Well-being and substance use.
The first questions are about your background.
Are you male or female?
1. Male
2. Female
How old are you?
Years:
Are you currently attending a school, an education, an internship or an apprenticeship?
1. Yes
2. No
Have you been attending school, an education, an internship or an apprenticeship in the past 30 days?
1. Yes
2. No
Which type of school are you currently attending/which type of education have you just been attending?
1. Primary and lower secondary education
2. Continuation School
3. Folk High School
4. Upper secondary education
5. Upper secondary education (A-levels)
6. Adult upper secondary level course
7. Production School
8. Technical and vocational secondary education
9. Basic social and health training program
10. Business College
11. Apprenticeship
12. Internship
13. Short term further education e.g. Social and health care assistant, BA in computer
science
14. Further education e.g. Nurse, Social worker
15. Higher education
16. Other education
1
If you checked # 1 or # 2 in the above mentioned training, which grade?
1. 7th grade
2. 8th grade
3. 9th grade
4. 10th grade
If you checked # 5 in the above mentioned training, is it?
1. Single course
2. Complete A-level course
If you checked # 6 in the above mentioned training, is it?
1. Single course
2. Complete course
If you checked # 9 in the above mentioned training, is it?
1. Basic training
2. Internship
If you checked # 11 in the above mentioned training, which area?
1. Craft
2. Business
3. Mercantile
If you checked # 16 in the above mentioned training, indicate which education or apprenticeship?
Education or apprenticeship:
What was your primary source of income in the past month?
1. Allowance (from family e.g.)
2. Paid employment, part-time (incl. spare time job)
3. Paid employment, full-time
4. Education grant from the state (SU)
5. Job activation, salary subsidy, employment rehabilitation
6. Unemployment benefit
7. Sick leave or maternity benefit
8. Social income support
9. Social security
10. Other source of income
2
If you checked # 10 in the above mentioned source of income, indicate what kind of income?
Income:
How many days have you been absent from school or work in the past 30 days?
Days:
Who are you currently living with?
1. Both parents
2. One parent
3. One parent and one step parent
4. Alone
5. Alone with child/children
6. Partner
7. Partner and child/children
8. Another family
9. Foster care
10. Institution for young people
11. Continuation school for young people
12. Dormitory
13. Friends (shared living/flat sharing)
14. Other
If you checked # 14 in the above mentioned living status, indicate what kind of housing situation?
Housing situation:
The next questions are about your physical well-being including your sleep
pattern.
How tall are you?
Centimeters:
How much do you weigh?
Kilos:
At what time have you typically gone to bed the in past 7 days?
Time:
3
How long has it typically taken you to fall asleep in the past 7 days?
Minutes:
What time have you typically gotten up in the morning in the past 7 days?
Time:
How many times have you typically woken up during the night in the past 7 days?
Times:
Do you typically take a nap during the day?
1. Yes
2. No
For how long do you nap?
Hours/minutes:
Number of days where you have used over-the-counter pain-relieving medication, such as Panodil,
kodimagnyl, Ipren, Ibuprofen or other non-prescription drugs the past 30 days?
Days:
Number of days where you have used medicine for physical problems (prescribed by a physician) the past
30 days?
Days:
Number of days where you have been in contact with your general practitioner the past 3 months?
Days:
Number of days where you have experienced physical problems the past 30 days?
Days:
Indicate all the different physical problems you have had the past 30 days:
1. Headache
2. Nausea
3. Fatigue
4. Infection
5. Sports injury
6. Other kind of pain in muscles, joints, bones
Which one:
7. Other physical problems
4
If you checked # 6 in the above mentioned physical problems, indicate what kind of pain in joints and
bones?
Pain in joints and bones:
If you checked # 7 in the above mentioned physical problems, indicate what other kind of physical
problems?
Other physical problems:
Do you have a chronic physical illness?
1. Yes
2. No
3. Do not want to answer
If you have a chronic physical illness, please write the name
Name of chronic physical illness:
The next questions are about your use of legal and illicit drugs.
Number of days where you have smoked cigarettes in the past 30 days?
Days:
Do not want to answer
How many cigarettes have you typically been smoking during a week in the past 30 days?
1. Monday:
2. Tuesday:
3. Wednesday:
4. Thursday:
5. Friday:
6. Saturday:
7. Sunday:
Number of days where you have been drinking alcohol the past 30 days?
Days:
5
How many units have you typically been drinking during a week in the past 30 days?
1. Monday:
2. Tuesday:
3. Wednesday:
4. Thursday:
5. Friday:
6. Saturday:
7. Sunday:
How often do you drink 5 or more units on one occasion?
1. Never
2. Once a month or less
3. 2-3 times a month
4. Once a week
5. Twice a week
6. 3-4 times a week
7. 5 or more times a week
8. Do not want to answer
Have your consumption of alcohol resulted in not attending school or work in the past 30 days?
1. Yes
2. No
How many days?
Days:
Are you living with someone, who has a problem with alcohol?
1. Yes
2. No
Number of days where you have used cannabis (e.g. hash, pot, skunk or other kinds) in the past 30 days?
Days:
6
Focus on the day in the past week where you used the largest amount of cannabis.
Indicate all the times during the day when you used cannabis:
1. Have not been using cannabis the past week
2. 6-9 a.m.
3. 9-12 a.m.
4. 12-3 p.m.
5. 3-6 p.m.
6. 6-9 p.m.
7. 9-12 p.m.
8. 12-6 a.m.
Number of days where you have used amphetamines in the past 30 days?
Days:
Number of days where you have used cocaine in the past 30 days?
Days:
Number of days where you have used Ecstasy or MDMA in the past 30 days?
Days:
Number of days where you have used other drugs, such as: illegally obtained Ritalin, ketamin, psilocybin
mushroom, heroin or other drugs in the past 30 days?
Days:
Indicate all the different kinds
Other drugs:
Have your use of drugs, except cigarettes and alcohol, resulted in not attending school or work in the past
30 days?
1. Yes
2. No
How many days?
Days:
Are you living with someone, who uses other drugs than cigarettes and alcohol (e.g. hash, cocaine or other
illicit drugs)?
1. Yes
2. No
7
The next questions are about your consumption of alcohol or drugs (except for cigarettes) the past 12
months
How often have your use of drugs and/or alcohol been out of control?
1. Never/almost never
2. Sometimes
3. Often
4. Always/nearly always
How often has the prospect of missing a fix (or dose) and/or drink made you anxious or worried?
1. Never/almost never
2. Sometimes
3. Often
4. Always/nearly always
How often have you been worried about your use of drugs and/or alcohol?
1. Never/almost never
2. Sometimes
3. Often
4. Always/nearly always
How often have you wished you could stop using drugs and/or alcohol?
1. Never/almost never
2. Sometimes
3. Often
4. Always/nearly always
How difficult have you found it to stop or go without drugs and/or alcohol?
1. Not difficult
2. Quite difficult
3. Very difficult
4. Impossible
Do you or do others think that you have a problem with excessive consumption of food?
1. Yes
2. No
8
Do you or do others think that you have a problem with excessive consumption of sugary sweets (sodas
included)?
1. Yes
2. No
Do you or do others think that you have a problem with excessive shopping?
1. Yes
2. No
Do you or do others think that you have a problem with excessive exercise (running, bodybuilding, other
kinds)?
1. Yes
2. No
Do you or do others think that you have a problem with excessive use of computer or console games?
1. Yes
2. No
Do you or do others think that you have a problem with excessive gambling (lotto, sports results, cards,
casino e.g.)?
1. Yes
2. No
Do you gamble for money?
1. Yes
2. No
9
The next questions are about your friends and family.
First you will see some questions about your close friends
How many of your friends do you regard as close friends?
Number of close friends:
Do not want to answer
If you experienced problems today (not financial) to what extent do you think your close friends would be
supportive?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what degree have you experienced conflicts with your close friends in the past 30 days?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
How many of your close friends, do you think have used cannabis or drugs other than cigarettes and
alcohol in the past 30 days?
Number of close friends:
Now you will see some questions about your girlfriend/boyfriend
Have you ever had a girlfriend/boyfriend?
1. Yes
2. No
Do you have a girlfriend/boyfriend at the moment?
1. Yes
2. No
10
If you experienced problems today (not financial) to what extent do you think your girlfriend/boyfriend
would be supportive?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what degree have you experienced conflicts with your girlfriend/boyfriend the past 30 days?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
Have your girlfriend/boyfriend used cannabis or drugs other than cigarettes and alcohol the past 30 days?
1. Yes
2. No
Do not want to answer
The next questions are about your parents
Is your father still living?
1. Yes
2. No
If you experienced problems today (not financial) to what extent do you think your father would be
supportive?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
11
To what degree have you experienced conflicts with your father in the past 30 days?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Have had no contact the past 30 days
7. Do not want to answer
Is your mother still living?
1. Yes
2. No
If you experienced problems today (not financial) to what extent do you think your mother would be
supportive?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what degree have you experienced conflicts with your mother in the past 30 days?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Have had no contact the past 30 days
7. Do not want to answer
Do any of your parents currently have or did any of your parents use to have a substance use problem with
either alcohol or other drugs (cigarettes not included)?
1. Yes
2. No
Which one of your parents?
1. Father
2. Mother
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3. Both
4. Do not want to answer
Have you been living with both your parents until you turned 14?
1. Yes
2. No
Are your parents still living together?
1. Yes
2. No
How many times have you changed address before you turned 14?
Times:
How many times have you changed school before you turned 14?
Times:
Do you have a stepfather?
1. Yes
2. No
If you experienced problems today (not financial) to what extent do you think your stepfather would be
supportive?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
Do you have a stepmother?
1. Yes
2. No
If you experienced problems today (not financial) to what extent do you think your stepmother would be
supportive?
1. Not at all
2. To a lesser degree
3. To some degree
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4. To a high degree
5. To a very high degree
6. Do not want to answer
If you experienced problems today (not financial) would you then be able to get support to a high or very
high degree from someone other than your parents/stepparents?
1. Yes
2. No
From whom?
1. Siblings
2. Other family members
3. Other persons, not family members
If you checked # 3 in the above mentioned other persons, please indicate the connection
Other person:
Now you will see some questions about how you experienced your upbringing
Think of the period until you turned 14. The term “parent” is seen in a broader perspective and includes
birth parents, adoptive parents, stepparents and foster parents. Do not distinguish between for instance
mother and father. If you have been living in an institution and have no recollection of other times, then
your answer should be based on the period in the institution.
To what extent have your parents outlined transparent boundaries for your behavior?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent have your parents checked up on what you were doing?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
14
To what extent have your parents been aware of how you were feeling about yourself or others?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent would you say that you had a strict upbringing?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent would you say that you had a loving upbringing?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent, have your parents assisted you with your home-work?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
The next questions are about your leisure time activity.
Are you engaged in sports?
1. Yes
2. No
15
Are you a member of a sports club e.g. fitness, soccer, handball, swimming, martial arts or other sports
club?
1. Yes
2. No
Indicate all the sports clubs you are a member of:
1. Badminton
2. Basketball
3. Ping-pong
4. Dance
5. Fitness
6. Soccer
7. Gymnastics
8. Handball
9. Martial arts (boxing, wrestle, taekwondo, aikido, MMA e.g.)
10. Motocross
11. Horseback riding
12. Swimming
13. Tennis
14. Other sports club
If you checked # 14 in the above mentioned sports clubs, indicate all the different sports clubs
Other sports clubs:
Number of days where you have played your sport or sports in a club in the past 30 days?
Days:
Do you do sports activities outside a club (e.g. running, skater, parkour)?
1. Yes
2. No
Indicate all the different sport activities
Sport activities:
Number of days where you have played your sport or sports outside a club in the past 30 days?
Days:
16
Do you have other leisure time activities/hobbies (e.g. computer games, console games, music, youth
club)?
1. Yes
2. No
Indicate all the different leisure time activities/hobbies:
Leisure time activities/hobbies:
Number of days where you have been doing your different leisure time activities in the past 30 days?
Days:
The next questions are about your life and mental health.
First you will see a couple of questions about joy and interest
Choose the statement that best describes how you have been feeling in the past 2 weeks:
0. I get as much satisfaction out of things as I used to
1. I don’t enjoy things the way I used to
2. I don’t get real satisfaction out of anything anymore
3. I am dissatisfied or bored with everything
Choose the statement that best describes how you have been feeling the past 2 weeks:
0. I haven’t lost interest in other people
1. I am less interested in people than I used to be
2. I have lost most of my interest in other people
3. I have lost all of my interest in other people
The next questions are about the ability to concentrate
How often do you have trouble wrapping up the final details of a project?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
17
How often do you have difficulties handling things that require organization?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How often do you have difficulties remembering appointments or obligations?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
When you have a task that requires a lot of thoughts, how often do you avoid or delay getting started?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How often do you fidget or squirm with your hands or feet when you have to sit down?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How often do you feel overly active and compelled to do things all the time?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
18
The next questions are about your health and different physical and mental problems, you may have
experienced
Have you had a period in life where you felt lonely?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
Have you been affected by this loneliness in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
Have you had a period in life where you were affected by depression?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How affected have you been by depressive symptoms in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
19
Have you had a period in life where you experienced anxiety?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How affected have you been by anxiety in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
Have you had a period in life where you experienced unpleasant intrusive thoughts that were difficult to let
go of?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How affected have you been by these thoughts in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
20
Have you had a period in life where you, to an excessive degree, had to, check doors and locks, wash
yourself or other excessive behaviors?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How affected have you been by these excessive behaviors in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
Have you had a period in life where you had difficulties controlling your aggression or your temper?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How affected have you been by these difficulties in controlling your aggression or temper in the past 30
days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
21
Have you ever directly physically harmed other people e.g. been in a fight, assaulted other people or similar
acts (play or accident do not count)?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How many times have you been in a fight or behaved aggressively in the past 30 days?
0. Not at all
1. Once
2. Twice
3. 3 times
4. More than 3 times
6. Do not want to answer
Have you had a period in life where you had suicidal thoughts?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How affected have you been by suicidal thoughts in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
Have you ever attempted suicide?
1. Yes
2. No
22
How many times have you, all in all, attempted suicide?
1. Once
2. Twice
3. 3 times
4. More than 3 times
5. Do not want to answer
Have you attempted suicide in the past 30 days?
1. Yes
2. No
Have you ever purposely hurt yourself e.g. cut or burned yourself or the like?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
How many times have you purposely hurt yourself the past 30 days?
0. Not at all
1. Once
2. Twice
3. 3 times
4. More than 3 times
6. Do not want to answer
Have you had a period in life where you had an eating disorder e.g. avoided eating food or purposely
vomited?
1. Never
2. Almost never
3. Sometimes
4. Often
5. Nearly always
6. Do not want to answer
23
How affected have you been by an eating disorder in the past 30 days?
1. Not at all
2. A little
3. Somewhat
4. A lot
5. Very much
6. Do not want to answer
Have you been diagnosed with ADHD by a psychiatrist?
1. Yes
2. No
Have you ever been diagnosed with another mental disorder by a psychiatrist?
1. Yes
2. No
Indicate the psychiatric diagnoses
Psychiatric diagnoses:
Have you ever been on medication for mental problems?
1. Yes
2. No
Number of days where you have taken the medication for mental problems in the past 30 days?
Days:
Did you get the medication due to?:
1. Depression
2. Anxiety
3. Stress
4. ADHD
5. Sleep problems
6. Excessive thoughts or restlessness
7. OCD (compulsive behaviour/thoughts)
8. Psychosis
9. Other problems
If you checked # 9 in the above mentioned other problems, indicate all other problems that resulted in
medication:
Other problems:
24
The next questions are about what you may have experienced in your childhood
and youth.
First you will see some questions concerning your experiences in the primary and lower secondary school
To what extent were you/are you and your friends troublemakers?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent have you had/do you have conflicts with your teachers?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent were you/are you disruptive in class?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent were you/are you a quiet student?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
25
To what extent have you had/do you have conflicts with your classmates?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent were you/are you good at solving assignments?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent were you/are you good at math?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent were you/are you focused?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent did you/do you like attending school?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
26
To what extent did you/do you skip school?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
To what extent were you/are you a good reader?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
Do you think you have dyslexia?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
Have you ever been expelled from school due to your behavior?
1. Yes
2. No
Next you will see some statements concerning your self-perception, how well do the particular statements
apply to you?
I consider myself as a pretty impulsive person
1. Does not apply at all
2. Does not apply well
3. Applies fairly well
4. Applies very well
27
It often happens that I talk first and think later
1. Does not apply at all
2. Does not apply well
3. Applies fairly well
4. Applies very well
I get bored quickly doing the same thing over and over
1. Does not apply at all
2. Does not apply well
3. Applies fairly well
4. Applies very well
It often happens that I do things without thinking ahead
1. Does not apply at all
2. Does not apply well
3. Applies fairly well
4. Applies very well
It happened several times that I’ve borrowed something and then lost it
1. Does not apply at all
2. Does not apply well
3. Applies fairly well
4. Applies very well
Next you will see a few questions regarding frequently experiences, but in a general matter
I have excessive thoughts
1. Never/almost never
2. Now and then
3. Often
4. Very often
5. Do not want to answer
I change my hobbies
1. Never/almost never
2. Now and then
3. Often
4. Very often
5. Do not want to answer
28
I get intruding thoughts, when I am thinking
1. Never/almost never
2. Now and then
3. Often
4. Very often
5. Do not want to answer
The next questions are about personality. How well do the following statements describe your personality?
I see myself as someone who is reserved
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who is generally trusting
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who tends to be lazy
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who is relaxed, handles stress well
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
29
I see myself as someone who has few artistic interests
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who is outgoing, sociable
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who tends to find fault with others
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who does a thorough job
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
I see myself as someone who gets nervous easily
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
30
I see myself as someone who has an active imagination
1. Highly disagree
2. To some extent disagree
3. Neither agree nor disagree
4. To some extent agree
5. Highly agree
Next you will see some questions about different tough and stressful experiences, you may have had
Have you ever been subjected to bullying?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
If it affects you today, is it because you get bullied at work or in school today?
1. Yes
2. No
Have you ever been subjected to neglect?
1. Not at all
2. To a lesser degree
3. To some degree
4. To a high degree
5. To a very high degree
6. Do not want to answer
31
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
Have you ever been subjected to sexual assault or sexual abuse?
1. Never
2. Once
3. More than once
4. Do not want to answer
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
Have you ever been subjected to physical assault or abuse?
1. Never
2. Once
3. More than once
4. Do not want to answer
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
32
Have you ever been threatened to life and limb?
1. Never
2. Once
3. More than once
4. Do not want to answer
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
Have you ever been involved in a serious accident e.g. a traffic or work accident?
1. Yes
2. No
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
Have you, your parents or your sibling/siblings ever had a serious illness?
1. Yes
2. No
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
33
Have you ever experienced the death of a close family member e.g. mother, father or siblings?
1. Yes
2. No
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
Have you ever been divorced or have your parents divorced?
1. Yes
2. No
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
Have you ever had other tough and stressful experiences?
1. Yes
2. No
Indicate all the other tough and stressful experiences
Other tough and stressful experiences:
How much does it negatively affect you today?
1. Not at all
2. A little
3. Some
4. A lot
5. Very much
6. Do not want to answer
34
Last you will see some questions about your well-being in different areas in the past 30 days
On a scale from 0 to 10, please rate your general personal well-being e.g. how you have been feeling about
yourself in the past 30 days.
0 = really bad, 10 = really good.
0. Really bad
1.
2.
3.
4.
5. In between
6.
7.
8.
9.
10. Really good
11. Do not want to answer
On a scale from 0 to 10, please rate how you have generally felt about your close relations e.g. with family
and close friends in the past 30 days.
0 = really bad, 10 = really good.
0. Really bad
1.
2.
3.
4.
5. In between
6.
7.
8.
9.
10. Really good
11. Do not want to answer
35
On a scale from 0 to 10, please rate how you have generally felt socially e.g. with colleagues, in school or
with your acquaintances in the past 30 days.
0 = really bad, 10 = really good.
0. Really bad
1.
2.
3.
4.
5. In between
6.
7.
8.
9.
10. Really good
11. Do not want to answer
On a scale from 0 to 10, please rate how well you generally have been able to concentrate in the past 30
days.
0 = really bad, 10 = really good.
0. Really bad
1.
2.
3.
4.
5. In between
6.
7.
8.
9.
10. Really good
11. Do not want to answer
36
On a scale from 0 to 10, please rate how well you generally have been able to keep appointments and make
plans for your day, in the past 30 days.
0 = really bad, 10 = really good.
0. Really bad
1.
2.
3.
4.
5. In between
6.
7.
8.
9.
10. Really good
11. Do not want to answer
37