Resilience Survey Instructions: Choose the best value for each survey item.
Select "Submit"
only
after every item is completed. Note that a value must be selected for each survey item for a valid submission.
1. If I do not enjoy doing something, I usually do not do it.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2. If I do not do it myself, it does not get done.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
3. What I do is meaningful.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
4. I often feel I am on my own.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
5. My performance is adequately appreciated.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
6. There are people I can rely on.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
7. I usually feel rested after sleep.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
8. I often think about problems.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
9. At the end of the day I am exhausted.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
10. I am worried what my life will be like in 3 years.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
11. I am looking forward to the future.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Over the last
2 weeks
, how often have you been bothered by any of the following problems?
12. Little interest or pleasure in doing things.
Not at all
Several days
More than half the days
Nearly every day
13. Feeling down, depressed, or hopeless.
Not at all
Several days
More than half the days
Nearly every day
14. Trouble falling or staying asleep, or sleeping too much.
Not at all
Several days
More than half the days
Nearly every day
15. Feeling tired or having little energy.
Not at all
Several days
More than half the days
Nearly every day
16. Poor appetite or overeating.
Not at all
Several days
More than half the days
Nearly every day
17. Feeling bad about yourself - or that you are a failure or have let yourself or your family down.
Not at all
Several days
More than half the days
Nearly every day
18. Trouble concentrating on things, such as reading the newspaper or watching television.
Not at all
Several days
More than half the days
Nearly every day
19. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.
Not at all
Several days
More than half the days
Nearly every day
20. Thoughts that you would be better off dead, or of hurting yourself in some way.
Not at all
Several days
More than half the days
Nearly every day
21. If you checked off any problems in items 12 through 20, how difficult have these made it for you to do your work?.
Not difficult all
Somewhat difficult
Very difficult
Extremely difficult
Over the last
2 weeks
, how often have you been bothered by any of the following problems?
22. Feeling nervous, anxious, or on edge.
Not at all sure
Several days
More than half the days
Nearly every day
23. Not being able to stop or control worrying.
Not at all sure
Several days
More than half the days
Nearly every day
24. Worrying too much about different things.
Not at all sure
Several days
More than half the days
Nearly every day
25. Trouble relaxing.
Not at all sure
Several days
More than half the days
Nearly every day
26. Being so restless that it is hard to sit still.
Not at all sure
Several days
More than half the days
Nearly every day
27. Becoming easily annoyed or irritable.
Not at all sure
Several days
More than half the days
Nearly every day
28. Feeling afraid as if something awful might happen.
Not at all sure
Several days
More than half the days
Nearly every day
29. If you checked off any problems in items 22 through 28, how difficult have these made it for you to do your work?.
Not difficult all
Somewhat difficult
Very difficult
Extremely difficult
Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem and then select one of the options to indicate how much you have been bothered by that problem (regaring your stressful experience)
in the past week
.
In the past week
, how much were you bothered by:
30. Repeated, disturbing, and unwanted memories of the stressful experience?
Not at all
A little bit
Moderately
Quite a bit
Extremely
31. Repeated, disturbing dreams of the stress experience?
Not at all
A little bit
Moderately
Quite a bit
Extremely
32. Suddenly feeling or acting as if the stressful experience was actually happening again (as if you were actually back there reliving it)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
33. Feeling very upset when something reminded you of the stressful experience?
Not at all
A little bit
Moderately
Quite a bit
Extremely
34. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
35. Avoiding memories, thoughts, or feelings related to the stressful experience?
Not at all
A little bit
Moderately
Quite a bit
Extremely
36. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
37. Trouble remembering important parts of the stressful experience?
Not at all
A little bit
Moderately
Quite a bit
Extremely
38. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
39. Blaming yourself or someone else for the stressful experience or what happened after it?
Not at all
A little bit
Moderately
Quite a bit
Extremely
40. Having strong negative feelings such as fear, horror, anger, guilt, or shame?
Not at all
A little bit
Moderately
Quite a bit
Extremely
41. Loss of interest in activities that you used to enjoy?
Not at all
A little bit
Moderately
Quite a bit
Extremely
42. Feeling distant or cut off from other people?
Not at all
A little bit
Moderately
Quite a bit
Extremely
43. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
Not at all
A little bit
Moderately
Quite a bit
Extremely
44. Irritable behavior, angry outbursts, or acting aggressively?
Not at all
A little bit
Moderately
Quite a bit
Extremely
45. Taking too many risks or doing things that could cause you harm?
Not at all
A little bit
Moderately
Quite a bit
Extremely
46. Being
superalert
or watchful or on guard?
Not at all
A little bit
Moderately
Quite a bit
Extremely
47. Feeling jumpy or easily startled?
Not at all
A little bit
Moderately
Quite a bit
Extremely
48. Having difficulty concentrating?
Not at all
A little bit
Moderately
Quite a bit
Extremely
49. Trouble falling or staying asleep?
Not at all
A little bit
Moderately
Quite a bit
Extremely
The following are some personal questions related to killing oneself. Please indicated the response that best applies to you by
selecting
one
circle.
50. Have you
ever
thought about or attempted to kill yourself?
Never
It was just a brief passing thought
I have had a plan at least once to kill myself, but did not try to do it
I have attempted to kill myself, but did not want to die
I have had a plan at least once to kill myself and really wanted to die
I have attempted to kill myself and really wanted to die
51. How often have you thought about killing yourself in the past
year
?
Never
Very often
52. In the past
year
, have you had an internal debate/argument (in your head) about whether to live or die?
Never
Very frequently
53.
Right now
, how much do you wish to live?
Not at all
Very much
54.
Right now
, how much do you wish to die?
Not at all
Very much
55. How likely is it that you will attempt suicide someday?
Not at all
Very Likely