GENERAL SCREENING QUESTIONS

For the purposes of this research study, your comments will be anonymous.

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* 1. Are you a Veteran who has been diagnosed with post-traumatic stress disorder (PTSD)?

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* 2. Are you 20 years of age or older?

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* 3. Have you served in the Air Force, Army, Coast Guard, Merchant Marines, Marine Corps, and/or Navy?

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* 4. PTSD Checklist for DSM-5 (PCL-5)

Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem carefully and then select the response that indicates how much you have been bothered by that problem in the past month.

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* 5. Repeated, disturbing, and unwanted memories of the
stressful experience?

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* 6. Repeated, disturbing dreams of the stressful experience?

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* 7. Suddenly feeling or acting as if the stressful experience were
actually happening again (as if you were actually back there
reliving it)?

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* 8. Feeling very upset when something reminded you of the
stressful experience?

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* 9. Having strong physical reactions when something reminded
you of the stressful experience (for example, heart
pounding, trouble breathing, sweating)?

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* 10. Avoiding memories, thoughts, or feelings related to the
stressful experience?

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* 11. Avoiding external reminders of the stressful experience (for
example, people, places, conversations, activities, objects, or
situations)?

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* 12. Trouble remembering important parts of the stressful
experience?

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* 13. Having strong negative beliefs about yourself, other people,
or the world (for example, having thoughts such as: I am
bad, there is something seriously wrong with me,
no one can be trusted, the world is completely dangerous)?

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* 14. Blaming yourself or someone else for the stressful
experience or what happened after it?

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* 15. Having strong negative feelings such as fear, horror, anger,
guilt, or shame?

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* 16. Loss of interest in activities that you used to enjoy?

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* 17. Feeling distant or cut off from other people?

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* 18. Trouble experiencing positive feelings (for example, being
unable to feel happiness or have loving feelings for people
close to you)?

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* 19. Irritable behavior, angry outbursts, or acting aggressively?

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* 20. Taking too many risks or doing things that could cause you
harm?

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* 21. Being “superalert” or watchful or on guard?

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* 22. Feeling jumpy or easily startled?

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* 23. Having difficulty concentrating?

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* 24. Trouble falling or staying asleep?

 
 33% of survey complete.

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