STRESS & WELL BEING SURVEY

Life Changes
Please check the boxes for those events that you have experienced in the last twelve months.


1: Death of spouse/partner
2: Divorce
3: Marital separation
4: Death of a close family member
5: Breakup of a long-term relationship
6: Major injury or illness
7: Lost your job
8: Major change in health or behavior of a family member
9: Sexual difficulties
10: New family member (birth, adoption, someone moving in)
11: Major business readjustment (reorganization, bankruptcy, etc.)
12: Major change in personal financial status
13: Death of a close friend or more distant family member
14: Change to a different line of work
15: Taking out a mortgage or a loan for a major purpose
16: Major change in responsibilities at work (promotion, demotion, transfer)

LEVEL OF STRESS



Choose the radio button that reflects how frequently you have experienced the following during the last month.


1: Inadequate sleep 1 2 3 4 5
2: Body aches (joint pain, backaches, etc.) 1 2 3 4 5
3: Indigestion, heartburn, or stomach upset 1 2 3 4 5
4: Rapid heartbeats 1 2 3 4 5
5: Muscle tension 1 2 3 4 5
6: Headaches / Migraines 1 2 3 4 5
7: Fatigue 1 2 3 4 5

LIFE SITUATIONS


Before you respond to each of the following questions, it is important that you pause to bring an image into your mind of the situation, relationship, or person described in the question. Take a moment to become aware of what you are feeling, and then answer the question.


1: Are you currently working in a job?
If no skip to question 7 below. Yes No
2: Bring to mind the face of your supervisor and think about any difficulties or tension in this relationship. Now indicate how you typically feel about this relationship. Not Applicable

1 2 3 4 5
3: Think about any tension created by what your job demands from you and how much control you have over how you do your job. Now indicate how you typically feel about these aspects of your job. 1 2 3 4 5
4: Think about how much effort you have to put into your job and how rewarded you feel in terms of salary, benefits, promotion prospects, and your sense of being valued for your work. Now indicate how you typically feel about this. 1 2 3 4 5
5: Bring to mind the faces of your co-workers and think about any difficulties or tension in your relations with them at work. Now indicate how you typically feel about your coworker relations. 1 2 3 4 5
6: Now reflect on your work situation overall, and indicate the level of stress you typically feel. 1 2 3 4 5



7: Are you currently married or in a long-term relationship?
If no skip to question 13 below. Yes No
8: Bring to mind any specific difficulties or tensions in your relationship with your parents or your spouse/partner?s parents. Now indicate how you typically feel about these tensions. Not Applicable

1 2 3 4 5
9: Think of the sources of tension between you and your spouse/partner in caring for your children. Now indicate how you typically feel about these child care issues. Not Applicable

1 2 3 4 5
10: Bring to mind the face of your spouse/partner and reflect on any underlying tension in your relationship. Now indicate how you typically feel about this tension. 1 2 3 4 5
11: Think about any unresolved problems and specific dissatisfactions in your relationship with your spouse/partner. Now indicate how you typically feel about this in your relationship. 1 2 3 4 5
12: Now reflect on your relationship with your spouse/partner overall, and indicate the level of stress you typically feel. 1 2 3 4 5



13: Think about any health issues or illnesses you or a family member have and any financial difficulties you face in meeting these health care costs. Now indicate how you typically feel when trying to provide for these health care needs. Not Applicable

1 2 3 4 5
14: Think about any worries or concerns you have about paying for your own or your children?s education. Now indicate how you typically feel when trying to plan or provide for these education needs. Not Applicable

1 2 3 4 5
15: Bring to mind any specific difficulties or worries you have about your present financial circumstances. Now indicate how you typically feel when dealing with your finances. 1 2 3 4 5
16: Bring to mind any concerns or worries you have about your long-term future financial security. Now indicate how you typically feel about your ability to meet your future financial needs. 1 2 3 4 5
17: Now reflect on your overall financial situation, and indicate the level of stress you typically feel. 1 2 3 4 5



18: Think about how often you are able to share the experiences of your daily life with people who are really close to you. Now indicate how you typically feel about whether you are able to share your life with someone close in this way. 1 2 3 4 5
19: Bring to mind times you have faced a very difficult personal issue or decision and whether you were able to get support from someone who really loves you no matter what. Now indicate how you typically feel in such situations when trying to get support from someone you can confide in. 1 2 3 4 5
20: Think about the times you have faced a pressing practical problem and whether you were able to get help from someone you can trust. Now indicate how you typically feel about trying to get help from someone you can rely on in such situations. 1 2 3 4 5
21: Now reflect on your overall level of social connection and support, and indicate the level of stress you typically feel. 1 2 3 4 5

OTHER SOURCES OF STRESS



Rate each item in relation to how often you have been aware that it is a source of stress or tension in your life over the past three months.


1: Lack of time 1 2 3 4 5
2: Health concerns 1 2 3 4 5
3: Uncertainty about the future 1 2 3 4 5
4: Home/housing situation 1 2 3 4 5
5: Threat of crime 1 2 3 4 5
6: Traffic/commuting 1 2 3 4 5
7: National Security 1 2 3 4 5

FEELINGS & EMOTIONS



Take a moment to reflect on your life experience over the past three months, and indicate how often you have felt the way described in each statement below.


1: I feel tense and anxious inside 1 2 3 4 5
2: I feel resentful that I have not been treated well 1 2 3 4 5
3: I feel pessimistic that things will turn out for the worst 1 2 3 4 5
4: I feel frustrated about how my life is going right now 1 2 3 4 5
5: I feel angry with people or situations in my life 1 2 3 4 5
6: I feel sad and gloomy in most situations 1 2 3 4 5
7: I feel overwhelmed by even the smallest task 1 2 3 4 5
8: I feel very unhappy and hopeless about my life right now 1 2 3 4 5

RESPONSE TO STRESS



Read the following statements and mark the category that best describes how you handle the stress in your life:


1: I get easily upset with minor problems 1 2 3 4 5
2: I find it difficult to get along with people I used to enjoy 1 2 3 4 5
3: I find that little gives me pleasure anymore 1 2 3 4 5
4: I find that I am constantly thinking about my problems 1 2 3 4 5
To handle my reactions to stress...


5: I try to manage my stress in the moment it happens 1 2 3 4 5
6: I try to breathe deeply or relax 1 2 3 4 5
7: I try to activate a positive emotion 1 2 3 4 5
8: I try to do physical exercise or some other activity 1 2 3 4 5
9: I try to be less judgmental when feeling angry at myself 1 2 3 4 5
10: I try to change to hopeful feelings when feeling depressed 1 2 3 4 5
11: I try to become more peaceful when I'm feeling anxious 1 2 3 4 5
12: I try to share my feelings with someone I feel close to 1 2 3 4 5

WELL-BEING



Read the following statements and mark the category that best describes how you feel:

When dealing with problems and difficulties in my life...


1: I try to be as flexible and adaptable as possible 1 2 3 4 5
2: I try to be optimistic and hopeful about the outcome 1 2 3 4 5
3: I try to welcome these as opportunities for personal growth and change 1 2 3 4 5
In reflecting on how I live my day-to-day life...


4: I generally feel happy with who I am as a person 1 2 3 4 5
5: I believe that I matter as an individual and that I make a difference in the lives of others 1 2 3 4 5
6: I feel that there is someone in my life who cares about me and loves me no matter what 1 2 3 4 5
7: I feel grateful for the gift of my life and I appreciate all it is has brought me, both good and bad 1 2 3 4 5
8: I feel that I am able to influence my life for the better 1 2 3 4 5
9: Spiritual belief and practice is an important part of how I live my life 1 2 3 4 5
Take a moment to reflect on your life experience over the past three months, and indicate how often you have felt the way described in each statement below.


10: I feel calm and peaceful inside 1 2 3 4 5
11: I feel appreciation for the care I receive from those around me 1 2 3 4 5
12: I wake up feeling hopeful and look forward to the promise of each new day 1 2 3 4 5
13: I approach situations with a cheerful feeling 1 2 3 4 5
14: I feel a warm, loving connection to nearly everyone and everything in my life 1 2 3 4 5
15: I feel enlivened and enthusiastic about what I am doing in my life 1 2 3 4 5
16: I feel a strong sense of joy and delight about how wonderful life is 1 2 3 4 5
17: I feel a heartfelt passion for almost everything I do