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pdfTHE LONGITUDINAL INVESTIGATION OF GENDER,
HEALTH, AND TRAUMA SURVEY (LIGHT Survey)
Time 3
Welcome to the third survey! Thank you in advance
for completing this survey.
Q2a Would you consider yourself the or one of the
primary caregivers for your child/children?
Yes
If you have any questions, you may contact our
helpdesk at 1-855-462-7577.
INSTRUCTIONS
Choose one answer for each question unless the
instructions say otherwise.
Read each question carefully. Different questions
ask about different timeframes.
No
Q3
What is your current living situation?
Rent an apartment, house, or room
Own my house or apartment
Live with a relative or friend and not paying
rent
Live in a car, on the street, or in a homeless
shelter
Other (Please describe)
400001
This number preserves your confidentiality and allows us to mail you
the incentive as a thank you for your time.
*300001*
Q1
Q4
What is the highest degree or level of
education you have completed?
Have you been homeless in the
past 4 months?
Yes
No
Some high school but no diploma or GED
High school diploma / GED
Post-high school vocational or technical
training
Some college credit, no degree
Associate’s degree (for example, AA, AS)
Bachelor’s degree (for example, BA, BS)
Master’s, Doctorate or professional degree (for
example, MA, MSW, MBA, PhD, MD, JD)
Q2
How many children do you have (both your
biological children and other children for whom
you have parenting responsibilities)?
Number of children:
I do not have any children → Go to question 3
3 (F)
Light Survey - Time 3 (M)
340
Q5
What is your current employment status?
Select all that apply.
Working for pay full-time (≥30 hours/week)
Working for pay part-time (<30 hours/week)
Not working for pay but actively looking for
paid work
Full-time care of children under the age of 18
or adult (for example, disabled adult
child/parent/spouse)
Full-time homemaker without full-time child or
elder care responsibilities
Retired
Disabled
1
Q6
Please provide an estimate of your
HOUSEHOLD’S yearly income before taxes
are taken out. Include all sources of income
from all earners in your household. If you do
not know the answer, please make your best
guess.
No income
Less than $15,000 per year
$15,000 – $24,999
$25,000 – $34,999
$35,000 – $44,999
$45,000 - $54,999
$55,000 – $74,999
$75,000 – $99,999
$100,000 - $149,999
$150,000 or more per year
Q7
How many people are supported by this
HOUSEHOLD income, including yourself, your
significant other (if you have one), and anyone
else partially or fully supported by this income
whether or not they live with you?
Q9
In the past 4 months...
Not
at all
Once or Several
twice
times
Many
times
a. Serious accident (for
example, car / boat
accident, accident at
work)
b. Exposure to toxic
substance (for example,
dangerous chemicals,
radiation)
c. Witnessed sudden,
violent death or
aftermath (for example,
homicide, suicide)
d. Sudden, unexpected
death of someone close
to you
e. Serious injury, harm,
or death you caused to
someone else
f. Captivity (for example,
being kidnapped, held
hostage, prisoner of
war)
g. Community violence
(for example, terrorist
attack, bombing, riots)
h. Natural disaster (for
example, flood,
hurricane, tornado,
earthquake)
This section is about violent attacks against
you by someone who is NOT a romantic
partner or spouse.
Q8
Have you been incarcerated for longer than 24
hours within the past 4 months?
Yes
No
In past surveys you told us about exposures
to traumatic events across your lifespan. The
next set of questions ask about experiences
you may have had in the last 4 months (since
the last survey). If the event does not apply
to you, mark “Not at all.”
Light Survey - Time 3 (M)
In the past 4 months...
Not
at all
Once or Several
twice
times
Many
times
i. Sexual assault by
anyone who is NOT an
intimate partner (rape,
attempted rape, made to
perform any sexual act
through force or threat of
harm)
j. Serious physical
assault by anyone who
is NOT an intimate
partner (attacked with or
without a weapon,
threatened with a
weapon)
2
This section is about violence against you by
someone who WAS/IS a romantic partner or
spouse.
In the past 4 months...
Not at all
Once or Several
twice
times
Many
times
k. Physical assault
(pushed, grabbed, shaken,
hit, beat up by a significant
other/spouse)
l. Unwanted sexual
experience by a significant
other/spouse (pressured
or forced to do sexual
things you didn’t want to
do)
m. Emotional mistreatment
by significant other/spouse
(name-calling, criticized,
not allowed to see
friends/family, humiliated,
or denied money)
n. Other traumatic event:
please specify. Please
describe the event below.
Combat/ exposure to warzone
Physical assault
Sexual assault
Accident
Natural disaster
Seen someone killed or seriously injured
Death of loved one through homicide or suicide
I did not have an experience like this → Go to
question 15
Other: (Please describe)
Q9o We are interested in other natural disasters
you have experienced in your life. Please
tell us the number of times you’ve
experienced a natural disaster across each
time in your life
Not at all
Childhood (birth – age
17)
Age 18 to enlistment (if
applicable)
During military service
After military service
until January 2019
Light Survey - Time 3 (M)
Q10 Of all the traumatic events that you have ever
experienced across your life, please select the
ONE experience that causes you the MOST
distress. If you have never had an experience
like these, please select “I did not have an
experience like this” and proceed to question
15. Check one only.
Once or Several
twice
times
Q11 How old were you when this most distressing
trauma (the trauma selected from Q10)
occurred?
Many
times
Q12 How long ago did this trauma (from Q10)
occur?
Within the past month
Within the past 4 months
Over 4 months ago
3
Below is a list of problems that people sometimes have in response to a very stressful
experience. Please read each problem carefully and then choose one of the responses
below to indicate how much you have been bothered by that problem in the past month.
Please base your answers on problems related to the experience you named as the worst in
question 10.
Q13 Thinking about the experience you named in question 10, in the past month, how much were you
bothered by:
Not at all
A little bit
Moderately
Quite a bit
Extremely
a. Repeated, disturbing, and unwanted memories of the
stressful experience?
b. Repeated, disturbing dreams of the stressful
experience?
c. Suddenly feeling or acting as if the stressful
experience were actually happening again (as if you
were actually back there reliving it)?
d. Feeling very upset when something reminded you of
the stressful experience?
e. Having strong physical reactions when something
reminded you of the stressful experience (for example,
heart pounding, trouble breathing, sweating)?
f. Avoiding memories, thoughts, or feelings related to the
stressful experience?
g. Avoiding external reminders of the stressful
experience (for example, people, places, conversations,
activities, objects, or situations)?
h. Trouble remembering important parts of the stressful
experience?
i. 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)?
j. Blaming yourself or someone else for the stressful
experience or what happened after it?
k. Having strong negative feelings such as fear, horror,
anger, guilt, or shame?
l. Loss of interest in activities that you used to enjoy?
m. Feeling distant or cut off from other people?
n. Trouble experiencing positive feelings (for example,
being unable to feel happiness or have loving feelings for
people close to you)?
o. Irritable behavior, angry outbursts, or acting
aggressively?
p. Taking too many risks or doing things that could cause
you harm?
q. Being “superalert” or watchful or on guard?
r. Feeling jumpy or easily startled?
s. Having difficulty concentrating?
t. Trouble falling or staying asleep?
Light Survey - Time 3 (M)
4
Q14 For these questions, please continue to think of the traumatic event that bothers you most (from
Q10). What do you do when memories of the traumatic event pop into your mind? Please check
the answer that applied best to you during the past week.
Never
Sometimes
Often
Always
a. I think about how life would have been different if the
event had not occurred.
b. I dwell on how the event could have been prevented.
c. I think about why the event happened to me.
d. I dwell on how I used to be before the event.
e. I dwell on what other people have done to me.
f. I dwell on what I should have done differently.
g. I go over what happened again and again.
h. I worry that something similar will happen to me or my
family.
Q15 The next set of items ask about potentially stressful situations you may be currently
experiencing. Think about whether or not the stressful situation described happened within the
past 4 months. If the situation IS NOT occurring for you, choose "N/A" and go to the next item. If
the situation IS occurring, please rate the extent to which it is NOW stressful/distressing to you
on a scale from 1-10.
N/A
Not at all
distressing
1
2
3
4
Somewhat
distressing
5
6
7
8
9
Extremely
distressing
10
a. Laid off or fired from work
b. At risk for losing your
home/lost your home
c. Caring of seriously ill
and/or disabled dependents
(e.g., children, elders)
d. Divorce or separation
from romantic partner
e. Legal problems, court
proceedings, ongoing
litigation
f. Major negative change in
financial status
g. Major problems at
school/At risk of losing spot
at school or Veteran
subsidies
h. Major health problem
i. Major problem with your
significant other or child(ren)
j. Moved to a new home
Light Survey - Time 3 (M)
5
Q16 Over the past two weeks how often have you been bothered by any of the following problems?
Not at all
Several days
More than half Nearly every
the days
day
a. Little interest or pleasure in doing things
b. Feeling down, depressed, or hopeless
c. Trouble falling or staying asleep, or sleeping too much.
d. Feeling tired or having little energy
e. Poor appetite or overeating
f. Feeling bad about yourself – or that you are a failure or
have let yourself or your family down
g. Trouble concentrating on things, such as reading the
newspaper or watching television
h. Moving or speaking so slowly that other people could have
noticed. Or the opposite – being so fidgety or restless that
you have been moving around a lot more than usual
i. Thoughts that you would be better off dead, or of hurting
yourself
j. Feeling nervous, anxious, or on edge
k. Not being able to stop or control worrying
l. Worrying too much about different things
m. Trouble relaxing
n. Being so restless that it's hard to sit still
o. Becoming easily annoyed or irritable
p. Feeling afraid as if something awful might happen
Q17 People think and do many different things when they feel depressed. Please read each of the
items below and indicate whether you almost never, sometimes, often or always think or do each
one when you feel down, sad, or depressed. Please indicate what you generally do, not what you
think you should do.
Almost
never
Sometimes
Often
Almost
always
a. Think about how alone you feel.
b. Think “I won’t be able to do my job if I don’t snap out of this.”
c. Think about your feelings of fatigue and achiness.
d. Think about how hard it is to concentrate.
e. Think “What am I doing to deserve this?”
f. Think about how passive and unmotivated you feel.
g. Analyze recent events to try to understand why you are depressed.
h. Think about how you don’t seem to feel anything anymore.
i. Think “Why can’t I get going?”
j. Think “Why do I always react this way?”
k. Go away by yourself and think about why you feel this way.
l. Write down what you are thinking and analyze it.
Light Survey - Time 3 (M)
6
(continued)
Amost
never
Sometimes
Often
Almost
always
m. Think about a recent situation, wishing it had gone better.
n. Think “I won’t be able to concentrate if I keep feeling this way.”
o. Think “Why do I have problems other people don’t have?”
p. Think “Why can’t I handle things better?”
q. Think about how sad you feel.
r. Think about all your shortcomings, failings, faults, mistakes.
s. Think about how you don’t feel up to doing anything.
t. Analyze your personality to try to understand why you are depressed.
u. Go someplace alone to think about your feelings.
v. Think about how angry you are with yourself.
Q18 Have you been diagnosed with any of the following emotional/mental health conditions within the past 4
months? Select all that apply.
Post-traumatic Stress Disorder (PTSD)
Depression
Anxiety Disorder (for example, panic disorder, generalized anxiety disorder)
None
Other mental health problem (please specify):
Please check the one box beside the
statement or phrase that best applies to
you.
Q19b How often have you thought about killing
yourself in the past 4 months? Check one
only.
Never
Rarely (1 time)
Sometimes (2 times)
Q19a Have you thought about or attempted to kill
yourself in the past 4 months? Check one
only.
Never
It was just a brief passing thought
I have had a plan at least once to kill myself
but did not try to do it
I have had a plan at least once to kill myself
and really wanted to die
I have attempted to kill myself, but did not
want to die
I have attempted to kill myself, and really
hoped to die
Light Survey - Time 3 (M)
Often (3-4 times)
Very often (5 or more times)
Q19c Have you ever told someone in the past 4
months that you were going to commit
suicide, or that you might do it? Check one
only.
No
Yes, at one time, but did not really want to die
Yes, at one time, and really wanted to die
Yes, more than once, but did not want to do it
Yes, more than once, and really wanted to do
it
7
Q19d How likely is it that you will attempt suicide someday? Check one only.
Never
No chance at all
Rather unlikely
Unlikely
Likely
Rather likely
Very likely
Having thoughts of hurting yourself can be a common response to feeling distressed.
We want you to know that help is available. We recommend that you contact your
primary care provider or call the Veterans Crisis Hotline (1-800-273-8255) if you are
experiencing suicidal thoughts.
Q20 Thinking over the past month, check the option that best describes the amount of time you felt
that way.
None or
All or almost
almost none A little of the Some of the Most of the all of the
of the time
time
time
time
time
a. I found myself getting angry at people or situations.
b. When I got angry, I got really angry.
c. When I got angry, I stayed mad.
d. When I got angry at someone I wanted to hit them.
e. My anger prevented me from getting along with people
as well as I'd have liked to.
Q21 What is your current marital status?
Never married
Married - first and only marriage → Go to question 23
Married - second or later marriage → Go to question 23
Separated
Divorced
Widowed
Q22 Are you currently in a romantic relationship?
Currently in a relationship and living as a couple
Currently in a relationship but not living as a couple
Not currently in a relationship → Go to question 24
Light Survey - Time 3 (M)
8
If you are married or currently in a romantic relationship, please answer the following
questions. If you are not married or in a romantic relationship, please skip to question 24:
Q23 Over the past month, how often have you done the following in your romantic relationship:
Never
Rarely
Sometimes
Often
Most or all of
the time
a. Provided your significant other with the emotional
support they sought.
b. Shared your intimate thoughts and feelings.
c. Done your fair share of day-to-day tasks (for example,
grocery shopping, errands, planning activities).
d. Initiated leisure time activities that both you and your
significant other enjoy.
e. Made effort to work through disagreements
respectfully.
f. Expressed interest and/or willingness to engage in
regular sexual or physical intimacy.
If you currently have parenting responsibilities for any children 18 or under please answer
the following questions. If not, please skip to question 25.
Q24 All parents have strengths and weaknesses. Over the past month, how often have you:
Never
Rarely
Sometimes
Often
Most or all
of the time
a. Provided a healthy environment for your children (for
example, preparing healthy meals, caring for their health,
keeping them safe).
b. Been a good example for your children (for example,
being respectful during disagreements with others,
taking good care of your own health).
c. Been actively involved in your child(ren)’s activities (for
example, regularly attending sporting and school events,
giving your full attention during time together).
d. Met your children’s needs for physical affection and
emotional support (for example, giving them hugs, being
sympathetic to their problems).
e. Been able to successfully manage your child(ren)’s
unique challenges (for example, effectively disciplining
children).
Light Survey - Time 3 (M)
9
Q25 How dissatisfied or satisfied are you with…
Extremely
dissatisfied
0
Extremely
satisfied
Neither
1
2
3
4
5
6
7
8
9
10
a. Your physical health (the health of
your body)?
b. How well you care for yourself, for
example, preparing meals, bathing, or
shopping?
c. How well you think and remember?
d. The amount of walking you do?
e. How often you get outside the house,
for example, going into town, using
public transportation, or driving?
f. How well you carry on a conversation,
for example, speaking clearly, hearing
others, or being understood?
g. The kind and amount of food you eat?
h. How often you see or talk to your
family and friends?
i. The help you get from your family and
friends, for example, helping in an
emergency, fixing your house, or doing
errands?
j. The help you give to your family and
friends?
k. Your contributions to your community,
for example, a neighborhood, religious,
political or other group?
l. Your work situation, for example, your
current job, retirement for any reason, or
never having worked?
m. Yhe kind and amount of recreation or
leisure you have?
n. Your level of sexual activity or lack of
sexual activity?
o. The way your income meets your
needs?
p. How respected you are by others?
q. The meaning and purpose of your
life?
r. The amount of variety in your life?
s. The amount and kind of sleep you
get?
Q26 How happy are you?
Extremely
unhappy
0
Extremely
happy
Neither
1
Light Survey - Time 3 (M)
2
3
4
5
6
7
8
9
10
10
The following questions ask about your neighborhood and community.
Q27 How likely are these things to happen in your neighborhood…
Neither
Very
Likely or
Unlikely Unlikely Unlikely
Likely
Very
likely
a. People around here are willing to help their neighbors.
b. This is a close-knit neighborhood.
c. People in this neighborhood can be trusted.
d. People in this neighborhood generally don’t get along with each other.
e. People in this neighborhood do not share the same values.
Q28 On the whole, how much do you like this neighborhood as a place to live?
Not at all
A little
Somewhat
A great deal
Q29 We are interested in how you feel about the following statements. Read each statement carefully.
Indicate how you feel about each statement.
Strongly
disagree Disagree
Agree
Strongly
agree
a. There is a lot of graffiti in my neighborhood.
b. My neighborhood is noisy.
c. Vandalism is common in my neighborhood.
d. There are a lot of abandoned buildings in my neighborhood.
e. My neighborhood is clean.
f. People in my neighborhood take good care of their houses and
apartments.
g. There are too many people hanging around on the streets near my home.
h. There is a lot of crime in my neighborhood.
i. There is too much drug use in my neighborhood.
j. There is too much alcohol use in my neighborhood.
k. I’m always having trouble with my neighbors.
l. In my neighborhood, people watch out for each other.
m. My neighborhood is safe.
Q30 In the past 4 months, how often have you
heard gunshots associated with crime or
violence in your neighborhood?
Q31 How common would you say it is for people to
belong to street gangs in your neighborhood?
Very common
Never
Somewhat common
Once or twice
Somewhat uncommon
Three to five times
Very uncommon
More than five times
Light Survey - Time 3 (M)
11
Q32 How common do you think it is for people to
carry guns in the neighborhood?
Q38
Very common
In your neighborhood, it is sometimes
necessary for people to carry guns to protect
themselves or their family.
Somewhat common
Strongly agree
Somewhat uncommon
Agree
Very uncommon
Disagree
Q33 Have you ever seen someone threatened with
a gun in the neighborhood within the last 4
months?
Strongly Disagree
Q39
Yes
In this neighborhood, it is sometimes
necessary for people to join a gang to protect
themselves or their family.
Strongly agree
No
Agree
Q34 Have you ever seen someone shot with a gun
in the neighborhood within the last 4 months?
Disagree
Strongly disagree
Yes
No
Q35 If a fight were to break out near your home,
how likely is it that your neighbors would
attempt to break it up?
The following questions ask about your
health.
Q40
Very likely
During the past month, what time have you
usually gone to bed at night (hh:mm)?
:
Somewhat likely
Somewhat unlikely
AM
Very unlikely
Q36
PM
If a fight were to break out near your home,
how likely is it that the police would be called?
Q41
During the past month, how long, has it
usually taken you to fall asleep each night?
Very likely
Number of Hours:
Somewhat likely
Somewhat unlikely
Number of minutes:
Very unlikely
Q37 How safe do you feel…
Very safe
a. Alone inside
your house?
b. Outside in your
neighborhood
during the day?
c. Outside in your
neighborhood at
night?
d. Walking alone
toward a group of
people that you
don’t know?
Light Survey - Time 3 (M)
Q42
SomewhatSomewhat Very
at safe
unsafe
unsafe
During the past month, what time have you
usually gotten up in the morning (hh:mm)?
:
AM
PM
Q43
During the past month, how many hours of
actual sleep did you get on average each
night? (This may be different from the number
of hours you spent in bed.)
Hours of sleep per night:
12
Q44
How often do you exercise for 30 minutes or
more?
Have you been diagnosed with alcohol abuse
or dependence in the past 4 months?
Daily or almost daily
No
3 to 4 times per week
Yes
2 to 3 times per week
1 to 2 times per week
Fewer than once per week
Please answer the following questions
related to your current substance use. Skip
any questions that are irrelevant to you.
Q45
Q49
How many cigarettes did you smoke on an
average day in the last month (if you do not
smoke write 0)?
Q50
In the past month, did you use marijuana? If
YES, how many times in a typical week?
No → Go to question 51
Yes
Times in a week:
Q50a Does your marijuana use cause any
problems?
Yes
No
For alcohol, one drink equals:
· 4 oz. wine
· 1 wine cooler
· 12 oz. beer
· 1 cocktail with 1 oz. hard liquor
Q46
How often do you currently have a drink
containing alcohol?
Never → Go to question 50
Monthly or less
2-4 times a month
2-3 times a week
4 or more times a week
Q47
How many standard drinks containing alcohol
do you have on a typical day?
1 or 2
3 or 4
5 or 6
Q48
N/A, I do not use marijuana
Q50b Did anyone else think your marijuana use
caused a problem?
Yes
No
N/A, I do not use marijuana
Q51 In the past month, did you use other drugs,
other than alcohol or marijuana? If YES, how
many times in a typical week did you use, if at
all? This includes cocaine, crack, heroin, acid,
speed, ecstasy, methamphetamines, steroids,
and medicines prescribed for someone else.
No → Go to question 52
Yes
Times in a week:
Q51a Does your use of drugs other than alcohol or
marijuana cause any problems?
7 to 9
Yes
10 or more
No
On average, how often do you have 5 or more
drinks on one occasion?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
Light Survey - Time 3 (M)
N/A, I do not use drugs, not including alcohol
or marijuana
Q51b Did anyone else think your use of drugs other
than alcohol or marijuana cause a problem?
Yes
No
N/A, I do not use drugs, not including alcohol
or marijuana
13
Q52
Have you been diagnosed with drug (including prescription drugs) abuse or dependence in the past 4
months?
No
Yes
If you are prescribed pain medication please answer the following questions, otherwise skip
to item 54.
Q53 In the past 4 months…
Never
Rarely
Sometimes
Often
Almost
Always
Not at all
A little bit
Somewhat
Quite a bit
Very much
a. I abused prescription pain medication.
b. I ran out of my prescription pain medication early.
c. I got prescription pain medication from someone other
than my healthcare provider.
d. I used more of my prescription pain medication than I
was supposed to.
e. I experienced cravings for pain medication.
f. I used more pain medication before the effects wore
off.
Q53a In the past 4 months…
When my prescription for pain medication ran out, I felt
anxious
The following questions are about food and eating behavior.
Q54 Please answer yes or no to the following
questions:
No
a. Do you make yourself sick
because you feel uncomfortably
full?
b. Do you worry that you have lost
control over how much you eat?
c. Have you recently lost more than
14 lbs in a 3-month period?
d. Do you believe yourself to be fat
when others say you are too thin?
e. Would you say that food
dominates your life?
Q55 What is your current weight?
Yes
Q56
Have you ever experienced any of the
following events in the past 4 months?
Select all that apply.
Blast or explosion (IED, RPG, Landmine,
Grenade, etc)
Vehicular accident/crash (any vehicle
including aircraft)
Fragment wound or bullet wound above the
shoulders
Fall
Blow to the head (head hit by falling/flying
object, head hit by another person, head hit
against something, etc)
Strangulation
Shaken violently
None of the above → Go to question 57
lbs
Light Survey - Time 3 (M)
14
Q56a Did you have any of these immediately after
any of the events in Q56? Select all that
apply.
The following questions ask about your use
of healthcare and thoughts about mental
health treatment.
Losing consciousness/”knocked out”
Being dazed, confused, or “seeing stars”
Not remembering the event
Concussion
Head injury that resulted in broken bones in
head, neck, face, damaged teeth, or ruptured
eardrum
None of the above
Q56b Did any of the following problems begin or get
worse afterwards? Select all that apply.
Memory problems or lapses
Balance problems or dizziness
Sensitivity to bright light
Irritability
Headaches
Sleep problems
Q58
Do you get any healthcare (physical and/or
mental health) at Veterans’ Administration
(VA) hospitals or clinics within the past 4
months?
Yes → Go to question 59
No
Q58a If NO, why not?
Not eligible
Distance to VA facilities/transportation
concerns
My VA does not provide the services I need.
I don’t feel comfortable seeking services at
the VA.
Preference for my current healthcare
providers
Other (please specify):
None of the above
Q56c In the past week, have you had any of the
symptoms from question 56? Select all that
apply.
Memory problems or lapses
Q59 I think that I am suffering from mental health
problems (for example, feeling anxious
depressed, or too angry).
Balance problems or dizziness
True
Sensitivity to bright light
False
Irritability
Headaches
Sleep problems
None of the above
Q60 I think that I might benefit from mental health
treatment.
True
False
Q57
Have you been diagnosed with any new
medical conditions in the past 4 months?
Yes
No
If yes, please specify the condition(s):
Q61 Are you currently receiving mental health
services (for example, seeing a therapist,
counselor, or medications) to help with
distress?
Yes → Go to question 62
No
Light Survey - Time 3 (M)
15
Q61a If NO, what prevents you from seeking mental
health treatment? Select all that apply.
Concern for job security
Judgment from others
Distance/transportation to mental healthcare
providers
Don’t think it will help me
No insurance coverage
I don't need mental health treatment
Other (please specify):
Q62
If I thought that I were suffering from serious depression, anxiety, anger, or fear, I would seek
assistance from (Select all that apply):
Good female friends
Good male friends
Spouse or intimate partner
Family member (brother, sister, mother, father, etc.)
Coworker
Religious leader (e.g. pastor, priest, rabbi)
Medical doctor (primary care doctor)
Therapist or counselor
Information on the internet
Self-help books or magazine articles
Other (please specify):
Q63 We are interested in your use of mental health services in the past 4 months. If you received any
help (even if it was only once or for a little while), please mark where you received this help. Mark
the no column only if you did not receive any of that type of help in the past 4 months.
No, I did not
get this kind
of help
Yes, from
a VA provider
Yes, from a
community
(non-VA)
provider
Yes, from both
a VA and a
community
provider
a. Medication for a mental health problem (e.g., an
antidepressant)
b. Individual counseling or therapy for a mental health
program
c. Group counseling or therapy for a mental health
problem
d. Family therapy
e. Inpatient or partial hospitalization program for a mental
health problem
f. Another type of mental health treatment (please
specify):
Light Survey - Time 3 (M)
16
Q64 If you felt as though you needed mental health
treatment, do you feel your health care provider
could get it for you?
Q66 If you have received any mental health
treatments within the past 4 months, how
helpful was this care in reducing your distress?
Yes
Not at all helpful
No
Slightly helpful
N/A
Moderately helpful
Very helpful
Extremely helpful
N/A
Q65 If you have received any mental health
treatments within the past 4 months, how
satisfied were you with the care you received?
Q68
Q67 If you have received any mental health
treatments within the past 4 months, how
difficult was it to find a therapist and schedule
your mental health appointments?
Very difficult
Not at all satisfied
Difficult
Slightly satisfied
Moderately difficult
Moderately satisfied
Neutral
Very satisfied
Easy
Extremely satisfied
Very easy
N/A
N/A
Please indicate how many times you have done each of these things to someone else in the past
4 months.
Once
Twice
3-5 times
Not in the
past 4
months, but This has
More than it did happen
never
6-10 times 11-20 times 20 times
before
happened
a. I insulted, swore, shouted or
yelled at someone.
b. I pushed, shoved, or
slapped someone.
c. I punched, kicked, or beatup someone.
d. I destroyed something
belonging to someone else or
threatened to hit someone.
Light Survey - Time 3 (M)
17
Q69
You will be asked to describe how you typically think about negative experiences or problems.
Please read the following statements and rate the extent to which they apply to you when you
think about negative experiences or problems.
Never
Rarely
Sometimes
Often
Almost
Always
a. The same thoughts keep going through my mind again and again.
b. Thoughts intrude into my mind.
c. I can’t stop dwelling on them.
d. I think about many problems without solving any of them.
e. I can’t do anything else while thinking about my problems.
f. My thoughts repeat themselves.
g. Thoughts come to my mind without me wanting them to.
h. I get stuck on certain issues and can’t move on.
i. I keep asking myself questions without finding an answer.
j. My thoughts prevent me from focusing on other things.
k. I keep thinking about the same issue all the time.
l. Thoughts just pop into my mind.
m. I feel driven to continue dwelling on the same issue.
n. My thoughts are not much help to me.
o. My thoughts take up all my attention.
Q70
Below are ten statements about yourself which may or may not be true. Using the 1-4 scale
below, please check the appropriate number following each item.
Not at all True
Barely True
Moderately True Exactly True
a. I can always manage to solve difficult problems if I try hard
enough.
b. If someone opposes me, I can find means and ways to get
what I want.
c. It is easy for me to stick to my aims and accomplish my
goals.
d. I am confident that I could deal efficiently with unexpected
events.
e. Thanks to my resourcefulness, I know how to handle
unforeseen situations.
f. I can solve most problems if I invest the necessary effort.
g. I can remain calm when facing difficulties because I can
rely on my coping abilities.
h. When I am confronted with a problem, I can usually find
several solutions.
i. If I am in a bind, I can usually think of something to do.
j. No matter what comes my way, I’m usually able to handle it.
The next set of questions asks you about your current support system and coping
strategies.
Light Survey - Time 3 (M)
18
Q71
We are interested in how you feel about the following statements. Read each statement
carefully. Indicate how you feel about each statement.
Very
strongly Strongly Mildly
disagree disagree disagree Neutral
Mildly
agree
Very
Strongly strongly
agree
agree
a. There is a special person who is around when I am in
need.
b. There is a special person with whom I can share my joys
and sorrows.
c. My family really tries to help me.
d. I get the emotional help and support I need from my
family.
e. I have a special person who is a real source of comfort to
me.
f. My friends really try to help me.
g. I can count on my friends when things go wrong.
h. I can talk about my problems with my family.
i. I have friends with whom I can share my joys and sorrows.
j. There is a special person in my life who cares about my
feelings.
k. My family is willing to help me make decisions.
l. I can talk about my problems with my friends.
Q72 In your day-to-day life, how often are you
treated unfairly because of such things as your
race, ethnicity, gender, age, religion, physical
appearance, sexual orientation, or other
characteristics?
Almost every day
At least once a week
A few times a month
A few times a year
Less than once a year
Never
Light Survey - Time 3 (M)
Q73 In dealing with these day-to-day
experiences, how often do you...
At A few
Less
Almost least times A few than
every once a a
times once a
day week month a year year Never
a. Try to
prepare for
possible
insults from
other people
before leaving
home.
b.Feel that
you always
have to be
very careful
about your
appearance
(to get good
service or
avoid being
harassed).
c. Carefully
watch what
you say and
how you say
it.
d. Try to avoid
certain social
situations and
places.
19
Q74 How did you respond to this/these
experience(s)?
Q76 Overall, how much harder has your life been
because of these experiences?
No
Yes
A lot
a. Tried to do something about it.
Some
b. Accepted it as a fact of life.
A little
c. Worked harder to prove them wrong.
d. Realized that you brought it on
yourself.
e. Talked to someone about how you
were feeling.
Not at all
f. Expressed anger or got mad.
g. Prayed about the situation.
Q75 Overall, how much have these experiences
interfered with you having a full and productive
life?
Q77 Overall, how stressful are these experiences
for you?
A lot
A lot
Some
Some
A little
A little
Not at all
Not at all
THANK YOU FOR YOUR CONTINUED PARTICIPATION IN THIS SURVEY.
PLEASE RETURN YOUR SURVEY IN THE ENCLOSED ENVELOPE.
ONCE WE RECEIVE THE SURVEY, $20 WILL BE MAILED TO YOU.
Light Survey - Time 3 (M)
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| File Type | application/pdf |
| File Modified | 2019-06-28 |
| File Created | 2019-06-14 |