE .................................................................................................................................................. 5
KIDNAPPED ..............................................................................................................................6
TOXIC CHEMICAL EXPOSURE .............................................................................................7
AUTOMOBILE ACCIDENT........................................................................................................... 8
OTHER LIFE THREATENING ACCIDENT................................................................................ 9
NATURAL DISASTER ........................................................................................................... 10
MAN-MADE DISASTER........................................................................................................ 11
LIFE-THREATENING ILLNESS ............................................................................................. 12
BEATEN UP BY CAREGIVER ............................................................................................... 13
BEATEN UP BY SPOUSE OR ROMANTIC PARTNER ....................................................... 14
BEATEN UP BY SOMEONE ELSE .........................................................................................15
MUGGED OR THREATENED WITH A WEAPON ................................................................... 16
RAPE ...........................................................................................................................................17
SEXUAL ASSAULT ........................................................................................................................ 18
STALKED .......................................................................................................................................... 19
UNEXPECTED DEATH OF LOVED ONE ..............................................................................20
CHILD WITH SERIOUS ILLNESS...........................................................................................21
TRAUMATIC EVENT TO LOVED ONE.................................................................................22
WITNESSED DEATH OR DEAD BODY, OR SAW SOMEONE SERIOUSLY HURT .......23
ACCIDENTALLY CAUSED SERIOUS INJURY OR DEATH ................................................. 24
PURPOSELY INJURED, TORTURED, OR KILLED SOMEONE.........................................25
SAW ATROCITIES ........................................................................................................................ 26
SOME OTHER EVENT ...........................................................................................................27
PRIVATE EVENT ....................................................................................................................28
NO LINKED EVENTS / NO PLAUSIBLE COMBINATIONS ............................................... 30

207

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*PT66.2 INTERVIEWER QUERY: IS RANDOM EVENT LINKED TO THE “WORST EVENT”?
YES .................................. 1
NO ........................................ 5

GO TO *PT122

INTERVIEWER: SEE *PT64, THEN PROBE:
*PT67.

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1
GO TO
*PT68

5

8

9

1
GO TO
*PT68

5

8

9

1
GO TO
*PT68

5

8

9

1
(GO TO
*PT68) **

5

8

9

[FOR “ONGOING” EVENTS: During the period of time when
(WORST EVENT) was happening repeatedly, did you ever
feel terrified or very frightened?]
[ALL OTHERS: Were you terrified or very frightened at the
time (WORST EVENT)?]

*PT67a. Did you feel helpless?

*PT67b. Did you feel shocked or horrified?

*PT67c. Did you feel numb?

208

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PT68. (RB, PG 43): (Look at Group 1 on Page 43 in your booklet.)
In the weeks, months, or years after (the event/ this experience
ended/ WORST EVENT), did you try not to think about (it/
what happened)?

YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

(IF YES: Please make a checkmark by reaction 1.)
(KEY PHRASE: tried not to think about it)
*PT69. Did you purposely stay away from places, people or activities
that reminded you of (it/ the event/ this experience/ WORST
EVENT)?
(IF YES: Please make a checkmark by reaction 2.)
(KEY PHRASE: stayed away from reminders of it)
*PT70. Were you ever unable to remember some important parts of
what happened?
IF VOL “UNCONSCIOUS,” “KNOCKED OUT,” OR
“HEAD INJURY,” CODE NO.
(IF YES: Please make a checkmark by reaction 3.)
[KEY PHRASE: were unable to remember part(s) of it]
*PT71. Did you lose interest in doing things you used to enjoy?
(IF YES: Please make a checkmark by reaction 4.)
(KEY PHRASE: lost interest in things you used to enjoy)
*PT72. Did you feel emotionally distant or cut-off from other people?
(IF YES: Please make a checkmark by reaction 5.)
(KEY PHRASE: felt distant from other people)
*PT73. Did you have trouble feeling normal feelings like love,
happiness, or warmth toward other people?
(IF YES: Please make a checkmark by reaction 6.)
(KEY PHRASE: had trouble feeling normal feelings)
*PT74. Did you feel you had no reason to plan for the future because
you thought it would be cut short?
(IF YES: Please make a checkmark by reaction 7.)
(KEY PHRASE: felt you had no reason to plan for the future)
*PT75. INTERVIEWER CHECKPOINT: (SEE *PT68 - *PT74)
ZERO “YES” RESPONSES IN *PT68 - *PT74................................................................................1 GO TO *PT116.1
ALL OTHERS......................................................................................................................................2 GO TO *PT86

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YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PT86. (RB, PG 43) (Look at Group 2 on page 43 in your
booklet.)
Did you ever have repeated unwanted memories of (it/ the
event/ this experience/ WORST EVENT) – that is, you kept
remembering it even when you didn’t want to?
(IF YES: Please make a checkmark by reaction 8 in the
booklet.)
(KEY PHRASE: had unwanted memories)
*PT87. Did you ever have repeated unpleasant dreams about (it/ the
event/ this experience/ WORST EVENT)?
(IF YES: Please make a checkmark by reaction 9 in the
booklet.)
(KEY PHRASE: had unpleasant dreams)
*PT88. Did you have flashbacks – that is, suddenly act or feel as if (it/
the event/ this experience/ WORST EVENT) were happening
all over again?
(IF YES: Please make a checkmark by reaction 10 in the
booklet.)
(KEY PHRASE: had flashbacks)
*PT89. Did you get very upset when you were reminded of (it/ the
event/ this experience/ WORST EVENT)?
(IF YES: Please make a checkmark by reaction 11 in the
booklet.)
(KEY PHRASE: got really upset when reminded of it)
*PT90. When you were reminded of (it/ the event/ this experience/
WORST EVENT), did you ever have physical reactions like
sweating, your heart racing, or feeling shaky?
(IF YES: Please make a checkmark by reaction 12 in the
booklet.)
(KEY PHRASE: had physical reactions)
*PT91. INTERVIEWER CHECKPOINT: (SEE *PT86 - *PT90)
ZERO “YES” RESPONSES IN *PT86 - *PT90..........................1
ALL OTHERS ...............................................................................2

GO TO *PT116.1
GO TO *PT102

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YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PT102. (RB, PG 43) (Look at Group 3 on Page 43 in your
booklet.)
During the time (this event/ this experience/ WORST
EVENT) affected you most, did you have trouble falling or
staying asleep?
(IF YES: Please make a checkmark by reaction 13.)
(KEY PHRASE: had sleep problems)
*PT103. Were you more irritable or short-tempered than you usually
are?
(IF YES: Please make a checkmark by reaction 14.)
(KEY PHRASE: were irritable)
*PT104. Did you have more trouble concentrating or keeping your
mind on what you were doing?
(IF YES: Please make a checkmark by reaction 15.)
(KEY PHRASE: had trouble concentrating)
*PT105. Were you much more alert or watchful, even when there was
no real need to be?
(IF YES: Please make a checkmark by reaction 16.)
(KEY PHRASE: were more alert or watchful)
*PT106. Were you more jumpy or easily startled by ordinary noises?
(IF YES: Please make a checkmark by reaction 17.)
(KEY PHRASE: were jumpy or easily startled)
*PT107. INTERVIEWER CHECKPOINT: (SEE *PT102 - *PT106)
ZERO “YES” RESPONSES IN *PT102 – *PT106...............................................1
ALL
OTHERS..........................................................................................................2

GO TO *PT116.1
GO TO *PT109

*PT109. You (KEY PHRASES FOR PROBLEMS REPORTED IN *PT68-*PT74, *PT86-*PT90, *PT102 *PT106). How soon after (the event/ this experience/ WORST EVENT) did you start having [this problem/
(either/any) of these problems]?
CODE “IMMEDIATELY” OR “SAME DAY” AS “0 DAYS”
ONSET NUMBER
CIRCLE UNIT OF TIME: DAYS .... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

DON’T KNOW ............................ 98
REFUSED .................................... 99

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*PT110. You had quite a few reactions, such as (FIRST KEY PHRASE FOR EACH OF THE 3 SETS OF
REACTIONS REPORTED IN *PT68 - * *PT74, *PT86 - *PT90, *PT102 - *PT106). For about how many
days, weeks, months, or years did you continue to have any of these reactions?
(IF VOL “IT’S STILL GOING ON,” PROBE: How long has it been so far?)
(IF DK, PROBE, “Was it at least a month?” IF YES, CODE 97 BELOW.)
DURATION NUMBER
CIRCLE UNIT OF TIME: DAYS.... 1

WEEKS....2

MONTHS....3

YEARS...... 4

“AT LEAST A MONTH” ................97
DON’T KNOW ...............................98
REFUSED ............................................ 99

*PT111. INTERVIEWER CHECKPOINT: (SEE *PT110)
LESS THAN ONE MONTH (30 DAYS) OF REACTIONS IN *PT110..............1
ALL OTHERS .........................................................................................................2

GO TO *PT120a
GO TO *PT113

*PT113. Think of the time when these reactions were most frequent and intense. How often did they occur – less
than once a month, one to two times a month, three to five times a month, six to ten times a month, or more
than ten times a month?
LESS THAN ONCE A MONTH ..................1
ONE TO TWO TIMES A MONTH .............. 2
THREE TO FIVE TIMES A MONTH .......... 3
SIX TO TEN TIMES A MONTH ................. 4
MORE THAN TEN TIMES A MONTH ...... 5
DON’T KNOW ............................................. 8
REFUSED ..................................................... 9

GO TO *PT116.1

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*PT114. How much distress did these reactions cause you – none, mild, moderate, severe, or very severe distress?
NONE....................................................................... 1
MILD........................................................................ 2
MODERATE........................................................... 3
SEVERE .................................................................. 4
VERY SEVERE ...............................................5
DON’T KNOW ................................................8
REFUSED ............................................................... 9

*PT115. How much did these reactions disrupt or interfere with your normal, daily life – not at all, a little, some, a lot, or
extremely?
NOT AT ALL ..................................................... 1
A LITTLE .........................................................2
SOME ...............................................................3
A LOT ...............................................................4
EXTREMELY ..................................................5
DON’T KNOW ................................................8
REFUSED ........................................................9

*PT116. INTERVIEWER CHECKPOINT: (SEE *PT114 *PT115)
RESPONSES CODED ‘3 – 5’ IN *PT114 OR *PT115 .............................1

GO TO *PT120a

ALL OTHERS ...............................................................................................2

*PT116.1. INTERVIEWER CHECKPOINT: (SEE RESPONDENT’S ID NUMBER)
RANDOM 20% OF RESPONDENTS ......................................1
ALL OTHERS ............................................................................2

GO TO *PT120a
GO TO *PT116.2

*PT116.2. INTERVIEWER CHECKPOINT: (SEE *PT107)
*PT107= 2 ..................................................................................1
ALL OTHERS ............................................................................2

GO TO *PT261
GO TO *CC1, NEXT SECTION

*PT118. INTERVIEWER: SEE *PT59, THEN PROBE
You reported [EVENT RECORDED IN *PT59] when you were [AGE]. The next questions are about that experience.
INTERVIEWER: THIS EVENT WILL NOW BE REFERRED TO AS “RANDOM EVENT.”
GO TO *PT122

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*PT119. 0. INTERVIEWER CHECKPOINT (SEE *PT59b)
IF *PT59b IS NOT "DON'T KNOW" AND *PT59b IS NOT "REFUSED" AND
*PT59b IS NOT EMPTY....................1 GO TO *PT119a
ALL OTHERS .................................... 2

*PT119. The next questions are about an event which we select at random – for you it is the (IF NEC: first/second/third/most
recent) time you experienced (RANDOM EVENT RECORDED IN *PT59). How old were you at that time?

YEARS OLD
DON’T KNOW ................ 998
REFUSED ........................ 999

GO TO *PT122
GO TO *PT122
GO TO *PT122

*PT119a. The next questions are about an event which we select at random – for you it is the (IF NEC:
first/second/third/most recent) time you experienced (RANDOM EVENT RECORDED IN *PT59). You were (AGE
RECORDED IN *PT59b) when that happened. Is that correct?
YES………………………1
NO………………………..5
DON’T KNOW…………..8
REFUSED………………..9

GO TO *PT120a

GO TO *PT120a

*PT119a.1. Would you give me your correct age?
YEARS OLD
DON'T KNOW ............... 998
REFUSED......................999

GO TO *PT122

*PT120.0 INTERVIEWER CHECKPOINT (SEE *PT59)
IF *PT59b IS NOT "DON'T KNOW" AND *PT59b IS NOT "REFUSED" AND
*PT59b IS NOT EMPTY....................1 GO TO *PT120a
ALL OTHERS .................................... 2

*PT120. The next questions are about a second event, which we select at random – for you it is the (IF NEC:
first/second/third/most recent) time you experienced (RANDOM EVENT RECORDED IN *PT59) How old were you
at that time?
YEARS OLD
DON’T KNOW ................ 998
REFUSED ........................ 999

GO TO *PT122

GO TO *PT122

*PT120a.The next questions are about an event, which we select at random — for you it is the (IF NEC: first/ second/ third/ most
recent) time you experienced (RANDOM EVENT RECORDED IN *PT59). You were (AGE RECORDED IN
*PT59b) when that happened. Is that correct?
YES………………………….1
NO…………………………...5

GO TO *PT122
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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
DON’T KNOW ................ …8
REFUSED ........................ …9

GO TO *PT122

*PT120a.1. Would you give me your correct age?
YEARS OLD
DON’T KNOW ................ 998
REFUSED ........................ 999

*PT122.

INTERVIEWER INSTRUCTION: CIRCLE THE NUMBER TO THE RIGHT OF R’S RANDOM EVENT TYPE.
THEN FOLLOW SKIP INSTRUCTION.
COMBAT EXPERIENCE ............................................................................... 1

GO TO *PT123

RELIEF WORKER IN WAR ZONE .............................................................. 2

GO TO *PT123

CIVILIAN IN WAR ZONE............................................................................. 3

GO TO *PT123

CIVILIAN IN REGION OF TERROR............................................................ 4

GO TO *PT123

REFUGEE ........................................................................................................ 5

GO TO *PT124

KIDNAPPED ................................................................................................... 6

GO TO *PT207

TOXIC CHEMICAL EXPOSURE ................................................................. 7

GO TO *PT207

AUTOMOBILE ACCIDENT .......................................................................... 8 GO TO *PT146
OTHER LIFE THREATENING ACCIDENT ................................................ 9 GO TO *PT207
NATURAL DISASTER................................................................................... 10 GO TO *PT155
MAN-MADE DISASTER ............................................................................... 11 GO TO *PT155
LIFE-THREATENING ILLNESS................................................................... 12 GO TO *PT207
BEATEN UP BY CAREGIVER ..................................................................... 13 GO TO *PT207
BEATEN UP BY SPOUSE OR ROMANTIC PARTNER ............................ 14 GO TO *PT207
BEATEN UP BY SOMEONE ELSE .............................................................. 15 GO TO *PT207
MUGGED OR THREATENED WITH A WEAPON.................................... 16 GO TO *PT207
RAPE ................................................................................................................ 17 GO TO *PT170
SEXUAL ASSAULT ....................................................................................... 18 GO TO *PT170
STALKED ........................................................................................................ 19 GO TO *PT207
UNEXPECTED DEATH OF LOVED ONE .................................................. 20 GO TO *PT173
CHILD WITH SERIOUS ILLNESS ............................................................... 21 GO TO *PT207
TRAUMATIC EVENT TO LOVED ONE ..................................................... 22 GO TO *PT207
WITNESSED PHYSICAL FIGHT AT HOME .............................................. 29 GO TO *PT207
WITNESSED DEATH/DEAD BODY,
OR SAW SOMEONE SERIOUSLY HURT................................................... 23 GO TO *PT207
ACCIDENTALLY CAUSED SERIOUS INJURY OR DEATH ................... 24 GO TO *PT207
PURPOSELY INJURED, TORTURED, OR KILLED SOMEONE ............. 25 GO TO *PT207
SAW ATROCITIES......................................................................................... 26 GO TO *PT207
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SOME OTHER EVENT .................................................................................. 27 GO TO *PT207

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PRIVATE EVENT........................................................................................... 28 GO TO *PT207

*PT123.

RANDOM EVENTS: COMBAT EXPERIENCE
RELIEF WORK OR PEACEKEEKER
CIVILIAN IN WAR
CIVILIAN IN REGION OF TERROR
INTERVIEWER: IF NEC, PROBE AS FOLLOWS AND RECORD DETAILED PARAPHRASE:
(Briefly, where were you and what was the situation?)
DON’T KNOW ........................................ 8
REFUSED ...................................................... 9

GO TO *PT125

*PT124.

RANDOM EVENT:

REFUGEE

INTERVIEWER: IF NEC, PROBE AS FOLLOWS AND RECORD DETAILED PARAPHRASE:
(Briefly, where were you and what was the situation when you became a refugee?)
DON’T KNOW ........................................ 8
REFUSED ...................................................... 9

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218

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

219

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT125. (IF NEC: Did you ever see anyone being killed during that time?)
YES ............................................................................. 1
NO ............................................................................... 5
R VOLUNTEERED “SAW A DEAD BODY” ........... 6
DON’T KNOW ........................................................... 8
REFUSED ................................................................... 9

GO TO *PT126
GO TO *PT126
GO TO *PT126

*PT125a. [IF NEC: Who (did you see die)?]
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

R’S SPOUSE ............................................................... 1
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 2
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 3
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 4
OTHER RELATIVE ................................................... 5
FRIEND ...................................................................... 6
ACQUAINTANCE ..................................................... 7
STRANGER ................................................................ 8
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

*PT126. [IF NEC: During that time, did anyone (else) close to you suddenly die unexpectedly?]
YES ...................................... 1
NO .................................... 5 GO TO *PT127
DON’T KNOW ................ 8 GO TO *PT127
REFUSED ........................ 9 GO TO *PT127

*PT126a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

R’S SPOUSE ............................................................... 1
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 2
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 3
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 4
OTHER RELATIVE ................................................... 5
FRIEND ...................................................................... 6
ACQUAINTANCE ..................................................... 7
STRANGER ................................................................ 8
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT127. [IF NEC: Were you or was anyone (else) close to you ever seriously harmed or imprisoned during that
period?]
YES............................... 1
NO ................................ 5 GO TO *PT128
DON’T KNOW ............ 8 GO TO *PT128
REFUSED..................... 9 GO TO *PT128

*PT127a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

RESPONDENT ........................................................... 1
R’S SPOUSE ............................................................... 2
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 3
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 4
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 5
OTHER RELATIVE ................................................... 6
FRIEND ...................................................................... 7
ACQUAINTANCE ..................................................... 8
STRANGER ................................................................ 9
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

*PT128. (IF NEC: During that time did you ever suffer greatly from lack of food, water, shelter or medical care?)
YES ...................................... 1
NO ........................................ 5
DON’T KNOW .............. 8
REFUSED .......................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT129. [IF NEC: In what country did (RANDOM EVENT) occur?]
INTERVIEWER: CIRCLE COUNTRY OR COUNTRIES IN WHICH RANDOM EVENT OCCURRED.
North and Central America
01. BAHAMAS
50. FORMER YUGOSLAVIA (CROATIA, SLOVENIA,
02. CANADA
ETC.)
03. COSTA RICA
51. EASTERN EUROPE –NO SPECIFIC COUNTRY
04. CUBA
52. WESTERN EUROPE – NO SPECIFIC COUNTRY
05. DOMINICAN REPUBLIC
53. EUROPE, OTHER
06. EL SALVADOR
(SPECIFY:)
07. GUADELOUPE
Asia
08. GUATEMALA
54. CHINA
09. HAITI
55. INDIA
10. HONDURAS
56. JAPAN
11. JAMAICA
57. KOREA
12. MARTINIQUE
58. PHILIPPINES
13. MEXICO
59. SINGAPORE
14. NICARAGUA
60. TAIWAN
15. PANAMA
61. THAILAND
16. PUERTO RICO
62. ASIA – NO SPECIFIC COUNTRY
17. ST. LUCIA
63. ASIA, OTHER
18. ST. VINCENT
(SPECIFY:)
19. TRINIDAD
Africa
20. UNITED STATES
64. ALGERIA
21. CENTRAL AMERICA/CARIBBEAN – NO
65. EGYPT
SPECIFIC COUNTRY
66. KENYA
22. NORTH/CENTRAL AMERICA, OTHER
67. MOROCCO
(SPECIFY:)
68. NIGERIA
69. SOUTH AFRICA
South America
23. ARGENTINA
24. BOLIVIA
25. BRAZIL
26. CHILE
27. COLOMBIA
28. ECUADOR
29. PERU
30. SURINAME
31. VENEZUELA
32. SOUTH AMERICA – NO SPECIFIC
COUNTRY
33. SOUTH AMERICA, OTHER
(SPECIFY:)
Europe
34. CZECH OR SLOVAK REPUBLIC
35. ENGLAND
36. FRANCE
37. GERMANY
38. GREECE
39. HUNGARY
40. IRELAND
41. ITALY
42. NETHERLANDS
43. NORWAY
44. POLAND
45. PORTUGAL
46. RUSSIA OR FORMER SOVIET UNION
47. SCOTLAND
48. SPAIN

49. SWEDEN

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
70.
71.
72.
73.

ZAIRE
ZIMBABWE
AFRICA – NO SPECIFIC COUNTRY
AFRICA, OTHER
(SPECIFY:)

Middle East
IRAN
IRAQ
ISRAEL
LEBANON
PAKISTAN
SAUDI ARABIA
TURKEY
MIDDLE EAST – NO SPECIFIC
COUNTRY
82. MIDDLE EAST,
OTHER (SPECIFY:)
74.
75.
76.
77.
78.
79.
80.
81.

Australia
83. AUSTRALIA
84. NEW ZEALAND
Other
85. OTHER COUNTRY
(SPECIFY:)
86. NONE
88. DON’T KNOW
89. REFUSED

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*PT130. INTERVIEWER CHECKPOINT:
RANDOM EVENT IS COMBAT EXPERIENCE ...... 1
ALL OTHERS............................................................. 5

GO TO *PT207

*PT131. (IF NEC: What was your affiliation during your combat experience - were you in a military, or were you a nonmilitary resistance fighter, freedom fighter, member of an organized liberation army, or part of a paramilitary
group?)
INTERVIEWER: CIRCLE ALL THAT APPLY.
MILITARY ..........................................................................1
NON-MILITARY RESISTANCE FIGHTER .............. 2
FREEDOM FIGHTER ................................................ 3
LIBERATION ARMY................................................. 4
PARAMILITARY ...............................................................5
OTHER ................................................................................6
DON’T KNOW ........................................................... 8
REFUSED ............................................................................9

*PT132. How many times did you go on combat patrol or have other very dangerous duty?
TIMES
DON’T KNOW ...............................998
REFUSED ............................................ 999

*PT133. On how many different occasions did you fire rounds at the enemy?
OCCASIONS
DON’T KNOW ...............................998
REFUSED ............................................ 999

*PT134. On how many different occasions did you see someone get hit either by incoming or outgoing rounds?
OCCASIONS
DON’T KNOW ...............................998
REFUSED ............................................ 999

*PT135. How many times were you in danger of being injured or killed -- for example, how many times were you pinned
down, overrun, ambushed, or near-missed?
TIMES
DON’T KNOW ...............................998
REFUSED ............................................ 999

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*PT136. How many times were you surrounded by the enemy?
TIMES
DON’T KNOW ...............................998
REFUSED ............................................ 999

*PT137. What percentage of the (men/ people/ personnel) in your unit were killed, wounded or missing in action?
PERCENT
DON’T KNOW ...............................998
REFUSED ............................................ 999

*PT138. How many days, weeks, months, or years altogether were you under enemy fire?
DURATION NUMBER
CIRCLE UNIT OF TIME:

GO TO *PT207

DAYS.........1

DON’T KNOW ...............................998
REFUSED .......................................999

WEEKS........2

MONTHS ........ 3

YEARS.......... 4

GO TO *PT207
GO TO *PT207

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*PT146.

RANDOM EVENT: AUTO ACCIDENT
Were you driving, a passenger, or a pedestrian?
DRIVER.........................................1
PASSENGER ................................2
IF VOL: PEDESTRIAN ...............3
IF VOL: BYSTANDER ...............4
IF VOL: CYCLIST .......................5
DON’T KNOW ...........................8
REFUSED....................................9

*PT147. Whose fault was the accident?
INTERVIEWER: CIRCLE ALL THAT APPLY.
R’S FAULT ........................................................................................................ 1
DRIVER OF R’S VEHICLE .........................................................................2
OTHER VEHICLE ......................................................................................3
BICYCLIST, PEDESTRIAN, OR BYSTANDER......................................4
“NO ONE’S FAULT” / WEATHER, ROAD CONDITIONS, ETC.......... 5
DON’T KNOW ....................................................................................... 8
REFUSED .......................................................................................................... 9

*PT148. Was anyone killed?
YES .................................. 1
NO .................................... 5 GO TO *PT149
DON’T KNOW ................ 8 GO TO *PT149
REFUSED ........................ 9 GO TO *PT149

*PT148a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

R’S SPOUSE ............................................................... 1
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 2
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 3
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 4
OTHER RELATIVE ................................................... 5
FRIEND ...................................................................... 6
ACQUAINTANCE ..................................................... 7
STRANGER ................................................................ 8
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT149. Were you or was anyone else seriously injured?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *PT207
GO TO *PT207
GO TO *PT207

*PT149a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

RESPONDENT ........................................................... 1
R’S SPOUSE ............................................................... 2
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 3
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 4
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 5
OTHER RELATIVE ................................................... 6
FRIEND ...................................................................... 7
ACQUAINTANCE ..................................................... 8
STRANGER ................................................................ 9
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99
GO TO *PT207

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*PT155.

RANDOM EVENTS: MAJOR NATURAL DISASTER
MAN-MADE DISASTER
INTERVIEWER: IF NEC, PROBE AS FOLLOWS AND RECORD DETAILED PARAPHRASE:
(Briefly, what happened?)
DON’T KNOW ........................................ 8
REFUSED ................................................ 9

*PT156. [IF NEC: Did you see anyone die during (RANDOM EVENT)?]
YES .......................................................................... 1
NO.....................................................................5
(IF VOL:) “SAW A DEAD BODY” ................6
DON’T KNOW ................................................8
REFUSED ........................................................9

GO TO *PT157
GO TO *PT157
GO TO *PT157

*PT156a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

R’S SPOUSE ............................................................... 1
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 2
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 3
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 4
OTHER RELATIVE ................................................... 5
FRIEND ...................................................................... 6
ACQUAINTANCE ..................................................... 7
STRANGER ................................................................ 8
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

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*PT157. [IF NEC: During the (RANDOM EVENT), did anyone (else) close to you die?]
YES .................................. 1
NO .................................... 5 GO TO *PT158
DON’T KNOW ................ 8 GO TO *PT158
REFUSED ........................ 9 GO TO *PT158

*PT157a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

R’S SPOUSE ............................................................... 1
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 2
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 3
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 4
OTHER RELATIVE ................................................... 5
FRIEND ...................................................................... 6
ACQUAINTANCE ..................................................... 7
STRANGER ................................................................ 8
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

*PT158. [IF NEC: Were you or was anyone (else) close to you seriously injured?]
YES .................................. 1
NO .................................... 5 GO TO *PT159
DON’T KNOW ................ 8 GO TO *PT159
REFUSED ........................ 9 GO TO *PT159

*PT158a. (IF NEC: Who?)
INTERVIEWER: CIRCLE ALL THAT APPLY.

IF VOL,
RECORD
# PEOPLE

RESPONDENT ........................................................... 1
R’S SPOUSE ............................................................... 2
R’S PARENT (BIOLOGICAL, ADOPTED, STEP) .. 3
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ...... 4
R’S SIBLING (BIOLOGICAL, ADOPTED, STEP) .. 5
OTHER RELATIVE ................................................... 6
FRIEND ...................................................................... 7
ACQUAINTANCE ..................................................... 8
STRANGER ................................................................ 9
DON’T KNOW ........................................................... 98
REFUSED ................................................................... 99

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*PT159.

[IF

NEC:

As

a

result of the (RANDOM EVENT), were you forced

to

leave your home?]

YES .................................. 1
NO ................................ 5 GO TO *PT160
DON’T KNOW ............ 8 GO TO *PT160
REFUSED.......................9 GO TO *PT160
*PT159a. (IF NEC: Did you have to leave it permanently or only temporarily?)
PERMANENTLY LEFT HOME............1
TEMPORARILY LEFT HOME .............2
DON’T KNOW .......................................8
REFUSED .....................................................9

*PT160. INTERVIEWER CHECKPOINT:
RANDOM EVENT IS NATURAL DISASTER .......... 1
ALL OTHERS............................................................. 2

GO TO *PT207

*PT161. (IF NEC: What kind of natural disaster was it?)
CIRCLE ALL THAT APPLY.
FLOOD.........................................................................1
HURRICANE .............................................................2
TORNADO.............................................................. 3
EARTHQUAKE .........................................................4
TIDAL WAVE .................................................5
MONSOON ............................................................. 6
FIRE ..............................................................................7
MISTRAL OR OTHER WIND ........................8
LIGHTNING ........................................................... 9
OTHER (SPECIFY) .........................................10

DON’T KNOW ................................................98
REFUSED ........................................................99
GO TO *PT207

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*PT170.

(RB PG 44) RANDOM EVENTS: RAPE
SEXUAL ASSAULT
(IF NEC: Who did this to you [when you were (AGE) years old]?)
CIRCLE ALL THAT APPLY.
SPOUSE OR ROMANTIC PARTNER................. 1
PARENT/GUARDIAN................................................ 2
STEP-RELATIVE ........................................................ 3
OTHER RELATIVE .............................................. 4
SOMEONE ELSE R KNEW ................................. 5
STRANGER.................................................................. 6
DON’T KNOW ...................................................... 8
REFUSED ..................................................................... 9

*PT171.

Was it a one-time occurrence, or did it happen repeatedly over a period of days, weeks, months, or even years?
ONE-TIME ................................1
REPEATEDLY .............................. 5
DON’T KNOW..........................8
REFUSED..................................9

GO TO *PT172
GO TO *PT172
GO TO *PT172

*PT171a. (IF NEC: How long did this continue?)

DURATION NUMBER
CIRCLE UNIT
OF TIME:

DAYS........ 1

WEEKS ...... 2

MONTHS ....... 3

YEARS ......... 4

DON’T KNOW .............98
REFUSED ........................ 99

*PT172. As you look back on it now, realistically is there anything you could have done to prevent this from happening?
YES ...................................................... 1
NO ........................................................ 5
DON’T KNOW ...............................8
REFUSED ............................................ 9
GO TO *PT207

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*PT173.

RANDOM EVENT:

UNEXPECTED DEATH OF LOVED ONE

(IF NEC: What was your relationship to this person?)
R’S SPOUSE OR ROMANTIC PARTNER ........................... 1
R’S PARENT ........................................................................... 2
R’S CHILD (BIOLOGICAL, ADOPTED, STEP) ................. 3
R’S SIBLING....................................................................... 4
GRANDPARENT ................................................................ 5
OTHER RELATIVE, BY BLOOD OR MARRIAGE.......... 6
NOT A FAMILY MEMBER ............................................... 7
DON’T KNOW .................................................................... 8
REFUSED ............................................................................ 9

*PT174.

How did (this person/ PERSON) die?
HOMICIDE/MURDER............................ 1
SUICIDE .................................................. 2
ACCIDENT ............................................. 3
ILLNESS OR HEALTH PROBLEMS..... 4
MEDICAL MISHAP................................ 5
NATURAL DISASTER ........................... 6
OTHER .................................................... 7
DON’T KNOW ........................................ 8
REFUSED ................................................ 9

GO TO *PT175
GO TO *PT175
GO TO *PT175
GO TO *PT175
GO TO *PT175
GO TO *PT175
GO TO *PT175

*PT174a. [IF NEC: Had (he/she) been ill for a period of time before (his/her) death?]
YES ......................................................... 1
NO.....................................................5
DON’T KNOW.................................8
REFUSED.........................................9

GO TO *PT175
GO TO *PT175
GO TO *PT175

*PT174b. [IF NEC: For about how long had (he/she) been ill?]

DURATION NUMBER
CIRCLE UNIT
OF TIME: DAYS ........... 1

WEEKS ...... 2

MONTHS ....... 3

YEARS ......... 4

DON’T KNOW .................................98
REFUSED .............................................. 99

*PT175.

How old was (this person/PERSON) at the time of (his/her) death?
YEARS OLD
DON’T KNOW ..........................998
REFUSED ...................................... 999

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*PT176.

Looking back on it now, is there any way you could have prevented this death from happening?
YES ............................. 1
NO............................... 5
DON’T KNOW ........... 8
REFUSED ................... 9

YES
(1)

NO
(5)

DK
(8)

RF
(9)

5

8

9

5

8

9

5

8

9

5

8

9

*PT207. [FOR “ONGOING” EVENTS: During the period of time when
(RANDOM EVENT) was happening repeatedly, did you often
feel terrified or very frightened?]
[ALL OTHERS: Were you terrified or very frightened at the
time (RANDOM EVENT)?]

*PT207a.

1
GO TO
*PT208

Did you feel helpless?
1
GO TO
*PT208

*PT207b.

Did you feel shocked or horrified?
1
GO TO
*PT208

*PT207c.

Did you feel numb?
1

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YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PT208. (RB, PG 43): (Look at Group 1 on Page 43 in your
booklet.)
In the weeks, months, or years after (the event/ the event/ this
experience ended/ RANDOM EVENT), did you try not to
think about (it/ what happened)?
(IF YES: Please make a checkmark by reaction 1.)
(KEY PHRASE: tried not to think about it)
*PT209. Did you purposely stay away from places, people or activities
that reminded you of (it/ the event/ this experience/ RANDOM
EVENT)?
(IF YES: Please make a checkmark by reaction 2.)
(KEY PHRASE: stayed away from reminders of it)
*PT210. Were you ever unable to remember some important parts of
what happened?
IF VOL “UNCONSCIOUS,” “KNOCKED OUT,” OR
“HEAD INJURY,” CODE NO.
(IF YES: Please make a checkmark by reaction 3.)
[KEY PHRASE: were unable to remember part(s) of it]
*PT211. Did you lose interest in doing things you used to enjoy?
(IF YES: Please make a checkmark by reaction 4.)
(KEY PHRASE: lost interest in things you used to enjoy)
*PT212. Did you feel emotionally distant or cut-off from other
people?
(IF YES: Please make a checkmark by reaction 5.)
(KEY PHRASE: felt distant from other people)
*PT213. Did you have trouble feeling normal feelings like love,
happiness, or warmth toward other people?
(IF YES: Please make a checkmark by reaction 6.)
(KEY PHRASE: had trouble feeling normal feelings)
*PT214. Did you feel you had no reason to plan for the future because
you thought it would be cut short?
(IF YES: Please make a checkmark by reaction 7.)
(KEY PHRASE: felt you had no reason to plan for the future)
*PT215. INTERVIEWER CHECKPOINT: (SEE *PT208 - *PT214)
ZERO ‘YES’ RESPONSES IN *PT208 - *PT214....................................... 1 GO TO *PT222
ALL OTHERS ............................................................................................... 2 GO TO *PT217

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT217. You (KEY PHRASES FOR REACTIONS REPORTED IN *PT208 - *PT214). How soon after (the event/ this
experience/ RANDOM EVENT) did you start having [this reaction/ (either/any) of these reactions]?
CODE “IMMEDIATELY” OR “SAME DAY” AS “0 DAYS”
ONSET NUMBER
CIRCLE UNIT OF TIME: DAYS .... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

DON’T KNOW .............................98
REFUSED .....................................99

*PT218. For about how many days, weeks, months, or years did you continue to have [this reaction/ (either/ any) of these (Group
1) reactions]?
(IF VOL “IT’S STILL GOING ON,” PROBE: How long has it been so far?)
(IF DK, PROBE, “Was it at least a month?” IF YES, CODE 97 BELOW.)

DURATION NUMBER
CIRCLE UNIT OF TIME: DAYS .... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

“AT LEAST A MONTH” ..............97
DON’T KNOW .............................98
REFUSED .....................................99

*PT219. Think of the time when [this reaction was/ these (Group 1) reactions were] most frequent and intense. How often
did (it/ they) occur – less than once a month, one to two times a month, three to five times a month, six to ten times
a month, or more than ten times a month?
LESS THAN ONCE A MONTH.................1
ONE TO TWO TIMES A MONTH .............. 2
THREE TO FIVE TIMES A MONTH .......... 3
SIX TO TEN TIMES A MONTH ............... 4
MORE THAN TEN TIMES A MONTH ..... 5
DON’T KNOW ........................................... 8
REFUSED ..................................................... 9

GO TO *PT222

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT220. How much distress did (this reaction/ these reactions) cause you – none, mild, moderate, severe, or very severe
distress?
NONE....................................................................... 1
MILD........................................................................ 2
MODERATE........................................................... 3
SEVERE .................................................................. 4
VERY SEVERE ...............................................5
DON’T KNOW ................................................8
REFUSED ............................................................... 9

*PT221. How much did (this reaction/ these reactions) disrupt or interfere with your normal, daily life – not at all, a little,
some, a lot, or extremely?
NOT AT ALL ..................................................... 1
A LITTLE .........................................................2
SOME ...............................................................3
A LOT ...............................................................4
EXTREMELY ..................................................5
DON’T KNOW ................................................8
REFUSED ........................................................9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PT222. (RB, PG 43): (Look at Group 2 on page 43 in your
booklet.)
Did you ever have repeated unwanted memories of (it/ the
event/ this experience/ RANDOM EVENT) – that is, you kept
remembering it even when you didn’t want to?
(IF YES: Please make a checkmark by reaction 8 in the
booklet.)
(KEY PHRASE: had unwanted memories)
*PT223. Did you ever have repeated unpleasant dreams about (it/ the
event/ this experience/ RANDOM EVENT)?
(IF YES: Please make a checkmark by reaction 9 in the
booklet.)
(KEY PHRASE: had unpleasant dreams)
*PT224. Did you have flashbacks – that is, suddenly act or feel as if
(it/ the event/ this experience/ RANDOM EVENT) were
happening all over again?
(IF YES: Please make a checkmark by reaction 10 in the
booklet.)
(KEY PHRASE: had flashbacks)
*PT225. Did you get very upset when you were reminded of (it/ the
event/ this experience/ RANDOM EVENT)?
(IF YES: Please make a checkmark by reaction 11 in the
booklet.)
(KEY PHRASE: got really upset when reminded of it)
*PT226. When you were reminded of (it/ the event/ this experience/
RANDOM EVENT), did you ever have physical reactions like
sweating, your heart racing, or feeling shaky?
(IF YES: Please make a checkmark by reaction 12 in the
booklet.)
(KEY PHRASE: had physical reactions)
*PT227.

INTERVIEWER CHECKPOINT: (SEE *PT222 - *PT226)
ZERO “YES” RESPONSES IN *PT222 - *PT226......................... 1
ALL OTHERS ................................................................................... 2

GO TO *PT233

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT228. You (KEY PHRASES FOR REACTIONS REPORTED IN *PT222 - *PT226). How soon after (the event/ this
experience/ RANDOM EVENT) did you start having [this reaction/ (either/any) of these reactions]?
CODE “IMMEDIATELY” OR “SAME DAY” AS “0 DAYS”
ONSET NUMBER
CIRCLE UNIT OF TIME: DAYS .... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

DON’T KNOW .............................98
REFUSED .....................................99

*PT229. For about how many days, weeks, months, or years did you continue to have [this reaction/ (either/ any) of these (Group
2) reactions]?
(IF VOL “IT’S STILL GOING ON,” PROBE: How long has it been so far?)
(IF DK, PROBE, “Was it at least a month?” IF YES, CODE 97 BELOW.)

DURATION NUMBER
CIRCLE UNIT OF TIME: DAYS .... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

“AT LEAST A MONTH” ..............97
DON’T KNOW .............................98
REFUSED .....................................99

*PT230. Think of the time when [this reaction was/ these (Group 2) reactions were] most frequent and intense. How often
did (it/ they) occur – less than once a month, one to two times a month, three to five times a month, six to ten times
a month, or more than ten times a month?
LESS THAN ONCE A MONTH.................1
ONE TO TWO TIMES A MONTH .............. 2
THREE TO FIVE TIMES A MONTH ........ 3
SIX TO TEN TIMES A MONTH ............... 4
MORE THAN TEN TIMES A MONTH ..... 5
DON’T KNOW ........................................... 8
REFUSED ................................................... 9

GO TO *PT233

*PT231. How much distress did (this reaction/ these reactions) cause you – none, mild, moderate, severe, or very severe
distress?
NONE....................................................................... 1
MILD........................................................................ 2
MODERATE........................................................... 3
SEVERE .................................................................. 4
VERY SEVERE ...............................................5
DON’T KNOW ................................................8
REFUSED ............................................................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17

*PT232. How much did (this reaction/ these reactions) disrupt or interfere with your normal, daily life – not at all, a little,
some, a lot, or extremely?
NOT AT ALL ................................................... 1
A LITTLE ...................................................... 2
SOME ............................................................ 3
A LOT ............................................................ 4
EXTREMELY ............................................... 5
DON’T KNOW ............................................. 8
REFUSED...................................................... 9
YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PT233. (RB, PG 43) (Look at Group 3 on Page 43 in your
booklet.)
During the time (this event/ this experience/ RANDOM
EVENT) affected you most, did you have trouble falling or
staying asleep?
(IF YES: Please make a checkmark by reaction 13.)
(KEY PHRASE: had sleep problems)
*PT234. Were you more irritable or short-tempered than you usually
are?
(IF YES: Please make a checkmark by reaction 14.)
(KEY PHRASE: were irritable)
*PT235. Did you have more trouble concentrating or keeping your
mind on what you were doing?
(IF YES: Please make a checkmark by reaction 15.)
(KEY PHRASE: had trouble concentrating)
*PT236. Were you much more alert or watchful, even when there was
no real need to be?
(IF YES: Please make a checkmark by reaction 16.)
(KEY PHRASE: were more alert or watchful)
*PT237. Were you more jumpy or easily startled by ordinary noises?
(IF YES: Please make a checkmark by reaction 17.)
(KEY PHRASE: were jumpy or easily startled)
*PT238.

INTERVIEWER CHECKPOINT: (SEE *PT233 - *PT237)
ZERO “YES” RESPONSES IN *PT233 - *PT237......................... 1
ALL OTHERS ................................................................................... 2

GO TO *PT244

239

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT239. You (KEY PHRASES FOR REACTIONS REPORTED IN *PT233 - *PT237). How soon after (the event/ this
experience/ RANDOM EVENT) did you start having [this reaction/ (either/any) of these reactions]?
CODE “IMMEDIATELY” OR “SAME DAY” AS “0 DAYS”
ONSET NUMBER
CIRCLE UNIT OF TIME: DAYS .... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

DON’T KNOW .............................98
REFUSED .....................................99

*PT240. For about how many days, weeks, months, or years did you continue to have [this reaction/ (any/ either) of these (Group
3) reactions]?
(IF VOL “IT’S STILL GOING ON,” PROBE: How long has it been so far?)
(IF DK, PROBE, “Was it at least a month?” IF YES, CODE 97 BELOW.)

DURATION NUMBER
CIRCLE UNIT OF TIME: DAYS ...... 1

WEEKS....2

MONTHS .... 3

YEARS .... 4

“AT LEAST A MONTH” ..............97
DON’T KNOW .............................98
REFUSED .....................................99

*PT241. Think of the time when [this reaction was/ these (Group 3) reactions were] most frequent and intense. How often
did (it/ they) occur – less than once a month, one to two times a month, three to five times a month, six to ten times
a month, or more than ten times a month?
LESS THAN ONCE A MONTH.................1
ONE TO TWO TIMES A MONTH .............. 2
THREE TO FIVE TIMES A MONTH ........ 3
SIX TO TEN TIMES A MONTH ............... 4
MORE THAN TEN TIMES A MONTH ..... 5
DON’T KNOW ........................................... 8
REFUSED ................................................... 9

GO TO *PT244

*PT242. How much distress did (this reaction/ these reactions) cause you – none, mild, moderate, severe, or very severe
distress?
NONE....................................................................... 1
MILD........................................................................ 2
MODERATE........................................................... 3
SEVERE .................................................................. 4
VERY SEVERE ...............................................5
DON’T KNOW ................................................8
REFUSED ............................................................... 9

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT243. How much did (this reaction/ these reactions) disrupt or interfere with your normal, daily life – not at all, a little,
some, a lot, or extremely?
NOT AT ALL ................................................... 1
A LITTLE .......................................................2
SOME .............................................................3
A LOT .............................................................4
EXTREMELY ................................................5
DON’T KNOW ..............................................8
REFUSED.......................................................9

*PT244. INTERVIEWER CHECKPOINT: (SEE *PT215, *PT219, *PT220, *PT221, *PT227, *PT230, *PT231, *PT232,
*PT238, *PT241, *PT242, *PT243)
IF *PT215 EQUALS ‘2’ AND *PT219 EQUALS ‘2’-‘5’ AND (*PT220 EQUALS ‘3’-‘5’
OR *PT221 EQUALS ‘3’-‘5’) AND *PT227 EQUALS ‘2’ AND *PT230 EQUALS ‘2’-‘5’
AND (*PT231 EQUALS ‘3’-‘5’ OR *PT232 EQUALS ‘3’-‘5’) AND *PT238 EQUALS ‘2’
AND *PT241 EQUALS ‘2’-‘5’ AND (*PT242 EQUALS ‘3’-‘5’ OR
*PT243 EQUALS ‘3’-‘5’) .................................................................................................................. 1
ALL OTHERS.............................................................................................................................. 2 GO TO *PT259

*PT246. Did you ever in your life talk to a medical doctor or other professional about your reactions to (RANDOM
EVENT)? (By other professional we mean psychologists, counselors, spiritual advisors, herbalists, acupuncturists,
and other healing professionals.)
YES ..................................................1
NO....................................................5
DON’T KNOW ...............................8
REFUSED........................................9
*PT246a.

GO TO *PT259
GO TO *PT259
GO TO *PT259

How old were you the first time (you talked to a professional about your reactions)?
YEARS OLD
DON’T KNOW ...........998
REFUSED ..................999

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT256. Did you ever get treatment for your reactions that you considered helpful or effective?
YES ...................................... 1
NO .................................. 5 GO TO *PT256c
DON’T KNOW .............. 8 GO TO *PT256c
REFUSED ...................... 9 GO TO *PT256c
*PT256a. How old were you the first time (you got helpful treatment for your reactions)?

YEARS OLD
DON’T KNOW 998
REFUSED ...................... 999
*PT256b. How many professionals did you ever talk to about your reactions, up to and including the first time you
got helpful treatment?
NUMBER OF PROFESSIONALS
DON’T KNOW..........98
REFUSED..................99

GO TO *PT258

GO TO *PT258
GO TO *PT258

*PT256c. How many professionals did you ever talk to about your reactions?
NUMBER OF PROFESSIONALS
DON’T KNOW ..........98
REFUSED ..................99

*PT258.

Were you ever hospitalized overnight for your reactions?
YES ..................................................... 1
NO ....................................................... 5
DON’T KNOW..............................8
REFUSED .......................................... 9

*PT259. INTERVIEWER CHECKPOINT: (SEE *PT107)
*PT107 EQUALS ‘2’................................................................................1
ALL OTHERS ...........................................................................................2

GO TO *PT261

*PT260.1. INTERVIEWER CHECKPOINT: (SEE *PT215, PT227, PT238)
*PT215 EQUALS ‘2’ and PT227 EQUALS ‘2’ and PT238 EQUALS
‘2’ ...............................................................................................................1
ALL OTHERS ...........................................................................................2

GO TO *PT261
GO TO *CC1

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT261. (RB, PG 43) (Look at all the reactions on PG 43 in your booklet.) The next question is about whether in the past 12
months you had any reactions like these associated with any traumatic event that ever happened to you in your entire
life. Did you have any reactions of this sort over the past 12 months?
YES .................................. 1
NO .................................. 5 GO TO *CC1, NEXT SECTION
DON’T KNOW .............. 8 GO TO *CC1, NEXT SECTION
REFUSED ...................... 9 GO TO *CC1, NEXT SECTION

*PT262. When was the last time you had any of these reactions – within the past month, between 2 and 6 months ago, or
more than 6 months ago?
PAST MONTH .............................................. 1
TWO TO SIX MONTHS AGO ..................... 2
MORE THAN SIX MONTHS AGO ............. 3
DON’T KNOW ............................................. 8
REFUSED ............................................................ 9

*PT263. About how many weeks altogether in the past 12 months did you have any of these reactions? (You can use any
number between 0 and 52.)
NUMBER OF WEEKS
DON’T KNOW ................................................98
REFUSED ............................................................... 99

*PT264. INTERVIEWER CHECKPOINT: (SEE *PT263)
ZERO TO THREE WEEKS IN *PT263 ... 1
ALL OTHERS ............................................. 2

GO TO *CC1, NEXT SECTION

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6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
*PT265. What were the traumatic events that caused these recent reactions?
(PROBE UNTIL NO MORE MENTIONS: Any other traumatic events that caused these reactions during the past
12 months?)
INTERVIEWER: CIRCLE ALL THAT APPLY.
COMBAT EXPERIENCE ............................................................................................................ 1
RELIEF WORKER IN WAR ZONE.................................................................................................2
CIVILIAN IN WAR ZONE ................................................................................................................ 3
CIVILIAN IN REGION OF TERROR ........................................................................................ 4
REFUGEE .................................................................................................................................................... 5
KIDNAPPED ............................................................................................................................................... 6
TOXIC CHEMICAL EXPOSURE............................................................................................... 7
AUTOMOBILE ACCIDENT ............................................................................................................. 8
OTHER LIFE THREATENING ACCIDENT .................................................................................. 9
NATURAL DISASTER ............................................................................................................... 10
MAN-MADE DISASTER ............................................................................................................ 11
LIFE-THREATENING ILLNESS ............................................................................................... 12
BEATEN UP BY CAREGIVER .................................................................................................. 13
BEATEN UP BY SPOUSE OR ROMANTIC PARTNER.......................................................... 14
BEATEN UP BY SOMEONE ELSE ........................................................................................... 15
MUGGED OR THREATENED WITH A WEAPON ................................................................. 16
RAPE ............................................................................................................................................................ 17
SEXUAL ASSAULT........................................................................................................................... 18
STALKED .................................................................................................................................................... 19
UNEXPECTED DEATH OF LOVED ONE ............................................................................... 20
CHILD WITH SERIOUS ILLNESS ............................................................................................ 21
WITNESSED PHYSICAL FIGHT AT HOME ........................................................................... 29
TRAUMATIC EVENT TO LOVED ONE .................................................................................. 22
WITNESSED DEATH OR DEAD BODY, OR SAW SOMEONE SERIOUSLY HURT ......... 23
ACCIDENTALLY CAUSED SERIOUS INJURY OR DEATH................................................. 24
PURPOSELY INJURED, TORTURED, OR KILLED SOMEONE ........................................... 25
SAW ATROCITIES ..................................................................................................................... 26
SOME OTHER EVENT (SPECIFY) ........................................................................................... 27

DON’T KNOW ...................................................................................................................98 GO TO *PT269
REFUSED............................................................................................................................99 GO TO *PT269

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*PT266. INTERVIEWER CHECKPOINT: (SEE *PT265)
R GAVE ONLY ONE EVENT IN *PT265 .............................................. 1
R GAVE MORE THAN ONE EVENT IN *PT265 .................................. 2

GO TO *PT269

*PT267. Of these events, was there one that caused you the most upsetting reactions during the past 12 months?
YES .................................. 1
NO .................................... 5
DON’T KNOW ................ 8
REFUSED ........................ 9

GO TO *PT269
GO TO *PT269
GO TO *PT269

*PT268. (IF NEC: Which one?)
INTERVIEWER: RECORD NUMBER OF MOST UPSETTING EVENT REPORTED IN *PT265.
NUMBER
INTERVIEWER: THIS EVENT WILL NOW BE REFERRED TO AS “WORST 12-MONTH EVENT.”
DON’T KNOW .............................. 8
REFUSED....................................... 9
YES
(1)

NO
(5)

DK
(8)

RF
(9)

1

5

8

9

1

5

8

9

*PT271. Did you have trouble feeling normal feelings like love, happiness, or
warmth toward other people?

1

5

8

9

*PT272. Did you feel you had no reason to plan for the future because you
thought it would be cut short?

1

5

8

9

1

5

8

9

1

5

8

9

1

5

8

9

*PT269. Please think of the 30-day period in the past 12 months when your
reactions to [(WORST 12-MONTH EVENT)/ these events/ these
experiences] were most frequent and intense. During that month, did
you lose interest in doing things you used to enjoy?
*PT270. Did you feel emotionally distant or cut off from other people during
that month?

*PT273.

Did you have any trouble falling or staying asleep during that
month?

*PT274.

Were you more jumpy or more easily startled by ordinary noises?

*PT275.

Did you purposely stay away from places, people or activities that
reminded you of [(WORST 12-MONTH EVENT)]/ these events]?

*PT277. INTERVIEWER CHECKPOINT: (SEE *PT269-*PT275)
ZERO “YES” REPONSES IN *PT269-*PT275 ............. 1
ALL OTHERS ............................................................... 2

GO TO *CC1, NEXT SECTION

245

6464 Supported Employment Demonstration Attachment K. CIDI 05-03-17
No
Interference
0

Mild
1

2

Moderate
3

4

5

Very Severe
Interference

Severe
6

7

8

9

10

*PT278.(RB, PG 9) Think about the month or longer in the past 12 when your reactions to (WORST 12-MONTH EVENT/
these events) were most severe. Using a 0 to 10 scale on page 9 of your booklet, where 0 means no interference and
10 means very severe interference, what number describes how much your reactions to (WORST 12-MONTH
EVENT/ these events) interfered with each of the following activities during that time?
(IF NEC: How much did your reactions interfere with (ACTIVITY) during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)

NUMBER (0-10)

*PT278a. Your home management, like cleaning,
shopping, and taking care of the (house/ apartment)?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*PT278b. Your ability to work?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*PT278c. Your ability to form and maintain close
relationships with other people?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99
*PT278d. Your social life?
DOES NOT APPLY .............. 97
DON’T KNOW ...................... 98
REFUSED .............................. 99

*PT279. INTERVIEWER CHECKPOINT: (SEE *PT278a - *PT278d)
ALL FOUR RESPONSES TO *PT278a - *PT278d SERIES EQUAL ‘0’ OR ‘97’ .......... 1
ALL OTHERS ...................................................................................................................... 2

GO TO *PT281

246

*PT280. About how many days out of 365 in the past 12 months were you totally unable to work or carry out your normal
activities because of your reactions [to (WORST 12-MONTH EVENT/ these events)]?
(IF NEC: You can use any number between 0 and 365 to answer.)
NUMBER OF DAYS
DON’T KNOW ................ 998
REFUSED ........................ 999

*PT281. Did you receive any professional treatment for your reactions to (WORST 12-MONTH EVENT/ these events) in the 12
months prior to this interview?
YES.....................................1
NO.......................................5
DON’T KNOW ..................8
REFUSED ..........................9

GO TO *CC1, NEXT SECTION
GO TO *CC1, NEXT SECTION
GO TO *CC1, NEXT SECTION
GO TO *CC1, NEXT SECTION

END OF SECTION

247