DSM-5 World Mental Health

College Student Survey

Baseline

SHORT FORM

VERSION 3

March 12, 2020

Ronald C. Kessler, Ph.D.

McNeil Family Professor of Health Care Policy
Harvard Medical School

___________________________
Comments to: RC Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston,
MA, USA 02115; [email protected]; 617-432-3587 (Voice); 617-432-3588 (Fax)

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SECTION ORDER:

SECTION A: YOUR BACKGROUND

SECTION B: YOUR HEALTH
SECTION D: ATTENTION AND CONCENTRATION
SECTION E: EMOTIONAL PROBLEMS
SECTION F: ALCOHOL AND DRUGS
SECTION G: SELF-HARM
SECTION H: SEEKING TREATMENT
SECTION I: CHILDHOOD BACKGROUND
SECTION J: RECENT EXPERIENCES
SECTION K: SEXUALITY
SECTION L: CONCEPT OF SELF

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 SECTION A: YOUR BACKGROUND

NOTE: Variable names for each question are listed in red.

A1. How old are you?

Age

[DROPDOWN LIST]16or younger, 17, … ,35, 36 or older

A2. What was your sex at birth, as it appears on your birth certificate?
GenderBirth

Male
Female

A3. What is your current gender identity?

GenderIdent

Male
Female
Other (Briefly describe in the textbox below)
GenderIdent_3_TEXT

A4. What is your current student status?

StudStatus

Full-time degree student

Part-time degree student
Non-degree student
Other (Briefly describe in the textbox below)
StudStatus_4_TEXT

A5. Are you an international student (i.e., a citizen of another country who came to this country for
education)?
InterStud

Yes
No

[PROGRAMMER NOTE: A5 IS AN OPTIONAL QUESTION. IT WILL NEED TO BE PROGRAMMED AS A SEPARATE BLOCK

IN QUALTRICS]

END OF SECTION

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 SECTION B: YOUR HEALTH

B1. How would you rate your overall physical health?

PhysH_Rate

Excellent
Very good
Good
Fair
Poor

B2. How would you rate your overall mental health?

MentH_Rate

Excellent
Very good
Good
Fair
Poor

B3. The following questions are about activities you might do during a typical day. Does your health
now limit you in these activities? If so, how much?

Yes, limited Yes, limited No, not

a lot a little limited at all

a. Moderate activities (e.g., moving a table, pushing a

vacuum cleaner, bowling, playing golf) HlthLim_1
b. Climbing several flights of stairs HlthLim_2

B4. In the past 30 days, how often have you had any of the following problems with your work or
other regular activities as a result of your physical health?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. Accomplished less than you would
like PhysHProb_1
b. Were limited in the kind of work or
other activities PhysHProb_2
c. Had difficulty performing work or
other activities (e.g., it took extra
effort) PhysHProb_3
d. Cut down on the amount of time
you spent on work or other
activities PhysHProb_4

B5. In the past 30 days, how often have you had any of the following problems with your work or
other regular activities as a result of any emotional problems (e.g., feeling depressed or anxious)?

All or Most of Some of A little of None of

almost all the time the time the time the time
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 the time
a. Accomplished less than you would
like MentHProb_1
b. Did work or activities less carefully
than usual MentHProb_2
c. Cut down on the amount of time
you spent on work or other
activities MentHProb_3

B6. In the past 30 days, how much of the time has your physical health or emotional problems
interfered with your social activities, like going out with friends or participating in extracurricular
activities?
PhysMent_Inter

All or almost all of the time

Most of the time
Some of the time
A little of the time
None of the time

B7. In the past 30 days, how often did you…

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. have sleep problems (e.g., falling
asleep, staying asleep, waking too
early, sleeping too much)?
Hlth30d_1
b. have a lot of energy? Hlth30d_2
c. feel calm or peaceful? Hlth30d_3
d. feel emotionally much higher,
happier, or excitable than usual?
Hlth30d_4
e. feel much more hyper or wound up
than usual? Hlth30d_5
f. have thoughts race through your
mind so fast you could hardly keep
track of them? Hlth30d_6

B8. In the past 30 days, how much did pain interfere with your normal work, including work outside
the home and housework?
Pain_Inter

Extremely
A lot
Some
A little
Not at all

B9. Have you ever in your life had any of the following emotional problems?

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 Yes No

a. Depression EmoProbEver_1
b. Manic-depression, mania, or bipolar disorder EmoProbEver_2
c. Panic attacksEmoProbEver_3
d. Problems with anxiety (nerves, worries, fears, compulsions,
obsessions) EmoProbEver_4
e. Any other serious emotional problemEmoProbEver_5

END OF SECTION                                                                    

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 SECTION D: ATTENTION AND CONCENTRATION

D1. In the past 6 months, how often did you have problems with organization or concentration, such
as being easily distracted in class, disorganized, or had difficulty wrapping up a project or
assignment?
ADHD_Freq

Very often
Often
Sometimes
Rarely
Never

CKPT.D2.
1. D1 = “OFTEN” OR “VERY OFTEN,” GO TO D2
2. ALL OTHERS GO TO NEXT SECTION

D2. How often did you have each of the following difficulties with organization, concentration, or
impulsivity in the past 6 months?

Very
Often Sometimes Rarely Never
often
a. You avoided or delayed getting started
when you had a task that required a
lot of thought ADHD6mSxs_1
b. You had problems remembering
appointments or obligations
ADHD6mSxs_2
c. You had difficulty getting things in
order when you had to do a task that
required organizationADHD6mSxs_3
d. You had trouble wrapping up the final
details of a project once the
challenging parts were
doneADHD6mSxs_4
e. You felt overly active and compelled to
do things, like you were driven by a
motorADHD6mSxs_5
f. You fidgeted or squirmed with your
hands or feet when you had to sit
down for a long time ADHD6mSxs_6

CKPT.D3.
1. THREE OR MORE RESPONSES IN D2a-f SERIES = AT LEAST “SOMETIMES,” GO TO D3
2. ALL OTHERS GO TO NEXT SECTION

D3. About how old were you the very first time you had problems with organization, concentration, or
impulsivity?
ADHD_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

END OF SECTION

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 SECTION E: EMOTIONAL PROBLEMS

NOTE: We are screening 5 disorders: panic (E14-E22), bipolar disorder (E24-E34), PTSD (E39-E43), alcohol use
disorder (F4-F10), and self-harm (G3-G5, G7-G10, G12-G19, G21-G23). All participants will be asked the screener
questions for all of these 5 disorders: panic = E13, bipolar disorder = E23, PTSD = E38, alcohol use disorder = F1-F3,
self-harm = G1-G2 and G20. Then they will be randomly assigned to be administered the full set of disorder-specific
questions for a random 2 out of these 5 questions. If a screener is not endorsed for one or both of the disorders
assigned to the respondent, then that respondent will not be administered any additional questions about those
disorders. There are 10 logically possible ways to create 2 out of 5, so each respondent will be assigned to 1 of 10
groups, where each group is assessed for only 2 disorders. The below checkpoint lists the groups, numbered 1 to 10.

[PROGRAMMER NOTE: RANDOMLY ASSIGN EACH PARTICIPANT TO ONE OF TEN GROUPS IN CKPT.E1 USING THE
CODES BELOW TO INDICATE THE GROUP. CHECKPOINTS THROUGHOUT THE SURVEY REFERENCE THESE CODES FOR
SKIPS.]

CKPT.E1.
1 Alcohol use disorder +self-harm
2 Bipolar disorder +alcohol use disorder
3 Bipolar disorder + PTSD
4 Bipolar disorder + self-harm
5 Panic + alcohol use disorder
6 Panic + bipolar disorder
7 Panic + PTSD
8 Panic + self-harm
9 PTSD + alcohol use disorder
10 PTSD + self-harm

E1. The next questions are about emotional difficulties you might have experienced at some time in
your life.

(B9a = “YES”: Earlier in the survey you reported having a history of depression. Think about a time
in your life lasting 2 weeks or longer when you had the strongest feelings of this sort. During those
2 weeks, how often did you have each of the following experiences? /ALL OTHERS: Virtually
everyone has times in their life when they feel sad, depressed, or discouraged about how things
are going in their life. Think about a time in your life lasting 2 weeks or longer when you had the
strongest feelings of this sort. During those 2 weeks, how often did you have each of the following
experiences? (If you are one of the few people that never had such times, mark “none of the time” to all the
following questions.))

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. Feel sad or
depressedDeprLTCritA1_1
b. Feel discouraged about how things
were going in your
lifeDeprLTCritA1_2
c. Take little or no interest or
pleasure in thingsDeprLTCritA1_3
d. Feel down on yourself, no good, or
worthlessDeprLTCritA1_4

CKPT.E2.
1. (E1a OR E1b = AT LEAST “MOST OF THE TIME”) OR (E1c = AT LEAST “MOST OF THE TIME”), GO TO E2

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 2. E1a = “NONE OF THE TIME” AND E1b = “NONE OF THE TIME” AND E1c = “NONE OF THE TIME” AND E1d =
“NONE OF THE TIME,” GO TO E7
3. ALL OTHERS GO TO E6

E2. During those 2 weeks, how often did you have each of the following experiences?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. Think a lot about death (your own,
someone else’s, or death in
general) DeprLTCritA2_1
b. Have trouble concentrating or
making day-to-day
decisionsDeprLTCritA2_2
c. Have a poor appetite or
overeatDeprLTCritA2_3
d. Have problems falling asleep,
staying asleep, waking up too
early, or sleeping too
muchDeprLTCritA2_4
e. Talk or move more slowly than
usualDeprLTCritA2_5
f. Feel tired out, low in energy, or
easily fatiguedDeprLTCritA2_6
g. Feel so low that it either caused
distress or interfered with your
activities at home, work, school, or
in your social lifeDeprLTCritA2_7

CKPT.E3.
1. (FIVE OR MORE RESPONSES IN (E1a OR E1b), E1c, E1d, E2a, E2b, E2c, E2d, E2e, E2f = AT LEAST “SOME OF
THE TIME”) AND [(E1a OR E1b = AT LEAST “MOST OF THE TIME”) OR (E1c = AT LEAST “MOST OF THE
TIME”)], GO TO E3
2. ALL OTHERS GO TO E6

E3. About how old were you the very first time you had problems with (E1a = AT LEAST “MOST OF THE
TIME”: sadness or depression/E1b = AT LEAST “MOST OF THE TIME”: feeling discouraged/ALL
OTHERS: taking little interest or pleasure in things)lasting 2 weeks or longer?
Depr_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

E4. About how many different years in your life did you have problems like these lasting 2 weeks or
longer?
Depr_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

E5. About how many months in the past 12did you have problems like these?
Depr_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

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CKPT.E6.
1. E5 = 0, GO TO E7
2. ALL OTHERS GO TO E6

E6. In the past 30 days, how often did you have each of the following experiences?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time

a. Feel sad or depressedDepr30d_1

b. Feel discouraged about how things
were going in your lifeDepr30d_2
c. Take little or no interest or
pleasure in thingsDepr30d_3
d. Feel down on yourself, no good, or
worthlessDepr30d_4

E7. (B9d = “YES”: Earlier in the survey you reported having a history of anxiety. Think about a time in
your life lasting 6 months or longer when you had the strongest feelings of this sort. During those
6 months, how often did you have each of the following experiences? /ALL OTHERS: Virtually
everyone has times in their life when they feel worried or anxious. Think about a time in your life
lasting 6 months or longer when you had the strongest feelings of this sort. During those 6
months, how often did you have each of the following experiences? (If you are one of the few people
that never had such times, mark “never” to all the following questions.))

Less than
Just about More days 1-3 days
1 day a Never
every day than not a week
week

a. Feel worried or anxiousAnxLTCritA_1

b. Worry about a number of different
things in your life, such as your work,
family, health, or financesAnxLTCritA_2
c. Feel more worried than other people in
your same situationAnxLTCritA_3
d. Worry excessively or too
muchAnxLTCritA_4
e. Have trouble controlling your worry
AnxLTCritA_5

CKPT.E8.
1. E7a = AT LEAST “MORE DAYS THAN NOT” AND E7b = AT LEAST “MORE DAYS THAN NOT,” GO TO E8
2. E7a = “NEVER” AND E7b = “NEVER” AND E7c = “NEVER” AND E7d = “NEVER,” GO TO E13
3. ALL OTHERS GO TO E12

E8. During those 6 months, how often did you have each of the following experiences?

Less than
Just about More days 1-3 days
1 day a Never
every day than not a week
week
a. Feel restless, keyed up, or on
edgeAnxLTCritC_1
b. Feel tired out, low in energy, or easily
fatiguedAnxLTCritC_2
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 c. Have difficulty concentrating or your
mind going blankAnxLTCritC_3
d. Feel irritated, annoyed, or
grouchyAnxLTCritC_4
e. Have muscle aches or
tensionAnxLTCritC_5
f. Have difficulty falling or staying asleep
or have restless, unsatisfying
sleepAnxLTCritC_6
g. Feel so upset that it either caused
distress or interfered with your activities
at home, work, school, or in your social
lifeAnxLTCritC_7

CKPT.E9.
1. (E7a = AT LEAST “MORE DAYS THAN NOT”) AND (E7b = AT LEAST “MORE DAYS THAN NOT”) AND (THREE OR
MORE RESPONSES IN E8a, E8b, E8c, E8d, E8e, E8f= AT LEAST “1-3 DAYS A WEEK”), GO TO E9
2. ALL OTHERS GO TOE12

E9. About how old were you the very first time you had problems with worry and anxiety lasting 6
months or longer?
Anx_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

E10. About how many different years in your life did you have problems like these lasting 6 months or
longer?
Anx_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

E11. About how many months in the past 12did you have problems like these?
Anx_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.E12.
1. E11 = 0, GO TO E13
2. ALL OTHERS GO TO E12

E12. In the past 30 days, how often did you have each of the following experiences?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time

a. Feel worried or anxiousAnx30d_1

b. Worry about a number of different things
in your life, such as your work, family,
health, or financesAnx30d_2
c. Feel more worried than other people in
your same situationAnx30d_3

d. Worry excessively or too muchAnx30d_4

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E13. (B9c = “YES”: Earlier in the survey you reported having a history of panic attacks. About how
many panic attacks did you ever have in yourlife?/ALL OTHERS: The next question is about panic
attacks, also sometimes called anxiety attacks. These are sudden, strong feelings of fear or anxiety
that reach their peak within a few minutes and areusually accompanied by physical reactions like
racing heart, sweating, shortness of breath, feeling faint, or feeling sick to your stomach. People
who have panic attacks sometimes feel like they might lose control, go crazy, or suddenly die. With
this definition in mind, abouthow many panic attacks did you ever have in your life?)(You can use
any number between 0 and 999 to answer.)
Panic_NumAtt

______ NUMBER OF PANIC ATTACKS

CKPT.E14.
1. E13 ≥ 3 AND ≠ MISSING AND CODE AT CKPT.E1 = 5 OR 6 OR 7 OR 8, GO TO E14
2. ALL OTHERS GO TO CKPT.E23

E14. Which of the following problems do you usually have during these attacks?(Check all that apply.)

A pounding or racing heartPanicLTCritA_1

SweatingPanicLTCritA_2
Trembling or shakingPanicLTCritA_3
Shortness of breathPanicLTCritA_4
Feeling like you might throw up PanicLTCritA_5
Chest pain or discomfortPanicLTCritA_6
Feelings of choking PanicLTCritA_7
Feeling dizzy, light-headed, or faintPanicLTCritA_8
Chills or heat sensationsPanicLTCritA_9
Numbness or tinglingPanicLTCritA_10
Fear of losing control or going crazyPanicLTCritA_11
Fear of dyingPanicLTCritA_12
Feeling like things around you were unreal or like a dreamPanicLTCritA_13
Feeling like you were “not really there,” like you were watching a movie of yourselfPanicLTCritA_14

CKPT.E15.
1. FOUR OR MORE RESPONSES CHECKED IN E14, GO TO E15
2. ALL OTHERS GO TO CKPT.E23

E15. Attacks like these sometimes happen without provocation (“out of the blue”) and other times
occur in situations where a person has a strong fear (e.g., a fear of heights or of snakes) or is in
real danger (e.g., a motor vehicle accident). When did your panic attacks occur?
Panic_OutBlue

All of your attacks occurred without provocation (“out of the blue”)

Some of your attacks occurred “out of the blue” and others in situations where you had a strong fear or
were in real danger
All of your attacks occurred in situations where you had a strong fear or were in real danger

CKPT.E16.
1. E15 = “ALL OF YOUR ATTACKS OCCURRED WITHOUT PROVOCATION,” GO TO E17
2. E15 = “SOME OF YOUR ATTACKS OCCURRED ‘OUT OF THE BLUE’ AND OTHERS IN SITUATIONS WHERE YOU
HAD A STRONG FEAR OR WERE IN REAL DANGER,” GO TO E16

12
 3. E15 = “ALL OF YOUR ATTACKS OCCURRED IN SITUATIONS WHERE YOU HAD A STRONG FEAR OR WERE IN
REAL DANGER,” GO TO E21
4. ALL OTHERS GO TO CKPT.E23

E16. About how many “out of the blue” attacks did you ever have in your life? (You can use any number
between 1 and 999 to answer.)
Panic_NumOutBlue

______ NUMBER OF ATTACKS

CKPT.E17.
1. E15 = “SOME OF YOUR ATTACKS OCCURRED ‘OUT OF THE BLUE’ AND OTHERS IN SITUATIONS WHERE YOU
HAD A STRONG FEAR OR WERE IN REAL DANGER” AND E16 = 0-2, GO TO E21
2. ALL OTHERS GO TO E17

E17. (E15 = “SOME OF YOUR ATTACKS OCCURRED “OUT OF THE BLUE” AND OTHERS IN SITUATIONS
WHERE YOU HAD A STRONG FEAR OR WERE IN REAL DANGER”: After having one of these “out of
the blue” attacks, did you ever have a time lasting 1 month or longer when you often worried that
you might have another attack or that something terrible might happen because of the attacks like
an accident, heart attack, or that you might lose control?/ALL OTHERS: After having one of these
attacks, did you ever have a time lasting 1 month or longer when you often worried that you might
have another attack or that something terrible might happen because of the attacks like an
accident, heart attack, or that you might lose control?)
Panic_MonWorry

Yes
No

CKPT.E18.
1. E17 = “YES,” GO TO E19
2. ALL OTHERS GO TO E18

E18. (E15 = “SOME OF YOUR ATTACKS OCCURRED “OUT OF THE BLUE” AND OTHERS IN SITUATIONS
WHERE YOU HAD A STRONG FEAR OR WERE IN REAL DANGER”: After having one of these “out of
the blue” attacks, did you ever have a time lasting 1 month or longer when you changed your
everyday activities because of fear about having another attack?/ALL OTHERS: After having one
of these attacks, did you ever have a time lasting 1 month or longer when you changed your
everyday activities because of fear about having another attack?)
Panic_MonChgAct

Yes
No

CKPT.E19.
1. E18 = “YES,” GO TO E19
2. ALL OTHERS GO TO E21

E19. (E15 = “SOME OF YOUR ATTACKS OCCURRED “OUT OF THE BLUE” AND OTHERS IN SITUATIONS
WHERE YOU HAD A STRONG FEAR OR WERE IN REAL DANGER”: About how old were you the very
first time you had an “out of the blue” panic attack? /ALL OTHERS: About how old were you the
very first time you had a panic attack?)
Panic_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

13
E20. (E15 = “SOME OF YOUR ATTACKS OCCURRED “OUT OF THE BLUE” AND OTHERS IN SITUATIONS
WHERE YOU HAD A STRONG FEAR OR WERE IN REAL DANGER”: About how many different years in
your life did you have at least one of these “out of the blue” attacks? /ALL OTHERS: About how
many different years in your life did you have at least one of these attacks?)
Panic_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

NOTE: In the DSM-IV World Mental Health College Student Survey, Question E21 asked: “About how many days out
of 365 in the past year did you have one or more of these attacks?” This question was edited in the current version of
the survey to instead ask about the number of months in the past year. These need to be converted to the same
metric when doing analysis.

E21. (E15 = “SOME OF YOUR ATTACKS OCCURRED “OUT OF THE BLUE” AND OTHERS IN SITUATIONS
WHERE YOU HAD A STRONG FEAR OR WERE IN REAL DANGER”: About how many months in the
past 12did you have one or more “out of the blue” panic attacks? /ALL OTHERS: About how many
months in the past 12 did you have one or more panic attacks?)
Panic_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.E22.
1. E21 = 1-11, GO TO E22
2. ALL OTHERS GO TO CKPT.E23

E22. (E15 = “SOME OF YOUR ATTACKS OCCURRED “OUT OF THE BLUE” AND OTHERS IN SITUATIONS
WHERE YOU HAD A STRONG FEAR OR WERE IN REAL DANGER”: About how many days in the past
30 did you have one or more “out of the blue” panic attacks? /ALL OTHERS: About how many days
in the past 30 did you have one or more panic attacks?)
Panic_Num30d

[DROPDOWN LIST] 0, 1, …, 29, 30

CKPT.E23.
1. B9b = “YES” AND CODE AT CKPT.E1 = 2 OR 3 OR 4 OR 6, GO TO E24
2. B9b = “YES,” GO TO E35
3. ALL OTHERS GO TO E23

E23. The next question is about whether you ever had an episode lasting 2 days or longer when your
mood was much higher than usual most of the day, much more irritable than usual most of the
day, or a mix of these things.

During these episodes, people are often much more excitable than usual, extremely self-confident,
or optimistic. They often do things they would normally not do. And this sometimes gets them in
trouble or puts them at risk of trouble.

With this definition in mind, did you ever in your life have an episode of this sort lasting 2 days or
longer?
Bip_Ever

Yes
No

CKPT.E24.
1. E23 = “YES”AND CODE AT CKPT.E1 = 2 OR 3 OR 4 OR 6, GO TO E24
2. ALL OTHERS GO TO E35
14
E24. (B9b = “YES”: Earlier in the survey you reported having a history of manic-depression, mania, or
bipolar disorder. Think about a typical intense episode lasting 2 days or longer when your mood
was much higher than usual most of the day, much more irritable than usual most of the day, or a
mix of these things. How much of the time during that episode…/ALL OTHERS: Think about a
typical intense episode of this sort lasting 2 days or longer. How much of the time during that
episode)?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. were you in a much better mood, much
happier, or much more excitable than
usual? BipLTCritA1_1
b. were you much more irritable or quick to
take offense than usual? BipLTCritA1_2
c. were you a lot more self-confident or
optimistic than usual or believed you
could do anything? BipLTCritA1_3

CKPT.E25.
1. E24aOR E24b= AT LEAST “SOME OF THE TIME,” GO TO E25
2. ALL OTHERS GO TO E35

E25. How much of the time during that episode were you?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. much more active or energetic than
usual? BipLTCritA2_1
b. much more hyper or wound up than
usual? BipLTCritA2_2
c. much more engaged, busy, or productive
than usual at school or work?
BipLTCritA2_3
d. much more sociable or outgoing than
usual? BipLTCritA2_4
e. much more involved than usual in
thinking about or doing something
sexual? BipLTCritA2_5

E26. How much of the time during that episod?

All or
Most of Some of A little of None of
almost all
the time the time the time the time
the time
a. did you sleep much less than usual and
still did not get tired or sleepy?
BipLTCritB_1
b. did you talk so much that other people
couldn’t get their say? BipLTCritB_2
c. did thoughts race through your mind so
fast you could hardly keep track of them?
15
 BipLTCritB_3
d. did you have a hard time concentrating
on what you were doing? BipLTCritB_4
e. did you make bad decisions that could
have caused problems for you?
BipLTCritB_5

CKPT.E27.
1. (E24a OR E24b = AT LEAST “SOME OF THE TIME”) AND (ONE OR MORE RESPONSES IN E25a-e SERIES = AT
LEAST “SOME OF THE TIME”) AND (TWO OR MORE RESPONSES IN E24c, (E25a OR E25b OR E25c OR E25d
OR E25e), E26a, E26b, E26c, E26d, E26e = AT LEAST “SOME OF THE TIME”), GO TO E27
2. ALL OTHERS GO TO E35

E27. About how old were you the very first time you had an episode of this sort lasting 2 days or
longer?
Bip_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

E28. About how many different years in your life did you have an episode of this sort lasting 2 days or
longer?
Bip_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

E29. What was the longest number of days in a row you ever had an episode of this sort?
Bip_LongEpi

[DROPDOWN LIST]

1-3 days
4-6 days
7-14 days
15 or more days

CKPT.E30.
1. E29 = “4-6 DAYS” OR “7-14 DAYS” OR “15 OR MORE DAYS,” GO TO E30
2. ALL OTHERS GO TO E35

E30. How much did episodes of this sort ever interfere with your activities at home, work, school, or in
your social life?
Bip_Inter

Extremely
A lot
Some
A little
Not at all

E31. How often during episodes of this sort did anyone notice or comment that you were much more
energetic, wound up, productive, or outgoing than usual?
Bip_OthNotice

16
 Often
Sometimes
Rarely
Never

E32. Were you ever hospitalized for one of these episodes?

Bip_Hosp

Yes
No

NOTE: In the DSM-IV World Mental Health College Student Survey, Question E33asked: “About how many days out of
365 in the past year did you have an episode of this sort?” This question was edited in the currentversion of the
survey to instead ask about the number of months in the past year. These need to be converted to the same metric
when doing analysis.

E33. About how many months in the past 12did you have an episode of this sort?
Bip_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.E34.
1. E33 = 1-11, GO TO E34
2. ALL OTHERS GO TO E35

E34. Did you have an episode of this sort at any time in the past 30 days?
Bip_30day

Yes
No

E35. Did you ever in your life have repeated attacks of anger when all of a sudden you lost control and
broke or smashed something, hit or tried to hurt someone, or threatened someone?
Anger_Ever

Yes
No

CKPT.E36.
1. E35 = “YES,” GO TO E36
2. ALL OTHERS GO TO E38

E36. About how many months in the past 12 did you have one or more of these anger attacks?
Anger_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.E37.
1. E36 = 1-11, GO TO E37
2. ALL OTHERS GO TO E38

17
E37. Did you have one of these attacks at any time in the past 30 days?
Anger_30day

Yes
No

E38. Did you ever in your life have times lasting 1 month or longer after an extremely stressful
experience when you had one or more of the following: frequent upsetting memories or dreams,
felt jumpy, felt emotionally distant or depressed, or had trouble sleeping or concentrating?
PTSD_Ever

Yes
No

CKPT.E39.
1. E38 = “YES” AND CODE AT CKPT.E1 = 3 OR 7 OR 9 OR 10, GO TO E39
2. ALL OTHERS GO TO E44

E39. During that month, how much were you bothered by the following reactions to any extremely
stressful experience that ever happened to you?

Extremely A lot Some A little Not at all

a. Avoiding external reminders of a

stressful experience (e.g., people,
places, conversations, activities,
objects, situations) PTSDLTSxs_1
b. Feeling distant or cut off from other
peoplePTSDLTSxs_2
c. Feeling irritable, having angry
outbursts, or acting
aggressivelyPTSDLTSxs_3
d. Suddenly feeling or acting as if a
stressful experience were actually
happening again, as if you were
actually back there reliving
itPTSDLTSxs_4

E40. About how old were you the very first time you had reactions like these lasting 1 month or
longerto any extremely stressful experience?
PTSD_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

E41. About how many different years in your life did you have reactions like these lasting 1 month or
longer?
PTSD_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

E42. About how many months in the past 12 did you have reactions like these?
PTSD_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

18
CKPT.E43.
1. E42 = 1-11, GO TO E43
2. ALL OTHERS GO TO E44

E43. Did you have reactions like these at any time in the past 30 days?
PTSD_30day

Yes
No

E44. Did you ever have a time in your life when you were much more fearful, anxious, or shy than other
people about being in social situations (e.g., meeting new people, attending a party, eating in
public, talking to people in authority, speaking up in class)?
SocAnx_Ever

Yes
No

CKPT.E45.
1. E44 = “YES,” GO TO E45
2. ALL OTHERS GO TO E49

E45. How often do you try to avoid these social situations?

SocAnx_Avoid

All or almost all the time

Most of the time
Some of the time
A little of the time
None of the time

E46. How much does your fear, anxiety, or avoidance of social situations ever interfere with your life?
SocAnx_Inter

Extremely
A lot
Some
A little
Not at all

CKPT.E47.
1. E45 = AT LEAST “SOME OF THE TIME” OR E46 = AT LEAST “SOME,” GO TO E47
2. ALL OTHERS GO TO E49

E47. About how many months in the past 12 were you much more fearful, anxious, or shy than other
people about being in social situations?
SocAnx_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

19
CKPT.E48.
1. E47 = 1-11, GO TO E48
2. ALL OTHERS GO TO E49

E48. Did you have this fear or anxiety at any time in the past 30 days?
SocAnx_30day

Yes
No

E49. Did you ever in your life have times lasting 3 months or longer when you had eating binges at least
once a week; that is, your eating was out of control and you ate a very large amount of food over a
short period of time (2 hours or less)?
Binge_Ever

Yes
No

CKPT.E50.
1. E49 = “YES,” GO TO E50
2. ALL OTHERS GO TO E52

E50. About how many months in the past 12 did you binge eat at least once a week?
Binge_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.E51.
1. E50 = 1-11, GO TO E51
2. ALL OTHERS GO TO E52

E51. Did you binge eat at least once a weekin the past 30 days?
Binge_30day

Yes
No

E52. (E49 = “YES”: Did you ever in your life have times lasting 3 months or longer when you made
yourself vomit, took laxatives, or did other things to avoid gaining weight after binge eating?/ALL
OTHERS: Did you ever in your life have times lasting 3 months or longer when you made yourself
vomit, took laxatives, or did other things to avoid gaining weight?)
Purge_Ever

Yes
No

CKPT.E53.
1. E52 = “YES,” GO TO E53
2. ALL OTHERS GO TO NEXT SECTION

20
E53. (E49 = “YES”: About how many months in the past 12 did you make yourself vomit, take laxatives,
or do other things to avoid gaining weight after binge eating? /ALL OTHERS: About how many
months in the past 12 did you make yourself vomit, take laxatives, or do other things to avoid
gaining weight?)
Purge_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.E54.
1. E53 = 1-11, GO TO E54
2. ALL OTHERS GO TO NEXT SECTION

E54. Did you do these things at any time in the past 30 days?
Purge_30day

Yes
No

END OF SECTION

21
 SECTION F: ALCOHOL AND DRUGS

F1. The following questions have to do with drinking alcohol. How often do you have a drink
containing alcohol?
Alc_Freq

4 or more times a week

2-3 times a week
2-4 times a month
Monthly or less
Never

CKPT.F2.
1. F1 = “NEVER,” GO TO F11
2. ALL OTHERS GO TO F2

F2. How many drinks containing alcohol do you have on a typical day when you are drinking?
Alc_Quan

10 or more
7 to 9
5 or 6
3 or 4
1 or2
I never drink alcohol [PROGRAMMER NOTE: RESPONSE OPTION ONLY DISPLAYS IF F1 =MISSING]

CKPT.F3.
1. F1 = MISSING AND F2 = MISSING OR “I NEVER DRINK ALCOHOL,” GO TO F11
2. ALL OTHERS GO TO F3

F3. (A2 = “MALE”: How often do you have 5 or more drinks on one occasion?/ALL OTHERS: How often
do you have 4 or more drinks on one occasion?)
Alc_Binge

Daily or almost daily

Weekly
Monthly
Less than monthly
Never

CKPT.F4.
1. (F1 = “MONTHLY OR LESS” OR MISSING) AND (F2 = “1 OR 2” OR MISSING) AND (F3 = “NEVER” OR
MISSING), GO TO F11
2. CODE AT CKPT.E1 = 1 OR 2 OR 5 OR 9, GO TO F4
3. ALL OTHERS GO TO F11

F4. How often in thepast 12 monthshave you…

Daily or
Less than
almost Weekly Monthly Never
monthly
daily
22
 a. found that you were not able to
stop drinking once you had
started? Alc12mSxs_1
b. failed to do what was normally
expected of you because of
drinking? Alc12mSxs_2
c. needed a first drink in the morning
to get yourself going after a heavy
drinking session? Alc12mSxs_3
d. had a feeling of guilt or remorse
after drinking? Alc12mSxs_4
e. been unable to remember what
happened the night before because
of your drinking? Alc12mSxs_5

F5. Have you or someone else been injured because of your drinking?
Alc_AnyInjury

Yes, in the past 12 months

Yes, but not in the past 12 months
No

F6. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or
suggested you cut down?
Alc_AnyConcern

Yes, in the past 12 months

Yes, but not in the past 12 months
No

CKPT.F7.
1. F3 = AT LEAST “LESS THAN MONTHLY,” GO TO F7
2. ONE OR MORE RESPONSES IN F4a-e SERIES = AT LEAST “LESS THAN MONTHLY,” GO TO F7
3. F5 OR F6= “YES,IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN THE PAST 12 MONTHS,”GO TO F7
4. ALL OTHERS GO TO F11

F7. [(F3 = AT LEAST “LESS THAN MONTHLY”) AND(ALL RESPONSES IN F4a-e SERIES = “NEVER” OR
MISSING) AND (F5 = “NO” OR MISSING) AND (F6 = “NO” OR MISSING) AND (A2 = “MALE”): You
reported having5 or more drinks on at least one occasion in your life./(F3 = AT LEAST “LESS THAN
MONTHLY”) AND(ALL RESPONSES IN F4a-e SERIES = “NEVER” OR MISSING) AND (F5 = “NO” OR
MISSING) AND (F6 = “NO” OR MISSING) AND (A2 ≠“MALE”): You reported having 4 or more
drinks on at least one occasion in your life./(F3 = “NEVER” OR MISSING) AND (F4a = AT LEAST
“LESS THAN MONTHLY”) AND (F4b AND F4c AND F4d AND F4e = “NEVER” OR MISSING) AND (F5 =
“NO” OR MISSING) AND (F6 = “NO” OR MISSING): You reported that you were not able to stop
drinking once you had started./(F3 = “NEVER” OR MISSING) AND (F4b = AT LEAST “LESS THAN
MONTHLY”) AND (F4a AND F4c AND F4d AND F4e = “NEVER” OR MISSING) AND (F5 = “NO” OR
MISSING) AND (F6 = “NO” OR MISSING): You reported that you failed to do what was expected of
you because of drinking./(F3 = “NEVER” OR MISSING) AND (F4c = AT LEAST “LESS THAN
”MONTHLY”) AND (F4a AND F4b AND F4d AND F4e = “NEVER” OR MISSING) AND (F5 = “NO” OR
MISSING) AND (F6 = “NO” OR MISSING): You reported that you needed a drink in the morning to
get yourself going./(F3 = “NEVER” OR MISSING) AND (F4d = AT LEAST “LESS THAN MONTHLY”)
AND (F4a AND F4b AND F4c AND F4e = “NEVER” OR MISSING) AND (F5 = “NO” OR MISSING) AND
(F6 = “NO” OR MISSING): You reported that you felt guilt or remorse after drinking./(F3 =
“NEVER” OR MISSING) AND (F4e = AT LEAST “LESS THAN MONTHLY”) AND (F4a AND F4b AND F4c
AND F4d = “NEVER” OR MISSING) AND (F5 = “NO” OR MISSING) AND (F6 = “NO” OR MISSING):
You reported that you were unable to remember what happened the night before because of
23
 drinking./(F3 = “NEVER” OR MISSING) AND (ALL RESPONSES IN F4a-e SERIES = “NEVER” OR
MISSING) AND (F5 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN THE PAST 12
MONTHS”) AND (F6 = “NO” OR MISSING): You reported that you or someone else has been injured
because of your drinking./(F3 = “NEVER” OR MISSING) AND (ALL RESPONSES IN F4a-e SERIES =
“NEVER” OR MISSING) AND (F5 = “NO” OR MISSING) AND (F6 = “YES, IN THE PAST 12 MONTHS”
OR “YES, BUT NOT IN THE PAST 12 MONTHS”): You reported that others have been concerned
about your drinking./ALL OTHERS: You reported several experiences associated with drinking
alcohol.][(TWO OR MORE RESPONSES IN F3, F4a-e SERIES = AT LEAST “LESS THAN MONTHLY”)
OR (ONE RESPONSE IN F3, F4a-e SERIES = AT LEAST “LESS THAN MONTHLY” AND F5 OR F6=
“YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN THE PAST 12 MONTHS”) OR (F5 AND F6 =
“YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN THE PAST 12 MONTHS”): About how old
were you the very first time you had any of these experiences?/ALL OTHERS: About how old were
you the very first time you had this experience?]
Alc_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

F8. About how many different years in your life did you have[(TWO OR MORE RESPONSES IN F3, F4a-e
SERIES = AT LEAST “LESS THAN MONTHLY”) OR (ONE RESPONSE IN F3, F4a-e SERIES = AT LEAST
“LESS THAN MONTHLY” AND F5 OR F6 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN
THE PAST 12 MONTHS”) OR (F5 AND F6 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN
THE PAST 12 MONTHS”): any of these experiences/ALL OTHERS: this experience] associated with
drinking alcohol?(If less than 1 full year, choose “1.”)
Alc_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

F9. About how many months in the past 12did you have [(TWO OR MORE RESPONSES IN F3, F4a-e
SERIES = AT LEAST “LESS THAN MONTHLY”) OR (ONE RESPONSE IN F3, F4a-e SERIES = AT LEAST
“LESS THAN MONTHLY” AND F5 OR F6 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN
THE PAST 12 MONTHS”) OR (F5 AND F6 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN
THE PAST 12 MONTHS”): any of these experiences/ALL OTHERS: this experience] associated with
drinking alcohol?
Alc_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.F10.
1. F9 = 1-11, GO TO F10
2. ALL OTHERS GO TO F11

F10. Did you have [(TWO OR MORE RESPONSES IN F3, F4a-e SERIES = AT LEAST “LESS THAN
MONTHLY”) OR (ONE RESPONSE IN F3, F4a-e SERIES = AT LEAST “LESS THAN MONTHLY” AND F5
OR F6 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN THE PAST 12 MONTHS”) OR (F5
AND F6 = “YES, IN THE PAST 12 MONTHS” OR “YES, BUT NOT IN THE PAST 12 MONTHS”): any of
these experiences/ALL OTHERS: this experience] associated with drinking alcoholat any time in
the past 30 days?
Alc_30day

Yes
No

F11. Think of the times in your life when you used each of the following substances most often. During
those times, how often did you use each substance?

Every or 3-4 1-2 1-3 Less

nearly days a days a days a than Never
every week week month once a
24
 day month
a. Cannabis (marijuana, pot, grass,
hash, etc.) DrugType_1
b. Cocaine (coke, crack, etc.)
DrugType_2
c. Any other street drugs (e.g.,
opioids, LSD, speed, ecstasy)
DrugType_3
d. Any prescription drug, either
without a doctor’s prescription or
more than prescribed to get high,
buzzed, or numbed out (e.g., a
stimulant, tranquilizer, muscle
relaxant, or pain medication)
DrugType_4

CKPT.F12.
1. ONE OR MORE RESPONSES IN F11a-d SERIES = AT LEAST “LESS THAN ONCE A MONTH,” GO TO F12
2. ALL OTHERS GO TO NEXT SECTION

F12. Think of the 1 year in your life when your drug use interfered most with your life. During that year,
how often did you have each of the following experiences?

Every or Less
3-4 1-2 1-3
nearly than
days a days a days a Never
every once a
week week month
day month
a. How often did your drug use or
being under the influence
interfere with your
responsibilities at home, work, or
school? DrugLTCritA1_1
b. How often did you continue to
use even when it caused
arguments or other serious
problems with your family or
friends? DrugLTCritA1_2
c. How often were you under the
influence in situations where you
could get hurt? DrugLTCritA1_3
d. How often did you greatly reduce
important activities with family,
friends, or at work because of
your drug use? DrugLTCritA1_4
e. How often did you either use
more or spend more time using
than you intended when you
started? DrugLTCritA1_5

F13. During that year, how often did you have each of these other experiences?

Every or Less
3-4 1-2 1-3
nearly than
days a days a days a Never
every once a
week week month
day month
25
 a. How often did you spend a great
deal of time obtaining, using, or
recovering from drug use?
DrugLTCritA2_1
b. How often did you have a strong
desire or craving to use?
DrugLTCritA2_2
c. How often did you feel the need
to cut down or stop your drug
use? DrugLTCritA2_3
d. How often did you continue to
use even when it either caused or
worsened a physical or emotional
health problem? DrugLTCritA2_4
e. You developed tolerance; that is,
either the same amount no
longer had the same effect or you
needed to use a lot more to get
the same effect? DrugLTCritA2_5
f. You experienced withdrawal
symptoms like trouble sleeping,
emotional problems,
restlessness, sweating, or nausea
when you tried to cut down your
use or you continued to use in
order to avoid having withdrawal
symptoms? DrugLTCritA2_6

CKPT.F14.
1. TWO OR MORE RESPONSES IN F12a-e SERIES, F13a-f SERIES = AT LEAST “LESS THAN ONCE A MONTH,” GO
TO F14
2. ALL OTHERS GO TO NEXT SECTION

F14. You reported several experiences associated with using drugs. About how old were you the very
first time you had any of these experiences?
Drug_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

F15. About how many different years in your life did you have any of these experiences? (If less than 1
full year, choose “1.”)
Drug_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

F16. About how many months in the past 12did you have any of these experiences?
Drug_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.F17.
1. F16 = 1-11, GO TO F17
2. ALL OTHERS GO TO NEXT SECTION

26
F17. Did you have any of these experiences in the past 30 days?
Drug_30day

Yes
No

END OF SECTION

27
 SECTION G: SELF-HARM

G1. Did you ever in your life wish you were dead or would go to sleep and never wake up?
Ideat_PassEver

Yes
No

G2. Did you ever in your life have thoughts of killing yourself?
Ideat_ActEver

Yes
No

NOTE: CKPT.G3 response #2 sends respondents who are not coded in the group that is asked the full self-harm
question series but who endorsed suicidal ideation at G1 or G2 to G6 to ask about ideation in the past 30 days and
then to G11 to ask about likelihood of acting on suicidal thoughts.

CKPT.G3.
1. G1 OR G2 = “YES” AND CODE AT CKPT.E1 = 1 OR 4 OR 8 OR 10, GO TO G3
2. G1 OR G2 = “YES,” GO TO G6
3. ALL OTHERS GO TO G20

G3. About how old were you the very first time you (G1 = “YES” AND G2 = “NO” OR MISSING: wished
you were dead or would go to sleep and never wake up/G1 = “NO” OR MISSING AND G2 = “YES”:
had thoughts of killing yourself/ALL OTHERS: wished you were dead, wished you would go to sleep
and never wake up, or had thoughts of killing yourself)?
Ideat_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

G4. About how many different years in your life did you (G1 = “YES” AND G2 = “NO” OR MISSING:
wish you were dead or would go to sleep and never wake up/G1 = “NO” OR MISSING AND G2 =
“YES”: have thoughts of killing yourself/ALL OTHERS: wish you were dead, wish you would go to
sleep and never wake up, or have thoughts of killing yourself)?(If less than 1 full year, choose “1.”)
Ideat_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

G5. About how many months in the past 12did you (G1 = “YES” AND G2 = “NO” OR MISSING: wish you
were dead or would go to sleep and never wake up/G1 = “NO” OR MISSING AND G2 = “YES”: have
thoughts of killing yourself/ALL OTHERS: wish you were dead, wish you would go to sleep and
never wake up, or have thoughts of killing yourself)?
Ideat_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.G6.
1. G5 = 1-12, GO TO G6
2. ALL OTHERS GO TOCKPT.G7

G6. In the past 30 days, how often did you (G1 = “YES” AND G2 = “NO” OR MISSING: wish you were
dead or would go to sleep and never wake up/G1 = “NO” OR MISSING AND G2 = “YES”: have

28
 thoughts of killing yourself/ALL OTHERS: wish you were dead, wish you would go to sleep and
never wake up, or have thoughts of killing yourself)?
Ideat_Freq30day

All or almost all of the time

Most of the time
Some of the time
A little of the time
None of the time

CKPT.G7.
1. CODE AT CKPT.E1 = 1 OR 4 OR 8 OR 10, GO TO G7
2. G6 = AT LEAST “A LITTLE OF THE TIME,” GO TO G11
3. ALL OTHERS GO TO G20

G7. Did you ever think about how you might kill yourself (e.g., taking pills, shooting yourself) or work
out a plan of how to kill yourself?
SuiPlan_Ever

Yes
No

CKPT.G8.
1. G7 = “YES,” GO TO G8
2. ALL OTHERS GO TO G11

G8. About how old were you the very first time you thought about how you might kill yourself or
worked out a plan of how to kill yourself?
SuiPlan_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

G9. About how many different years in your life did you think about how you might kill yourself or
work out a plan of how to kill yourself? (If less than 1 full year, choose “1.”)
SuiPlan_NumYrs

[DROPDOWN LIST] 1, 2, …, 35, 36 or more

G10. About how many months in the past 12did you think about how you might kill yourself or work out
a plan of how to kill yourself?
SuiPlan_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

G11. In the next 12 months, what is the likelihood that you will act on those thoughts of killing
yourself?
Ideat_12mActOn

Very likely
Somewhat likely
Not very likely
Not at all likely

29
CKPT.G12.
1. CODE AT CKPT.E1 = 1 OR 4 OR 8 OR 10, GO TO G12
2. ALL OTHERS GO TO G20

G12. Think of the one week in your life when you thought most about (G1 = “YES” AND G2 = “NO” OR
MISSING: wanting to be dead/G1 = “NO” OR MISSING AND G2 = “YES”: killing yourself/ALL
OTHERS: wanting to be dead or about killing yourself). How many days during that worst week did
you have those thoughts?
Ideat_NumDayWrst

[DROPDOWN LIST] 1, …, 6, 7

G13. (G12 ≥ 2 AND ≠ MISSING: How long during that worst week did those thoughts usually last on the
days that you had them? /ALL OTHERS: How long during that worst week did those thoughtslast
on the daythat you had them?)
Ideat_LongLast

Just a few seconds or minutes

Less than 1 hour
1-4 hours
5-8 hours
9 or more hours

G14. During that worst week, how easy was it for you to control those thoughts or push them out of
your mind when you wanted to?
Ideat_CntrlTho

Easy
A little difficult
Somewhat difficult
Very difficult
Impossible; unable to control the thoughts

G15. People who think about wanting to die sometimes do dangerous things as a way to tempt fate
(e.g., take a lot of drugs, drive too fast, volunteer for dangerous missions, act recklessly). How
often in your life did you ever do dangerous things like that to tempt fate?
Ideat_TemptFate

Very often
Often
Sometimes
Rarely
Never

G16. Have you ever made a suicide attempt (i.e., purposefully hurt yourself with at least some intent to
die)?
SuiAtt_Ever

Yes
No

30
CKPT.G17.
1. G16 = “NO” OR MISSING, GO TO G20
2. ALL OTHERS GO TO G17

G17. About how old were you the very first time you made a suicide attempt?
SuiAtt_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

G18. How many different suicide attempts have you ever made?
SuiAtt_NumLT

_____ NUMBER OF SUICIDE ATTEMPTS IN LIFETIME

G19. How many different suicide attempts have you made in the past 12 months?
SuiAtt_Num12m

_____ NUMBER OF SUICIDE ATTEMPTS IN PAST YEAR

G20. Did you ever do something to hurt yourself on purpose, without wanting to die (e.g., cutting
yourself, hitting yourself, or burning yourself)?
NSSI_Ever

Yes
No

CKPT.G21.
1. G20 = “YES” AND CODE AT CKPT.E1 = 1 OR 4 OR 8 OR 10, GO TO G21
2. ALL OTHERS GO TO NEXT SECTION

G21. About how old were you the very first time you did something to hurt yourself on purpose, without
wanting to die?
NSSI_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

G22. About how many times in your life did you do something to hurt yourself on purpose, without
wanting to die?
NSSI_NumLT

[DROPDOWN LIST]

1-2 times
3-4 times
5-10 times
11-20 times
21-30 times
31-50 times
51-100 times
101 or more times

31
G23. How many times in the past 12 months did you do something to hurt yourself on purpose, without
wanting to die?
NSSI_Num12m

[DROPDOWN LIST]

0 times
1-2 times
3-4 times
5-10 times
11-20 times
21-30 times
31-50 times
51-100 times
101 or more times

END OF SECTION

32
 SECTION H: SEEKING TREATMENT

NOTE: The examples given for H1c can be modified depending on what is appropriate for each country.

H1. Did you ever in your life receive psychological counseling, medication, or some other type of
treatment for an emotional or substance use problem? 

Yes No

a. Psychological counselingTxtTypeEver_1
b. MedicationTxtTypeEver_2

c. Other type of treatment (e.g., traditional

healer, minister, rabbi, self-help group)
TxtTypeEver_3

CKPT.H2.
1. H1a = “NO” OR MISSING AND H1b = “NO” OR MISSING, GO TO H6
2. ALL OTHERS GO TO H2

H2. How old were you the very first time you received psychological counseling or medication for an
emotional or substance use problem?
CKPT.H2.
3. H1a = “NO” OR MISSING AND H1b = “NO” OR MISSINGAND H1c = “NO” OR MISSING, GO TO H6
4. ALL OTHERS GO TO H2

H2. How old were you the very first time you received psychological counseling, medication,or some
other type of treatment for an emotional or substance use problem?
Txt_Onset

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

H3. About how many months in the past 12 did you receive psychological counseling, medication, or
some other type of treatment for an emotional or substance use problem?
Txt_Num12m

[DROPDOWN LIST] 0, 1, …, 11, 12

CKPT.H4.
1. H3 = 1-12, GO TO H5
2. ALL OTHERS GO TO H4

H4. How old were you the most recent time you received psychological counseling, medication, or
some other type of treatment for an emotional or substance use problem?
Txt_Recency

[DROPDOWN LIST] 4 or younger, 5, …, 35, 36 or older

GO TO H6

H5. Are you still in treatment or have you stopped?

Txt_CurrentTxt

Still in treatment

33
 Stopped

CKPT.H6.
1. H5 = “STILL IN TREATMENT,” GO TO NEXT SECTION
2. ALL OTHERS GO TO H6

H6. How would you rate your readiness or willingness to change any emotional or substance use
problems you are experiencing at this time?
Txt_Willingness

I do not have a problem that I need to change

I have a problem, but I am not yet sure I want to take action to change it
I have a problem and I intend to address it
I have a problem and I already am working actively to change it
I had a problem, but I have addressed it and things are better now

CKPT.H7.
1. H3 = 1-12, GO TO NEXT SECTION
2. ALL OTHERS GO TO H7

H7. Was there ever a time in the past 12 months when you felt that you might need psychological
counseling, medication, or some other type of treatment for any emotional or substance use
problems?
Txt_Need12m

Yes
No GO TO NEXT SECTION

[PROGRAMMERNOTE: SKIP MISSING WITH “NO”]

H8. How important were each of the following reasons for why you did NOT seekhelp for your
problem(s)?

Very Moderately Of little

Important Unimportant
important important importance
a. You were not sure if
available treatments were
very effectiveTxtNotSeek_1
b. You wanted to handle the
problem on your
ownTxtNotSeek_2
c. You were too
embarrassedTxtNotSeek_3
d. You talked to friends or
relatives
insteadTxtNotSeek_4
e. It costs too much
moneyTxtNotSeek_5
f. You were unsure of where
to go or who to
seeTxtNotSeek_6
g. You had problems with
time, transportation, or
34
 schedulingTxtNotSeek_7
h. You were afraid it might
harm your school or
professional
careerTxtNotSeek_8
i. You worried that people
would treat you differently
if they knew you were in
treatmentTxtNotSeek_9
j. Some other reason (Briefly
describe in the text box
below)TxtNotSeek_10
TxtNotSeek_10_TEXT

END OF SECTION

35
 SECTION I: CHILDHOOD BACKGROUND

NOTE: We are randomizing the childhood experiences series (I2-I5) and stressful experiences (J1-J3) based on
responses to disorder-related questions earlier in the survey (we also randomize personality, see note in section L).
The variable names created below are used to indicate whether the respondent met the threshold for the disorder
(screeners). For example, if they endorse 3 or more at least sometimes in the ADHD question series, then they
screened positive for ADHD, so the SCR_ADHD variable = yes. At CKPT.I2 we use these screening variables to
determine how to randomize respondents. 100% of respondents who screened positive for 5 disorderswill be asked all
of the childhood and stressful experiences questions (this is the “long” version of the survey). If they screened
positive for 3 or 4 disorders, a random 50% of respondents will receive the long version; a random 25% of
respondents with less than 3 disorders will be asked the long version; the remaining respondents will receive the short
version (so the remaining 50% of respondents with 3 or 4 disorders and remaining 75% with less than 3). Note that
we create a variable name called V3_LENGTH to indicate if the respondent was randomized to receive the “long”
version – i.e., asked all childhood and stressful experiences questions – or if they were randomized to the “short”
version – i.e., they were NOT asked about childhood or stressful experiences.

[PROGRAMMERNOTE: CREATE THE FOLLOWING VARIABLES, WHICH WILL BE USED AT CHECKPOINT I2]

1. SCR_HIST = YES IF ONE OR MORE RESPONSES IN B9a-e SERIES = “YES”

2. SCR_ADHD= YES IF THREE OR MORE RESPONSES IN D2a-f SERIES = AT LEAST “SOMETIMES”
3. SCR_MDE = YES IF (FIVE OR MORE RESPONSES IN (E1a OR E1b), E1c, E1d, E2a, E2b, E2c, E2d, E2e, E2f =
AT LEAST “SOME OF THE TIME”) AND [(E1a OR E1b = AT LEAST “MOST OF THE TIME”) OR (E1c = AT LEAST
“MOST OF THE TIME”)]
4. SCR_GAD = YES IF (E7a = AT LEAST “MORE DAYS THAN NOT”) AND (E7b = AT LEAST “MORE DAYS THAN
NOT”) AND (THREE OR MORE RESPONSES IN E8a, E8b, E8c, E8d, E8e, E8f= AT LEAST “1-3 DAYS A WEEK”)
5. SCR_PD = YES IFE13 ≥ 3 AND ≠ MISSING
6. SCR_BP= YES IFE23 = “YES”
7. SCR_IED= YES IFE35= “YES”
8. SCR_PTSD= YESIFE38 = “YES”
9. SCR_SA= YES IFE45= AT LEAST “SOME OF THE TIME” OR E46= AT LEAST “SOME”
10. SCR_BINGE= YES IFE49 = “YES”
11. SCR_PURGE= YES IFE52 = “YES”
12. SCR_ALC= YES IFF1 = “4 OR MORE TIMES A WEEK” AND F2 = “5 OR 6” OR “7 TO 9” OR “10 OR MORE”
13. SCR_DRUG= YES IFTWO OR MORE RESPONSES IN F12a-e SERIES, F13a-f SERIES = AT LEAST “LESS THAN
ONCE A MONTH”
14. SCR_IDEATION= YES IFG2 = “YES”

I1. What is the highest level of education of either of your parents or the people who raised you?
Parent_Educ

None
Primaryschool
Secondary school
Some post-secondary education
University graduate
Doctoral degree
Don’t know

[PROGRAMMERNOTE: USE THE VARIABLES CREATED ABOVE IN THE CHECKPOINT BELOW. CREATE A VARIABLE
CALLED V3_LENGTH TO INDICATE IF THE RESPONDENT RECEIVED THE LONG OR SHORT VERSION OF THE
INSTRUMENT USING THE CHECKPOINT BELOW]

CKPT.I2.
1. 100% OF RESPONDENTS WITH 5 OR MORE OF SCR_HIST, SCR_ADHD, SCR_MDE, SCR_GAD, SCR_PD,
SCR_BP, SCR_IED, SCR_PTSD, SCR_SA, SCR_BINGE, SCR_PURGE, SCR_ALC, SCR_DRUG, SCR_IDEATION =
YES, CODE V3_LENGTH = LONG AND GO TO I2

36
 2. RANDOM 50% OF RESPONDENTS WITH 3 OR 4 OF SCR_HIST, SCR_ADHD, SCR_MDE, SCR_GAD, SCR_PD,
SCR_BP, SCR_IED, SCR_PTSD, SCR_SA, SCR_BINGE, SCR_PURGE, SCR_ALC, SCR_DRUG, SCR_IDEATION =
YES, CODE V3_LENGTH = LONG AND GO TO I2
3. RANDOM 25% OF RESPONDENTS WITH 0-2 OF SCR_HIST, SCR_ADHD, SCR_MDE, SCR_GAD, SCR_PD,
SCR_BP, SCR_IED, SCR_PTSD, SCR_SA, SCR_BINGE, SCR_PURGE, SCR_ALC, SCR_DRUG, SCR_IDEATION =
YES, CODE V3_LENGTH = LONG AND GO TO I2
4. ALL OTHERS CODE V3_LENGTH = SHORT AND GO TO J4

I2. How much of the time did you have each of the following experiences up through age 17?

Very often Often Sometimes Rarely Never

a. One of your parents (or the people
who raised you) had a serious
emotional or mental health
problemChildhExp1_1
b. One of your parents (or the people
who raised you) had a serious alcohol
or drug problemChildhExp1_2
c. One of your parents (or the people
who raised you) attempted suicide or
died by suicideChildhExp1_3
d. One of your parents (or the people
who raised you) was involved in
criminal activitiesChildhExp1_4
e. Your parents (or the people who raised
you) hit each other or were violent to
each otherChildhExp1_5
f. Someone in your family hit you so
hard that it left bruises or
marksChildhExp1_6

I3. And how much of the time did you have each of these experiences up through age 17?

Very often Often Sometimes Rarely Never

a. You were physically abused at
homeChildhExp2_1
b. Someone in your family repeatedly
said hurtful or insulting things to
youChildhExp2_2
c. You were emotionally abused at
homeChildhExp2_3
d. Someone in your family made you feel
special or important ChildhExp2_4
e. Someone in your family touched you
or made you touch them in a sexual
way against your willChildhExp2_5

I4. And how much of the time did you have each of these experiences up through age 17?

Very often Often Sometimes Rarely Never

a. You were sexually abused at home
ChildhExp3_1
b. You were seriously neglected at home
(e.g., nobody took care of you or
37
 protected you or made sure you had
the things you needed) ChildhExp3_2
c. You had to do chores too hard or
dangerous for someone your
ageChildhExp3_3
d. You felt loved and cared for by your
family/at homeChildhExp3_4
e. People in your family looked out for
you and took care of youChildhExp3_5
f. You felt emotionally close to your
family membersChildhExp3_6

I5. The next questions are about how often you were bullied up through age 17. The term “bullying”
refers to times when someone hurts or scares another person on purpose and the person being
bullied has a hard time defending themselves. Usually, bullying happens over and over. With this
definition in mind, how often were you bullied in each of the following ways up through age 17?

Very often Often Sometimes Rarely Never

a. How often were you bullied at school
physically (i.e., repeatedly punched,
shoved or physically hurt)?
ChildhBully_1
b. How often were you bullied at school
verbally (i.e., teased, called names)?
ChildhBully_2
c. How often were you bullied at school by
someone who purposefully ignored you,
excluded you, or spread rumors about
you behind your back? ChildhBully_3
d. How often were you bullied over the
internet (e.g., Facebook, Twitter) or by
text messaging? ChildhBully_4
e. How often were you in a romantic
relationship where your partner
repeatedly hit you or hurt you?
ChildhBully_5
f. How often were you in a romantic
relationship where your partner
repeatedly said hurtful or insulting
things to you? ChildhBully_6

END OF SECTION

38
 SECTION J: RECENT EXPERIENCES

J1. Did you have any of the following stressful experiences in the past 12 months?

Yes No
a. A life-threatening illness or injury of a very close friend or family
memberStrExpOth_1
b. The death of a close friend or family memberStrExpOth_2
c. A break-up with a romantic partnerStrExpOth_3
d. You discovered that a romantic partner cheated on youStrExpOth_4
e. A serious betrayal by someone else close to youStrExpOth_5
f. Serious ongoing arguments or break-ups with some other close friend
or family memberStrExpOth_6

J2. Did you have any of the following stressful experiences in the past 12 months?

Yes No

a. A life-threatening illness or injuryStrExpYou_1

b. You were bulliedStrExpYou_2
c. You were physically assaulted (e.g., mugged) StrExpYou_3
d. You were sexually assaulted or rapedStrExpYou_4
e. You were sexually harassed (e.g., someone made inappropriate sexual
remarks about you or your body) StrExpYou_5
f. You had trouble with the police StrExpYou_6
g. You had a serious legal problemStrExpYou_7
h. Any other very stressful event (Briefly describe in the text box below)
StrExpYou_8
StrExpYou_8_TEXT

J3. How much stress do you currently have in each of the following areas of your life?

Very
Severe Moderate Mild None
severe
a. Your financial situation
SevStress_1
b. Your healthSevStress_2
c. Your academic
performanceSevStress_3
d. Your love lifeSevStress_4
e. Your relationships with your
familySevStress_5
f. Problems getting along with people
at work or schoolSevStress_6
g. The health of your loved
onesSevStress_7
h. Other problems experienced by
your loved onesSevStress_8
i. Your life overallSevStress_9

39
J4. The next few questions are about your social life. In a typical day, about how much time do you
spend using social media (e.g., Facebook, Twitter, Instagram, Snapchat)?
SocLif_SocMedia

[DROPDOWN LIST]

Never
Less than 1 hour a day
1-2 hours
3-4hours
5-6 hours
7-8 hours
More than 8 hours a day

J5. (J4 = AT LEAST “LESS THAN 1 HOUR A DAY”: Not counting the time you spend on social media,
how/ALL OTHERS: How) often do you talk on the phone, text, or chat online with friends?
SocLif_FreqTlk

Every day or almost every day

A few times a week
A few times a month
Once a month
Less than once a month
Never

CKPT.J6.
1. J5 = AT LEAST “LESS THAN ONCE A MONTH,” GO TO J6
2. ALL OTHERS GO TO J8

J6. On the days you do so, about how much time do you usually spend talking on the phone, texting,
or chatting online with friends?
SocLif_TimeTlk

[DROPDOWN LIST]

1-15 minutes a day

16-30 minutes
31-60 minutes
1-2 hours
More than 2 hours a day

J7. About how many friends do you talk to on the phone, text, or chat with online at least once a
month?
SocLif_NumTlk

[DROPDOWN LIST]

1
2
3-4

40
 5-9
10 or more

J8. How often do you get together in-person with friends?

SocLif_FreqHang

Every day or almost every day

A few times a week
A few times a month
Once a month
Less than once a month
Never

CKPT.J9.
1. J8= AT LEAST “ONCE A MONTH,” GO TO J9
2. ALL OTHERS GO TO J10

J9. About howmany friends do you get together with in person at least once a month?
SocLif_NumHang

[DROPDOWN LIST]

1
2
3-4
5-9
10 or more

J10. How often do you attend meetings of religious, fraternal, political, social, or recreational groups?
SocLif_FreqGrp

Every day or almost every day

A few times a week
A few times a month
Once a month
Less than once a month
Never

J11. How much do the people in your personal life make you feel loved and cared for?
SocSup_Loved

Not at all
A little
Some
A lot
Extremely

J12. How much could you depend on the people in your personal life for help if you needed it?
SocSup_Depend

41
 Not at all
A little
Some
A lot
Extremely

J13. How much do the people in your personal life understand the way you feel about things?
SocSup_Understnd

Not at all
A little
Some
A lot
Extremely

J14. How much do the people in your personal life show concern for your feeling and problems?
SocSup_Concern

Not at all
A little
Some
A lot
Extremely

J15. How often do the people in your personal life make unreasonable demands on you?
SocSup_Demand

Very often
Often
Sometimes
Rarely
Never

J16. How often do they argue with you or say things that make you feel bad?
SocSup_Argue

Very often
Often
Sometimes
Rarely
Never

J17. How many people in your personal life could you confide in without fear of negative judgement?
SocSup_NumConf

[DROPDOWN LIST]

None
1

42
 2
3-4
5-9
10 or more

CKPT.J18.
1. J17 = “1” OR “2” OR “3-4” OR “5-9” OR “10 OR MORE,” GO TO J18
2. ALL OTHERS GO TO J19

J18. When have a problem or worry, how often do you let (J17 = “1”: that person/J17 = “2”: either of
those people/ALL OTHERS: any of those people) know about it?
SocSup_FreqConf

Very often
Often
Sometimes
Rarely
Never

J19. How often do you feel lonely?

SocSup_FreqLonely

Very often
Often
Sometimes
Rarely
Never

CKPT.J20.
1. J19 = “NEVER,” GO TO NEXT SECTION
2. ALL OTHERS GO TO J20

J20. How severe are your feelings of loneliness when you have them?
SocSup_SevLonely

Mild
Moderate
Severe
Very severe

END OF SECTION

43
 SECTION K: SEXUALITY

K1. What is your sexual orientation?

SexOrient

Heterosexual or straight
Gay or lesbian
Bisexual
Asexual
Not sure
Other (Briefly describe in the textbox below)
SexOrient_6_TEXT

K2. Which of the following best describes your feelings of sexual attraction to women?
SexAttr_Women

Very sexually attracted

A good deal sexually attracted
Somewhat sexually attracted
A little sexually attracted
Not at all sexually attracted

K3. Which of the following best describes your feelings of sexual attraction to men?
SexAttr_Men

Very sexually attracted

A good deal sexually attracted
Somewhat sexually attracted
A little sexually attracted
Not at all sexually attracted

K4. In the past 5 years, who have you had sex with? (We use the word “sex” to mean any kind of sexual
contact with another person, including sexual intercourse, oral sex, and non-penetrative sex.)
SexPartGender

Men only
Women only
Both men and women
I have not had sex

K5. What is your marital status?

MaritalStatus

Married GO TO NEXT SECTION

Separated
Divorced
Widowed
Never married

[PROGRAMMERNOTE: SKIP MISSING WITH “NEVER MARRIED”]

44
K6. Which of the following best describes your current relationship situation?
RelatStatus

Living with someone in a marriage-like relationship or engaged to be married

Steadily dating one person, but not engaged
Dating one or more people, but not in a steady relationship
Not currently dating

END OF SECTION

45
 SECTION L: CONCEPTOF SELF

NOTE: Questions L1-L4 are the Personality Inventory for DSM-5 Brief Form (PID-5-BF). We created a short 10-item
version of the PID-5-BF (questions L5-L6) by taking 2 items from each personality trait domain (there are 5 domains:
negative affect, detachment, antagonism, disinhibition, psychoticism). CKPT.L1 randomizes participants to receive the
full PID-5-BF or the 10-item version, based on whether they were randomized to the long or short version of the
survey at CKPT.I2. As described above in section I, respondents who were randomized to the long version are asked
the childhood and stressful experiences question series and those randomized to the short are skipped over these
questions. At CKPT.L1, 50% of the long version respondents will be randomized to the short 10-item PID-5-BF; 50%
of the remaining long version respondents and 50% of short version respondents will be randomized to the full PID-5-
BF. The rest will be skipped out of the section (i.e., 25% with long version and 50% with short version will not be
asked any PID-5-BF questions).

CKPT.L1.
1. RANDOM 50% OF RESPONDENTS WITH V3_LENGTH = LONG, GO TO L5
2. REMAINING 50% OF RESPONDENTS WITH V3_LENGTH = LONG, GO TO L1
3. RANDOM 50% OF RESPONDENTS WITH V3_LENGTH = SHORT,GO TO L1
4. ALL OTHERS GO TO END OF SURVEY

L1. Below is a list of things different people might say about themselves. How well does each of the
following statements describe you?

Exactly Not at all

A lot Somewhat A little
like you like you
a. People would describe me as
recklessLongPers1_1
b. I feel like I act totally on
impulseLongPers1_2
c. Even though I know better, I can’t stop
making rash decisionsLongPers1_3
d. I often feel like nothing I do really
matters LongPers1_4
e. Others see me as
irresponsibleLongPers1_5
f. I’m not good at planning
aheadLongPers1_6

L2. How well does each of the followingstatements describe you?

Exactly Not at all

A lot Somewhat A little
like you like you
a. My thoughts often don’t make sense to
others LongPers2_1
b. I worry about almost
everythingLongPers2_2
c. I get emotional easily, often for very
little reasonLongPers2_3
d. I fear being alone in life more than
anything elseLongPers2_4
e. I get stuck on one way of doing things,
even when it’s clear it won’t
workLongPers2_5
f. I have seen things that weren’t really
thereLongPers2_6

46
L3. How well does each of the following statements describe you?

Exactly Not at all

A lot Somewhat A little
like you like you
a. I steer clear of romantic
relationshipsLongPers3_1
b. I’m not interested in making
friendsLongPers3_2
c. I get irritated easily by all sorts of
thingsLongPers3_3
d. I don’t like to get too close to
peopleLongPers3_4
e. It’s no big deal if I hurt other peoples’
feelingsLongPers3_5
f. I rarely get enthusiastic about
anythingLongPers3_6

L4. And how well does each of the following statements describe you?

Exactly Not at all

A lot Somewhat A little
like you like you
a. I crave attentionLongPers4_1
b. I often have to deal with people who
are less important than
meLongPers4_2
c. I often have thoughts that make sense
to me but that other people say are
strangeLongPers4_3
d. I use people to get what I
wantLongPers4_4
e. I often “zone out” and then suddenly
come to and realize that a lot of time
has passedLongPers4_5
f. Things around me often feel unreal, or
more real than usualLongPers4_6
g. It’s easy for me to take advantage of
othersLongPers4_7

GO TO END OF SURVEY

L5. Belowis a list of things different people might say about themselves. How well does each of the
followingstatements describe you?

Exactly Not at all

A lot Somewhat A little
like you like you
a. People would describe me as
recklessShrtPers1_1
b. Even though I know better, I can’t stop
making rash decisionsShrtPers1_2
c. I get emotional easily, often for very
little reasonShrtPers1_3
d. I have seen things that weren’t
reallythereShrtPers1_4

47
 e. I steer clear of romantic
relationshipsShrtPers1_5

L6. How well does each of the following statements describe you?

Exactly Not at all

A lot Somewhat A little
like you like you
a. I get irritated easily by all sorts of
thingsShrtPers2_1
b. I don’t like to get too close to
peopleShrtPers2_2
c. It’s no big deal if I hurt other peoples’
feelingsShrtPers2_3
d. I use people to get what I
wantShrtPers2_4
e. Things around me often feel unreal, or
more real than usualShrtPers2_5

L7. The following are descriptions of relationship styles. Please read each description and indicate how
well each statement describes you.

Exactly Not at all

A lot Somewhat A little
like you like you
a. I find it relatively easy to get close to
people. I am comfortable depending on
others and having them depend on
me. I do not worry about being
abandoned or about someone getting
too close to me. Attachment_1
b. I am somewhat uncomfortable being
close to others. I find it difficult to trust
them completely and difficult to
depend on them. I am nervous when
anyone gets too close to me.
Attachment_2
c. I find that others are reluctant to get
as close as I would like. I often worry
that people who I care about do not
love me or will not want to stay with
me. I want to merge completely with
another person and this desire
sometimes scares people away.
Attachment_3
d. I am comfortable without close
emotional relationships. It is very
important for me to feel independent
and self-sufficient, and I prefer not to
depend on others or have others
depend on me. Attachment_4

GO TO END OF SURVEY

48
 SECTION M: PERCEIVED STRESS

M1. Below is a list of stress perception assessed with the Perceived Stress Scale. How well does each
of the following statements describe how you have felt in the last month?

NOTE: For each question choose from the following alternatives: 0 - never 1 - almost never 2 - sometimes 3 - fairly
often 4 - very often

Never Almost never Sometimes Fairly often Very often

1. In the last month, how often have you been upset

because of something that happened
unexpectedly?
2. In the last month, how often have you felt that you
were unable to control the important things in
your life?
3. In the last month, how often have you felt nervous
and stressed?
4. In the last month, how often have you felt
confident about your ability to handle your
personal problems?
5. In the last month, how often have you felt that
things were going your way?
6. In the last month, how often have you found that
you could not cope with all the things that you had
to do?
7. In the last month, how often have you been able to
control irritations in your life?
8. In the last month, how often have you felt that you
were on top of things?
9. In the last month, how often have you been
angered because of things that happened that were
outside of your control?
10. In the last month, how often have you felt
difficulties were piling up so high that you could
not overcome them?

GO TO END OF SURVEY

49
 SECTION N: HOUSEHOLD INFORMATION

NOTE: Variable names for each question are listed in red.

N1. Describe your residence when in university?
tenurestatus
Owned by me
Hosted by a relative
Hosted by a non-relative
Rented house
Family house
University hall of residence
Rented Private students' hostel/dormitory
Others, please specify

N2. How many people are currently living in your household, including yourself?
Please specify ______________
N3. The following items refer to your parents/guardian's home. Do they have the following items
Select all that apply?
Itemsowned
Electricity
Radio
Television
Refrigerator
Cell phone
Bicycle
Motorcycle
Motor vehicle
Electricity
N4. What is the main source of water at your parents/guardian's home? Select all that apply.
Watersource
Piped water
Rainwater
Well water
Surface water
Other
N5. What is the type of floor at your parents/guardian's home? Select all that apply.
Floortype
Earth floor
Cement floor
Tile floor
Wood floor
Other
N6. What type of toilet is available at your parents/guardian's home? Select one
Toilettype
No toilet
Pit latrine
Flush toilet
Other
No toilet
N7. What is the main source of fuel used at your parents/guardians' home? Select all that apply?
Cookingfuel
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 Firewood
Charcoal
Kerosene
Gas
Electricity
Other

END OF SECTION

A9. What is your religion?

Relaffiliation
Protestant
Catholic
Islam
Indigenous Religion
Hindu but not sikh
Hindu but Sikh
Atheist
Others (Please specify)

Please insert here the name of your university

The year of study

State your faculty

State your course

Insert here your grade during the last semester. If this is your first semester at the university, insert the
worst and the best percentage marks you got in any of the subjects in your last CAT since you joined the
University: Worst--- Best-----

End of questionnaire
Thank you very much for your participation, I would like to repeat that your individual data will be
protected and will remain anonymous

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