Form 0920- Beck Anxiety

A Longitudinal Examination of Mental and Physical Health among Police Associated with COVID–19

Att D11- Beck Anxiety

Att D11- Beck Anxiety

OMB: 0920-1350

Document [docx]
Download: docx | pdf






Attachment D11

Beck Anxiety










Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx

Beck Anxiety

II. Below is a list of common symptoms of anxiety. Please read each item in the list carefully. Indicate how much you have been bothered by each symptom during the PAST WEEK by marking an “X” in the appropriate box.



During the PAST WEEK


Not at all

(1)


Did not bother me much

(2)


Moderately

(3)


Severely

(4)

1

Numbness or tingling

2

Feeling hot

3

Wobbliness in legs

4

Unable to relax

5

Fear of the worst happening

6

Dizzy or lightheaded

7

Heart pounding or racing

8

Unsteady

9

Terrified

10

Nervous

11

Feelings of choking

12

Hands trembling

13

Shaky

14

Fear of losing control

15

Difficulty breathing

16

Fear of dying

17

Scared

18

Indigestion or discomfort in abdomen

19

Faint

20

Face flushed

21

Sweating (not due to heat)

Shape2

Public reporting burden of this collection of information is estimated to average 3 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (XXXX).







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSawyer, Tamela (CDC/NIOSH/OD/ODDM)
File Modified0000-00-00
File Created2021-07-30

© 2024 OMB.report | Privacy Policy