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The next seven questions [P9-P15] assess PTSD symptoms. |
The next questions are about the time after the [TRAUMATIC EVENT]. Please answer yes or no for each question. After the [TRAUMATIC EVENT]… |
P9. Did you avoid being reminded of this experience by staying away from certain places, people, or activities? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P10. Did you lose interest in activities that were once important or enjoyable? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P11. Did you begin to feel more isolated or distant from other people? (PROMPT: Other people with whom you normally interact.) | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P12. Did you find it hard to have love or affection for other people? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P13. Did you begin to feel that there was no point in planning for the future? (PROMPT: I mean long-term future, such as planning for a career, children, or retirement.) | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P14. After this experience, were you having more trouble than usual falling asleep or staying asleep? (PROMPT: By this experience I mean the [TRAUMATIC EVENT].) | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P15. Did you become jumpy or get easily startled by ordinary noises or movements? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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The next six questions [P16-P21] assess anxiety symptoms. |
Since [TRAUMATIC EVENT] have you been distressed or bothered by… |
P16. Feelings of nervousness or shakiness inside? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P17. Suddenly scared for no good reason? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P18. Feeling fearful? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P19. Feeling tense or keyed up? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P20. Spells of terror or panic? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P21. Feeling so restless you couldn't sit still? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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The next six questions [P22-P27] assess anxiety symptoms. |
P22. Thoughts of taking your life? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P23. Feeling lonely? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P24. Feeling blue? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P25. Difficulty making decisions? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P26. Feeling hopeless about the future? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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P27. Feelings of worthlessness? | | YES | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 |
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The next question [P28] assesses frequency of symptoms. |
P.28 Are you currently having these reactions at least a few times a week? | | YES (skip to P29) | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 | N/A (SKIP) | 7 |
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The next question [P29] assesses professional help-seeking. |
P29. Have you discussed these reactions with a doctor, nurse, psychologist, or other health professional? | | YES (skip to P29) | 1 | NO | 2 | DON'T KNOW | 8 | REFUSE | 9 | N/A (SKIP) | 7 |
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The next two questions [P30-P31] assess heavy drinking. |
P30. How many drinks did you have on a typical day since the [TRAUMATIC EVENT]? | | None | 0 | 1 to 2 drinks | 0 | 3 to 4 drinks | 1 | 7 to 9 drinks | 2 | 10 or more drinks | 4 | DON'T KNOW | 8 | REFUSE | 9 | N/A (SKIP) | 7 |
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P31. How often did you have 6 or more drinks on one occasion since the [TRAUMATIC EVENT]? | | Never | 0 | Once | 1 | 2 to 3 times | 2 | 4 to 5 times | 3 | 6 or more times | 4 | DON'T KNOW | 8 | REFUSE | 9 | N/A (SKIP) | 7 |
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