PRISM SECTION 15 - STRESSFUL EVENTS

START TIME : PRISM SECTION 15 - STRESSFUL EVENTS Statement I.1: These next questions are about difficult or stressful things that can happen to people. It may be hard to remember everything about these things and it may be hard to talk about them. Let me know if you re feeling upset as we go along and we can slow down. Were you ever... [REPEAT FREQUENTLY] 1a....in active military combat? Experienced traumatic event - military combat 1 - SKIP TO Q. a 1b. At that time, did you feel extremely yourself or others? Did you feel horrified about what was happening? - subject felt only somewhat frightened or helpless = "" a....in a very serious accident? Were you hospitalized? Did you think you might die or be permanently disabled? b. At that time, did you feel extremely yourself or others? Did you feel horrified about what was happening? Experienced traumatic event - accident - subject felt only somewhat frightened or helpless = "" 1 - SKIP TO Q. 3a 3a....in a serious fire, flood, earthquake, hurricane, or other disaster? Were you ever trapped and in need of help? Did you think you might die or become permanently disabled? 3b. At that time, did you feel extremely yourself or others? Did you feel horrified about what was happening? Experienced traumatic event - natural disaster - subject felt only somewhat frightened or helpless = "" 1 - SKIP TO Q. 4a 4a....physically attacked, mugged, kidnapped, taken hostage, involved in a terrorist attack, or anything else like that? Did you think you might die or become permanently disabled? Experienced traumatic event - violent personal assault 1 - SKIP TO Q. 5a 4b. At that time, did you feel extremely yourself or others? Did you feel horrified about what was happening? - subject felt only somewhat frightened or helpless = "" 5a....sexually attacked or raped, or did you ever experience any unwanted sexual activity when you were a child or a teenager? Experienced traumatic event - sexual assault 1 - SKIP TO Q. 6a, PAGE 11 10

5b. At that time, did you feel extremely yourself? Did you feel horrified about what was happening? Response to event involved intense fear, helplessness, or horror - subject felt only somewhat frightened or helpless = "" - if sexual abuse occurred in childhood, fear response may be delayed 6a....told you had a fatal illness? What were you told? Was diagnosed with life-threatening illness - diagnosis of HIV, AIDS, or other illness only when subject is convinced it is life-threatening = 3 1 - SKIP TO Q. 7a 6b. At that time, did you feel extremely yourself? Did you feel horrified about what was happening? - subject felt only somewhat frightened or helpless = "" 7a....very upset by hearing that any of these things had happened to someone you were close to? What (was/is) your relationship to this person? What happened to (him/her)? Was confronted with the occurrence of a traumatic event to someone else - must be limited to family members, significant others, or close friends - events not included in this section = 1 1 - SKIP TO Q. 8a 7b. At that time, did you feel extremely this person? Did you feel horrified about what was happening? - subject felt only somewhat frightened or helpless = "" 8a. Did you ever see the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster? How were you involved? Witnessed a traumatic event, i.e, serious injury or unnatural death of another? 1 - SKIP TO CHECK ITEM 15.1 8b. At the time this happened, did you feel extremely frightened? Did you feel helpless to protect yourself or others? Did you feel horrified about what was happening? - subject felt only somewhat frightened or helpless = "" CHECK ITEM WAS SUBJECT FEARFUL, HELPLESS OR HORRIFIED NO - SKIP TO SECTION 15.1 IN RESPONSE TO ANY TRAUMATIC EVENT? 16, PAGE 18 YES (ARE ANY Q'S 1b - 8b, PAGES 10-11 CODED "3"?) 11

9. After (this experience/these experiences), did you find yourself thinking about it over and over, getting very upset when anything reminded you of what happened, or dreaming about it a lot? IF YES AND MULTIPLE TRAUMAS: Which of these experiences was the most upsetting to you? Potential posttraumatic stress disorder - recurrent and intrusive distressing recollections or dreams of the event = 3? SKIP TO 1 SECTION 16, PAGE 18 3 CHECK WORST TRAUMA: COMBAT ACCIDENT SEXUAL ASSAULT ILLNESS DISASTER ASSAULT CONFRONTED WITNESSED Statement I.: Now I would like to ask you a few questions about the ways (SPECIFIED WORST TRAUMA) may have affected you. After [TRAUMA] happened... [REPEAT FREQUENTLY] 10....did you remember it a lot, even though you didn t want to? Recurrent and intrusive distressing recollections of the event - images, thoughts, or perceptions of the traumatic event = 3 11....did you have bad dreams about it? Recurrent distressing dreams of the event 1....did it ever seem like [TRAUMA] was happening all over again? IF NO: Did you ever find yourself acting as if it was happening again, for example, reacting to sounds that are like the ones you heard when it happened? Acting or feeling as if the traumatic event were recurring - sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes = 3 - experiences that occur on awakening or when intoxicated = 3 13....did you ever get very upset whenever anything reminded you of [TRAUMA]? This could happen when you were in a situation that reminded you of it, or it could happen around the same time of year that it happened. Can you describe that to me? Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event - cues include anniversaries of the event, situations similar to those in which trauma occurred, etc. 1

14....did you ever have any physical reactions when something reminded you of [TRAUMA], like breaking out in a sweat, breathing fast, or feeling your heart pounding? Again, this could happen when you were in a situation that reminded you of it or it could happen around the same time of year that it happened. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event - cues include anniversaries of the event, situations similar to those in which trauma occurred, etc. Can you describe that to me? CHECK ITEM DID SUBJECT REEXPERIENCE THE TRAUMA? NO - SKIP TO SECTION 15. 16, PAGE 18 (ARE ANY Q'S 10-14, PAGES 1-13, CODED "3"?) YES 15....did you try to stop yourself from thinking or feeling anything about [TRAUMA]? Efforts to avoid thoughts, feelings, or conversations associated with the trauma IF NO: Did you try to stay away from conversations that had anything to do with it? What exactly did you avoid? 16....did you stay away from going places, doing things, or seeing people that might bring back memories of [TRAUMA]? Efforts to avoid activities, places or people that arouse recollections of the trauma What did you avoid? 17....did you find that you couldn t remember some important part of what happened? Inability to recall an important aspect of the trauma What was that like? 18....did you find you were much less interested in activities you ordinarily enjoyed, or that you participated in such activities much less than usual? Markedly diminished interest or participation in significant activities - must be change from level of activity prior to the trauma Which activities? 13

19....did you feel emotionally distant from other people, or cut off from others? Was that different from how you were before [TRAUMA]? Feeling of detachment or estrangement from others - must be change from feelings of attachment prior to trauma 0....did you feel as though you couldn t feel positive or loving feelings towards other people like you used to? Was that different from how you were before [TRAUMA]? Restricted range of affect (e.g., unable to have loving feelings) - must be change from emotional functioning prior to trauma - decreased ability to feel intimacy, tenderness, sexuality = 3 1....did you feel as if you couldn t really expect the future to turn out the way you had expected it to, in terms of your job, family, or the length of your own life? Can you tell me more about that? Sense of a foreshortened future - must be change from expectations about future prior to trauma - realistic sense of foreshortened future based on fatal medical illness = 1 - not expecting to have a career, marriage, children, or normal life span = 3 CHECK ITEM DID SUBJECT HAVE AVOIDANCE OR GENERAL NUMBING OF NO -SKIP TO SECTION 16, 15.3 RESPONSIVENESS? PAGE 18 (ARE 3 OR Q. S 15-1, PAGES 13-14, CODED "3"?) YES....did you have an unusual amount of trouble falling asleep or staying asleep? Difficulty falling or staying asleep 3....were you unusually angry or irritable a lot of the time? Irritability or outbursts of anger 4....did you find you were having unusual trouble concentrating on things? Difficulty concentrating 14

5....were you watchful or on guard, even when it probably wasn t necessary? Hypervigilance 6....were you unusually jumpy or easily startled by sudden noises? Exaggerated startle response CHECK ITEM DID SUBJECT HAVE PERSISTENT INCREASED AROUSAL? NO - SKIP TO SECTION 16, 15.4 PAGE 18 (ARE OR Q.'S -6, PAGES 14-15 CODED "3"?) YES 7. Did some of the after-effects of the trauma we ve been talking about ever happen around the same time for at least 1 month? (How long did you feel that way?) Symptom cluster for more than 1 month - symptom cluster must include reexperiencing the trauma, avoidance, and increased arousal 1 SKIP TO SECTION 16, PAGE 18 3 8. Did [SYMPTOMS]: interfere with your normal daily activities? (How?) make it harder for you to take care of your everyday responsibilities? (How?) cause any problems for you at (work/school)? (What kinds of problems?) cause any problems in your relationships or social life? (What kinds of problems?) Did anyone ever comment or complain about your [SYMPTOMS]? (What did they say?) Were the problems mild, moderate, or severe? Symptoms of reexperiencing, avoidance, numbering, or arousal cause impairment in social, occupational, or other important areas of functioning - questionable or slight interference = "" - interference must be due to fear or avoidance of phobic object or situation - interference in occupational/academic functioning includes job-task refusal or other poor performance - interference in social activities or interpersonal relationships includes social isolation, frequent arguments, or loss of friends 1 - MILD 3 - MODERATE 4 - SEVERE CHECK ALL THAT APPLY: NORMAL ROUTINE OCCUPATIONAL/ ACADEMIC SOCIAL/INTERPERSONAL CHECK ITEM DID SUBJECT REPORT SIGNIFICANT IMPAIRMENT? NO 15.5 (IS Q.8 CODED "3" OR "4"?) YES - SKIP TO CHECK ITEM 15.6, PAGE 16 15

9. Did you often feel very upset about the [SYMPTOMS]? IF NO: Did you think about getting some help for this? Symptoms of reexperiencing, avoidance, numbing or arousal caused clinically significant distress - anxiety reaction when reminded of trauma = "1" - recurrent low mood or low self-esteem about reexperiencing trauma or avoiding situations = "3" - thinking about or seeking help for trauma reactions = "3" CHECK ITEM DID SUBJECT REPORT IMPAIRMENT OR DISTRESS? NO - SKIP TO SECTION 16, 15.6 PAGE 18 (IS CHECK ITEM 15.5, PAGE 15 CODED "YES" OR IS Q.9 CODED "3"?) YES ASK IF NOT KNOWN: 30. When did the [TRAUMA] we ve been talking about happen? (How old were you then?) Onset of traumatic event - code time when worst trauma that caused posttraumatic stress disorder occurred AGO THAN 1 31. How old were you when you first began having [SYMPTOMS]? Onset of worst/only episode of posttraumatic stress disorder - must meet all criteria - criteria include: 1) reexperiencing the trauma; ) avoidance or general numbing of responsiveness; 3) persistent increased arousal; and 4) impairment or distress AGO THAN 1 ASK IF NOT KNOWN: 3. How long after [TRAUMA] did you begin to have these reactions? Length of time between worst/only trauma and onset of posttraumatic stress disorder - code length of time between traumatic event and onset of worst/only PTSD episode - if hours, code "1" day DAYS OR WEEKS OR YEARS (IF THAN 1 ) 33. Was there ever a time since then lasting at least two months when you didn't have these reactions? When was that? How long did it last? Remission of worst/only episode of posttraumatic stress disorder lasting at least months - reexperiencing, avoidance, and arousal must be absent for at least months 1 NO - SKIP TO Q.36, PAGE 17 3 YES 34. Was there ever another time lasting at least one month when you began having these reactions again? How long did it last? Did it cause any problems for you? What problems did it cause? Recurrence of posttraumatic stress disorder - must meet all criteria as defined in Q.31 - must persist for at least 1 month 1 NO - SKIP TO Q.36, PAGE 17 3 YES 16

35. When was the most recent time, lasting at least one month, when you began having these reactions and related problems? Onset of most recent episode of posttraumatic stress disorder - must persist for at least 1 month AGO THAN 1 36. Have these reactions gone away completely? When did that happen? Offset/recency of most recent (or only) episode of posttraumatic stress disorder - code time subject became and remained symptom-free - if currently has symptoms, code "1 WEEK AGO" and check box WEEKS AGO OR AGO THAN 1 CURRENTLY SYMPTOMATIC ASK IF NOT KNOWN: 37. How old were you the first time that a terrifying experience in your life caused problems for you? Onset of initial/only episode of posttraumatic stress disorder - code first time subject fulfilled all criteria as defined in Q.31 AGO THAN 1 ASK IF NOT KNOWN: 38. What was the longest period of time in your life that you had problems because of a terrifying experience? Duration of longest episode of posttraumatic stress disorder ever in lifetime - must meet all criteria as defined in Q. 31 YEARS END TIME : 17