Post-traumatic stress disorder among refugees and IDPs from...

Advising team:

Varduhi Petrosyan, MS, PhD

Vahe Khachadourian, MD, MPH

Post-traumatic stress disorder

among refugees and IDPs

from Eastern Ukraine military conflict zone

Master of Public Health Integrating Experience Project

Research grant proposal framework

by

Alina Bykova, MS, MPH Candidate

School of Public Health

American University of Armenia

Yerevan, Armenia, 2016

i

Table of Contents List of Abbreviations ................................................................................................................................. iii

Acknowledgements .................................................................................................................................... iv

Executive summary ..................................................................................................................................... v

1. Specific Aims ....................................................................................................................................... 1

2. Background ......................................................................................................................................... 2

a. Problem definition .......................................................................................................................... 2

b. History of PTSD .............................................................................................................................. 3

c. Magnitude ........................................................................................................................................ 3

d. Symptoms......................................................................................................................................... 4

e. Key determinants ............................................................................................................................ 5

f. Consequences of PTSD ................................................................................................................... 5

g. Refugees ........................................................................................................................................... 6

h. Situation in Ukraine ........................................................................................................................ 7

3. Research questions .............................................................................................................................. 8

4. Methods ................................................................................................................................................ 9

a. Study design ..................................................................................................................................... 9

b. Study setting and study population ............................................................................................... 9

c. Sample size ..................................................................................................................................... 10

d. Sampling ........................................................................................................................................ 11

e. Variables ........................................................................................................................................ 11

f. Instruments .................................................................................................................................... 12

g. Data management and analysis ................................................................................................... 14

5. Ethical considerations ....................................................................................................................... 15

6. Costs/budget ...................................................................................................................................... 16

Reference list ............................................................................................................................................. 17

Appendix 1. Map of global conflicts ........................................................................................................ 32

Appendix 2. PTSD criteria in DSM-IV versus DSM-5 .......................................................................... 33

Appendix 3a. LEC-5 (Life Events Checklist for CAPS-5)..................................................................... 35

Appendix 3b. LEC-5 (Life Events Checklist for CAPS-5) – Russian version ..................................... 37

Appendix 3c. CAPS-5 (CLINICIAN-ADMINISTERED PTSD SCALE FOR DSM-5) ..................... 39

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Appendix 3d. CAPS for DSM-IV - Russian version .............................................................................. 72

Appendix 4a. Center for Epidemiologic Studies Depression Scale (CES-D) ....................................... 89

Appendix 4b. Center for Epidemiologic Studies Depression Scale (CES-D) - Russian version ......... 90

Appendix 5a. Demographic questions ..................................................................................................... 91

Appendix 5b. Demographic questions – Russian version ...................................................................... 93

Appendix 6a. WHOQOL-BREF .............................................................................................................. 95

Appendix 6b. WHOQOL-BREF – Russian version ............................................................................... 99

Appendix 7. Budget ................................................................................................................................. 102

Appendix 8. Timeline .............................................................................................................................. 103

iii

List of Abbreviations

WHO World Health Organization

PTSD Post Traumatic Stress Disorder

IDP Internally Displaced person

APA American Psychiatric Association

DSM Diagnostic and Statistical Manual of Mental Disorders

ASD Acute Stress Disorder

UN United Nation

UNHCR Office of the United Nations High Commissioner for Refugees

SES Socioeconomic Status

ICD International Statistical Classification of Diseases and Related Health Problems

CAPS Clinician-Administrated PTSD Scale

QIDS Quick Inventory of Depressive Symptomatology

WHOQOL World Health Organization Quality of Life Instrument

SPSS Statistical Package for the Social Sciences

ID Identification

iv

Acknowledgements

I would like to express my deepest gratitude to everyone, providing me with the

possibility to complete this thesis project with their continuous support and inspiring

encouragement: my family, my friends and AUA community.

A special appreciation to the project advising team - Drs. Varduhi Petrosyan and Vahe

Khachadourian for their patience, guidance, support, feedbacks, improvements and advice during

the writing of the research proposal.

I am very grateful to the MPH program faculty and CHSR staff for their immense

knowledge, pedagogical skills and best human values. Learning from them has been a big

pleasure for me.

v

Executive summary

Specific aims. The proposed project aims to study the prevalence of post-traumatic stress

disorders (PTSD) among East Ukrainian refugees/internally displaced persons (IDPs) as well as

key factors related to PTSD occurrence and severity. Analysis and discussion of the study results

will help to develop recommendations for the efficient intervention mechanisms for quick

rehabilitation of victims of violence during armed conflict in Eastern Europe.

Background. PTSD is the most frequent mental health problem, resulting from the

exposure to a traumatic event, such as a natural disaster, a serious accident, a terrorist act,

war/combat or other violent assault. PTSD prevalence increase substantially within conflict-

affected population. Symptoms include persistent remembering and re-experiencing of the

event, flashbacks, prolonged psychological distress, negative emotional state, numbing,

increased psychological sensitivity and arousal, avoidance of thoughts and feelings associated

with the trauma. Different risk/resilience factors determine whether a person will get PTSD or

not (age, gender, SES, educational level, psychiatric history, individual psychological factors,

genetic predisposition, and others). PTSD symptoms negatively influence the well-being and

productivity of a particular individual and the whole society. Mental health becomes one of the

priority issues among refugees/IDPs who are living with “psychological war wounds”. More

than 3 million people have fled the fighting in eastern Ukraine and moved. Experts announced

that 25% of forcibly displaced Ukrainians develop depression and anxiety symptoms. The topic

of high prevalence of PTSD among Ukrainian refugees/IDPs is very important and needs to be

studied rigorously.

Method. Cross-sectional observational study design is proposed for the investigation of

the problem. The target population are the internally displaced adult population and the adult

refugees to the neighboring Russian cities, who were exposed to the military violence in Eastern

Ukraine. The proposed study will be conducted in shelters, transit camps, and refugees/IDPs

centers. Sample size is calculated to be 385. Systematic random sampling will be done. The

psychometric tools such as CAPS-5, LEC-5, CES-D, WHOQOL-BREF that are DSM-5

validated are proposed to be used as the study instruments. Statistical analysis will reveal the

trends and will serve as basis for the recommendations.

Ethical considerations. Participation will be confidential, voluntary, without any

physical and social harm. The benefit of the study is its contribution to future intervention

programs and research.

Budget. The estimated budget of the study totals to 83,700 UAH. The planned duration

is three months, in accordance to estimated timeline of activities.

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1. Specific Aims

During the recent years the world has witnessed numerous military conflicts in Africa,

the Middle East and Eastern Europe, including the refugee crisis in Syria and neighboring

countries; heavy fighting on the territory of Syria, Israel, Iraq, Central African Republic,

Democratic Republic of Congo, Somalia, South Sudan and Eastern Ukraine 1–4 (appendix 1).

Millions of people were affected during these armed conflicts. They are suffering from violence,

injuries, diseases outbreaks, displacements, food shortages, losses of beloved family members.5–

15 Psychological distress and other mental health problems are very common in such stressful

situations.16–19

To respond to this challenge we need to better understand the scope and the nature of the

problem and the needed resources to address them. Measures should be taken to assess not only

physical but also mental health effects of military conflicts. Psychological condition is very

important to the overall well-being and productivity not only of particular individuals but also

the whole society recovering from emergencies.20–22

WHO states “Mental disorders are common, disabling and usually untreated”.23 Among

them post-traumatic stress disorder (PTSD) is the most common consequence of military

conflicts.24–28 There are numerous other psychopathologies among victims of traumatic events

(e.g. acute stress disorder, depression, reactive attachment disorder, disinhibited social

engagement disorder, adjustment disorder, behavioral disorders, alcohol/substance use problems,

self-harm/suicide, medically unexplained somatic complaints),29–34 but many of them may also

occur in the absence of identifiable stressful life events.35–38 The Ukrainian political crisis

starting 2013 with subsequent military conflict in Donbass area led to numerous problems related

to the quality of life and health of people leaving there.39–44 Millions of people were affected in

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Eastern Ukraine.45 About 3.7 million people have fled the fighting in eastern Ukraine and

moved.46,47 Having in mind that IDPs and refugees are at higher risk for PTSD48–50 and it can be

one of the main internal barriers for adaptation51 to the normal peaceful life, research on this

topic is highly important. This type of research has never been conducted in Ukraine, as the

country was not involved in military conflicts for the last more than 25 years of its independent

history.

The proposed project aims to focus on the burden of mental disorders and PTSD in

particular. This proposal is about a study on the assessment of the prevalence of PTSD among

East Ukrainian IDPs/refugees in order to analyze the effect of violence associated with armed

conflict on mental health and exploration of key risk factors related to occurrence and severity of

PTSD. Analysis and discussion of the study results will help to develop recommendations for

the efficient intervention mechanisms for quick rehabilitation of victims of violence during

armed conflict in Eastern Europe.

2. Background

a. Problem definition

Prevalence of exposure to traumatic events worldwide is very high. In a WHO study

covering 21 countries, more than 10% of respondents reported witnessing violence (21.8%) or

experiencing interpersonal violence (18.8%), accidents (17.7%), exposure to war (16.2%) or

trauma to a loved one (12.5%). 52 Large proportions of populations in many countries have been

exposed to terrorism, forced relocation, and violence.6 Those may cause different mental

problems. PTSD is the most commonly studied and probably the most frequent and debilitating

psychological disorder that occurs after traumatic events and natural or man-made

disasters.24,36,37,53–56

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PTSD is a mental health disorder that some people get after seeing or living through a

dangerous event; it can occur to people who have experienced (directly or indirectly) or

witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act,

war/combat, or rape or other violent personal assault.57 When in danger, it is natural to feel fear.

This fear triggers many rapid changes in the body to prepare to defend against the danger or to

avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from

harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel

stressed or frightened even when they are no longer in danger.58 People with PTSD may re-

experience the event through intrusive memories, flashbacks and nightmares.59,60 They try to

avoid things that may remind them of the trauma and disrupt their lives.23,57,61

b. History of PTSD

PTSD was originally known as combat fatigue, shell shock, or war neurosis.20 Cases of

PTSD were first documented during the World War I when soldiers developed shell shock as a

result of the harrowing conditions in the trenches. But the condition was not officially

recognized as a mental health condition until 1980, when it was included in the Diagnostic and

Statistical Manual of Mental Disorders (DSM) developed by the American Psychiatric

Association (APA).62

c. Magnitude

The lifetime prevalence of PTSD among the general population is about 3.6% for men

and 9.7% for women.63 Rates of a wide range of mental health problems increase as a result of

emergencies. Rigorous studies have shown that the prevalence of depression and PTSD

increases substantially within conflict-affected populations.20,30,50,64–67 A meta-analysis of post-

conflict studies using representative samples and full diagnostic assessment found that 15.4% of

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people reported having PTSD and 17.3% depression.68 The rates of PTSD among veterans of

military conflicts varies from 10% to 30%.69–72

d. Symptoms

Commonly used and internationally recognized standard criteria for the diagnostic and

classification of mental disorders are published by APA in DSM.60,73 The latest edition of DSM

(DSM-5) was introduced in 2013.60,74 Revisions in the DSM-5 are proved to be notable and

evidence-based.60,75–79 There were three major PTSD symptom clusters in the previous DSM

edition (DSM-IV): re-experience, avoidance/numbing, and arousal.59 There are four PTSD

symptoms clusters in DSM-5, because the avoidance/numbing cluster is divided into two

separate clusters: avoidance and negative alterations in cognitions and mood.58–60 Appendix 2

presents detailed information on the diagnostic symptoms in DSM-IV and DSM-5.

Rigorous studies show that in all age groups, features associated with PTSD include

nervousness, anger, insomnia, nightmares, flashbacks, mood disorders, numbing, attention deficit

problems, anhedonia and medically unexplained complaints.34,57,60,80 PTSD symptoms of hyper-

arousal accompanying re-experience may include increase in blood pressure and heart rate,

hyperventilating, mood swings, fatigue.59,60,80–82

Common comorbid disorders with overlapping symptoms are depression, anxiety,

somatization, borderline personality disorders, neurocognitive disorder due to traumatic brain

injury, phobia, panic disorder, obsessive-compulsive disorder, suicidal ideation and substance

addiction.52,60,83–92 In addition, children with PTSD often display regressive behaviors, such as

bedwetting, clinging and temper tantrums.93,94 In adolescents with PTSD, risk-taking behavior is

a common feature.95,96

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It is expected to have some of these symptoms after a dangerous event. Sometimes

people demonstrate very serious symptoms which go away after a few weeks. This is called

acute stress disorder or ASD. When the symptoms last for more than four weeks and become an

ongoing problem, they might be PTSD.59,60 Some people with PTSD do not show any symptoms

for weeks or months (PTSD with delayed expression).58

e. Key determinants

Not everyone who lives through a dangerous event gets PTSD. Many factors play a role

in whether a person will get PTSD or not.67,82,97–99 Some of these are risk factors that make a

person more likely to get PTSD: female gender97,100–103, younger age97,102–105, low socio-

economic status (SES)97,106,107, lack of education97,104, low intelligence97,108,109, race (minority

status)97,104,110, psychiatric history97,103,104,107,111, childhood abuse67,96–98,107, other previous

trauma97,102,105,107,111,112 family psychiatric history27,97,107,111,113, trauma severity97,103,107, lack of

social support/social interactions97,98,107,111,copying style63,80,81,97,99,107,114, individual

psychological factors.80,97,99,107,115 The opposite factors, called resilience factors, can help reduce

the risk of the disorder.80,81,97,99,114,115

f. Consequences of PTSD

PTSD symptoms may negatively influence the daily routine, work and social interactions

of individuals; these symptoms can make it hard to sleep, eat, concentrate, or control

emotions.58,80,97,99,103,107 PTSD symptoms are the main internal barriers for adaptation to the

normal peaceful life after experiencing stressful event.18,20,21,37,112 Health and quality of life of

those having PTSD also may be affected by common comorbid psychopathologies (depression,

anxiety, somatization, borderline personality disorders, neurocognitive disorder due to traumatic

brain injury, phobia, panic disorder, obsessive-compulsive disorder, suicidal ideation and

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substance addiction).52,60,83–92 Continuous PTSD may lead to deviant behavior, violence, and

suicide.22,25,36,37,116,117

Traumatic or stressful experiences are linked to a number of physical health

conditions.81,82,97 Numerous publications on stress-associated illnesses such as heart disease,

gastric diseases, lung disease, major depression, diabetes, and psycho-neuroendocrine-immune

interaction problems show additional social and economic burden of PTSD with work days lost

to “stress, depression and anxiety” having increased by 24% since 2009, and days lost to serious

mental illness having doubled. 80,118–124

g. Refugees

In 2015, the United Nations High Commissioner for Refugees (UNHCR) estimated that

59.5 million people worldwide have been forced to flee their homes by wars, conflict and

persecution.125 This is the highest known historical level.125 One out of every 122 people

worldwide is now a refugee, asylum seeker or displaced person.125 According to UNHCR

Resettlement Handbook (2002), PTSD among refugees ranges from 39% to 100% , compared to

1% for the general population.126 Recent articles also highlights that refugees experience

extraordinary rates of PTSD (84%). 127,128 Prevalence estimates have however ranged from as

low as 5% to the highest 89%, depending mostly on the socio-economic situation in the host

country and the quality of the studies (in particular the sampling method).37,50,71,82,84,129–132

According to a comprehensive systematic review of the literature, the prevalence of PTSD

among refugees is approximately 9%.50 Even this relatively small rate is enough to state that

refugees resettled in western countries could be about ten times more likely to have PTSD than

age-matched general populations in those countries.50

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The situation is very important, however, the psychological support is not the single issue

in a situation of crisis, because there are numerous vital problems with security, basic services,

and the community and family support.133 At the same time, those with mental problems may

join the armed groups and get weapons into their hands, increasing public health risks.134

Moreover, mental well-being becomes the priority issue among survivors, refugees, who are now

living in a safe environment but with the “psychological war wounds”.133

h. Situation in Ukraine

During the last century Ukraine has been facing numerous stresses: October Revolution,

Civil War, struggling for independence, World War I, World War II, Stalin repressions,

“holodomor”, Chernobyl disaster, economically devastating collapse of the Soviet Union,

political instability with opposition movements/revolutions, low income level, and others.135–138

In addition, many industrial catastrophes such as frequent fatal methane blasts at coal mines,

where the majority of the male population of the region is employed, took place in Eastern

Ukraine.139 Finally, more than two year lasting military conflict devastated the region

dramatically.39–41,44,45,140,141

As a result of the ongoing fighting between armed groups and government forces in

Eastern Ukraine, people have been forced to leave their homes and have become increasingly

vulnerable as the conflict continues. As of April 2015, over 1,177,748 people are registered as

internally displaced (IDPs) and about 600,000 have fled to neighboring countries.141–145 As of

May 2016, The Ministry of Social Policy of Ukraine has registered 1,783,900 IDPs (1,444,165

householders from Donbass and Crimea).46 As of June 2016, according to government sources

in receiving countries, the total number of Ukrainians seeking asylum or other forms of legal stay

in neighboring countries now stands at 1,389,452, with the majority going to the Russian

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Federation (1,092,212) and Belarus (139,143)47 and others going to other neighboring countries:

261 Ukrainians sought asylum in Moldova, 79 in Romania, 71 in Hungary and 26 in Slovakia.47

As of June 2016, since the beginning of the crisis, here were 7,967 applications for international

protection in Germany, 7,267 in Italy, 5,153 in Poland, 3,176 in France and 2,742 in Sweden.47

During the international conference on the topic: “War trauma: psychological aid and

rehabilitation”, experts announced that 25% of persons displaced from Eastern Ukraine

developed depression and anxiety symptoms.146 The rates are higher among those who have

gone through the hell of combat, shelling and the death of friends.147

After getting back to the peaceful life, in addition to stress disorders related to military

acts, stresses related to social adaptation of refugees and internally displaced population happen.

Evidence suggests that adaptation to apparently similar settings is not necessarily easy, and

refugees themselves draw attention to cultural dissimilarity in settings that western researchers

judge to be similar on the basis of religion and language.148

The topic of high prevalence of PTSD among IDP and refugees from Eastern Ukraine is

widely used in Ukrainian and Russian press. PTSD research among refugees and IDP from

Eastern Ukraine is very important in order to identify the scope of the problem correctly and to

elaborate appropriate intervention, applying adequate psycho-correction methods.

3. Research questions

The proposed study will address the following research questions:

What is the prevalence rate of PTSD among IDPs and refugees from Eastern Ukraine

affected by the military conflict?

http://www.segodnya.ua/regions/donetsk/u-25-pereselencev-simptomy-depressii-i-trevogi-ekspert-ukrainskogo-nii-socialnoy-i-sudebnoy-psihiatrii-i-narkologii-moz-ukrainy-570320.html-570320-570320.html

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What are the risk factors and resilience factors associated with the PTSD occurrence

among IDPs and refugees from Ukraine affected by the military conflict?

4. Methods

In order not to overestimate the disease prevalence random sample should be used,

sample size should be large enough, and semi-structured interview should be used.149 The

interviewer should be trained on conducting the tests, controlling of the interviewer should be

done. The interviewer should speak Russian and tests should be done in Russian, as according to

the 2001 census, Russian is the main language of 74.9% of residents in Donetsk Oblast and

68.8% in Luhansk Oblast.150,151

a. Study design

A cross-sectional observational study design is proposed in order to investigate the

displaced Ukrainians from different IDP/refugee camps at a single point in time. The benefit of

a cross-sectional study design is that it is relatively quick and easy to conduct. The prevalence of

disease can be studied for assessing the burden of disease in a representative sample of the

selected target population and for planning and allocating health resources, good for descriptive

analyses and for generating hypotheses. However, cross-sectional studies may not provide

definite information about cause-and-effect relationships. Another problem with this design

might be the bias due to possible low response rate and recall bias.152,153

b. Study setting and study population

The target population is the internally displaced adult population/refugees who were

exposed to ongoing military violence in Eastern Ukraine. The proposed study would be

conducted in areas densely populated with IDPs (shelters/IDPs centers in Svyatogorsk,

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Sloviansk, Kramatorsk, Konstantinovka, Artemivsk, Bilovodsk, Krasni Liman,

Nikolayevka)154,155 and in transit camps with module houses (Kharkiv, Zaporozhia,

Dnipropetrovsk, Dniprodzerzhy, Kryvyi Rih, Nikopol, Pavlohrad).155,156 Refugees will be

investigated in Russian cities neighboring to the conflict zone (Belgorod, Donetsk and

Rostov).157,158

Inclusion criteria are: living in IDPs center/refugees center (which means: living in

Ukraine during the military conflict; being exposed to ongoing military violence directly or

indirectly (by learning that a close relative or close friend was exposed to trauma or

violent/accidental death); being IDP/refugee); being adult (18+years old) at the moment of the

exposure to the military violence; knowing Russian. The only exclusion criterion is being

children (0-18 years old).

c. Sample size

For this study, a sample size calculation based on alpha level of 0.05 and power of 0.8

for a population of 3,173,352 displaced individuals (1,783,900 IDPs ( as of May 2016)46 +

1,389,452 registered refugees (as of June 2016)47 ), and expected PTSD prevalence of 25%146,

the number of surveyed people should be equal to 385 . The number should be adjusted on non-

response rate after the pilot study (see below). The sample size n159–161 and margin of error E

are given by

x = Z(c/100)2r(100-r)

n = N x/((N-1)E2 + x)

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E = Sqrt[(N - n)x/n(N-1)]

where N is the population size, r is the fraction of responses, and Z(c/100) is the critical value,

for the confidence level c. This calculation is based on the Normal distribution. Calculation was

run on sample size calculator website recommended in peer reviewed public health journals.161

The same result was obtained with “Epi info 7” calculator, recommended by the Centers for

Disease Control and Prevention .159,160

Additionally, we propose to conduct pilot study in order to define contact/response rate

for adjusting calculated sample size for anticipating non-responses/refusals.

d. Sampling

The participants of this study should be randomly selected in the areas of dislocation

through the systematic random sampling. Investigator will get the sampling frame of all eligible

participants from the administration of the dislocation camps (shelters/transit camps with module

houses/other IDP and refugee centers in Ukraine and in neighboring to the conflict zone Russian

cities)154–158, then will give ID numbers to all participants and will choose the interval by

dividing the total number of the sampling frame by the sample size and will choose the first

participant with the help of Excel RANDBETWEEN function for the numbers between one and

the size of the interval.

e. Variables

The dependent variable of the study will be the PTSD score, obtained with the Clinician

Administrated PTSD scale and measured on a continuous scale.162–164

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Independent variables are the risk and resilience factors suggested by the comprehensive

literature reviews.27,50,66,68,80,81,97-118,130,164,165 They will be measured with demographic questions

(age at the time of exposure, gender, ethnicity, marital status, socioeconomic status (SES),

educational level, employment status, number of people in the family, psychiatric precondition,

family history of mental illness) and with the domains of WHO quality of life assessment

instrument (social interactions, social support, physical and psychological wellbeing). Exposure

to other stressful life event in the past will be investigated with the LEC-5 (trauma assessment

instrument for CAPS-5).

Depression score will be studied as individual independent variable. Depression is the

major comorbid disorder with many overlapping symptoms (confounder for our study). Having

in mind the DSM-5 H diagnostic criterion (other illnesses with overlapping symptoms should be

eliminated), we decided to control for depression during the statistical analysis. Depression

score will be measured with CES-D scale on a continuous basis.

f. Instruments

DSM-5 criteria is used to choose appropriate research tools. It was chosen as one of the

internationally recognized classifications widely used by clinicians and researchers in different

contexts.60,73 The new 5th revision of DSM is supported by strong empirical evidence, review

articles and position papers.60,75–78,165,167–176

The Clinician Administrated PTSD scale (CAPS-5) which is DSM-5 validated and will

be translated/adapted in Russian will be used as the main study instrument. CAPS is the “gold

standard” for PTSD diagnosis and assessment, as it has good psychometric properties across a

wide variety of clinical populations and research settings 162–164,177–184 This is an interviewer-

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administrated test which takes 30-60 minutes. CAPS-5 contains 30 questions assessing all PTSD

symptoms, required for diagnosis in DSM-5, including the frequency and severity of symptoms.

We propose to revise commonly used Russian version of CAPS for DSM-IV181–185

(appendix 3d) in accordance with the available English version of CAPS-5186 (appendix 3c).

There are several important changes in the revised CAPS updated for DSM-5 (a single (instead

of up to three) index trauma to serve as the basis of symptom inquiry; questions on added

symptoms; changes in questions corresponding to the changes in DSM diagnostic criteria; rating

with a single severity score).186

As part of the trauma assessment (Criterion A), the Life Events Checklist for CAPS-5

(LEC-5) 186,187 will also be used to identify experience of traumatic stressors (appendixes 3a-3b).

The Life Events Checklist for DSM-5 (LEC-5) is a self-report measure designed to screen for

potentially traumatic events in a respondent's lifetime. The LEC-5 assesses exposure to 16

events known to potentially result in PTSD or distress and includes one additional item assessing

any other extraordinarily stressful event not captured in the first 16 items.

The 20-item Center for Epidemiological Studies-Depression (CES-D) scale (appendix 4a)

translated into Russian (appendix 4b) is chosen to assess the severity of depressive symptoms,

which are common PTSD comorbid disorder with numerous overlapping

symptoms.22,32,50,60,63,95,171,175,188–190 The CES-D was originally published by Radloff in 1977191,

the revised CESD-R was produced in 2004 by Eaton192, and still it is a reliable psychometric tool

with good sensitivity and specificity and high internal consistency191,193–196 Russian translation is

also widely used, is reliable, and valid.197–205

Demographic questions (appendixes 5a-5b) will help to investigate common

risk/resilience factors, in particular age at the time of exposure, gender, ethnicity, marital status,

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socioeconomic status (SES), educational level, employment status, number of people in the

family, psychiatric precondition, family history of mental illness, pro-Russian/pro-Ukrainian

position. Self-assessed social interactions, social support (environment), physical and

psychological wellbeing will be assessed within the domains of The World Health Organization

Quality of Life questionnaire (WHOQOL-BREF) 206–210 (appendixes 6a-6b). Exposure to other

stressful life event in the past will be investigated with the LEC-5, which also will be used as

trauma assessment instrument for CAPS-5 (appendixes 3a-3b).

Other risk factors (copying style63,80,81,97,99,107,114, individual psychological factors

80,97,99,107,115, severity of trauma97,103,107) will not be assessed, because they are considered as

additional (not the main) and studying them will demand a lot of time from each respondent and

will increase reluctance to participate in investigation and non-response-rate.

g. Data management and analysis

SPSS 21.0 software will be used for data entry. Double entry will be conducted with

subsequent data cleaning to minimize possible data entry error and thereby increase the quality

of the database.

The statistical analysis will be carried out using SPSS 21.0 software. Final report will

provide descriptive statistics by gender in frequency, percentage, mean, standard deviation and

range. Chi-square test will be done to test possible differences between groups in terms of

categorical variables. Student’s T-test will be used to compare the continuous variables. Taking

into consideration that the PTSD is measured on a continuous scale, simple and multivariable

linear regression may also be used to study the role of the independent variables in developing

PTSD.

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5. Ethical considerations

Although the proposed study will not pose risk of physical or social harm for participants,

it targets vulnerable population and might cause emotional distress. The time also may be

considered to be a burden for the participants. On the other hand, the benefit of the study is its

contribution to future intervention programs and research. The information obtained from

participants might help to develop comprehensive and integrated public health interventions for

the refugees and IDP from Eastern Ukraine who are suffering from PTSD. Sampling method

will provide equal chances for everyone meeting the inclusion criteria to participate in the study

which will address matters of equity and equality.

All the forms that include personal information will be destroyed after the completion of

the last interview. The questionnaire will included some potentially identifiable data such as

gender, age and district. However, only the student investigator and the primary investigator will

have access to the electronic database, which will be password protected. The paper

questionnaires will be stored in a locked box and archived. The confidentiality of the

participants will be protected using four-digit ID codes.

Interviewers should be chosen among educated experienced psychologists or

psychotherapists. They should be trained on the Subject of Ethical Considerations in Human

Research. Native speaking specialists should conduct the study. The interviewer will start the

interview only after obtaining the oral informed consent of the participants. The oral consent

form will include information on the aims and objectives of the study, terms of participation and

termination, confidentiality and anonymity of the study subjects. The participation in this study

is voluntary and the refusal to participate will not pose any threat to the participant. Only well-

grounded, reliable, relevant and valid instruments (translated and adapted if needed) will be used.

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The research will start only after the approval by the Institutional Review Board of the American

University of Armenia.

6. Costs/budget

It is recommended to rent office and hire personnel in Slavyansk. Low rates, higher

availability of human resources and the city being situated nearby numerous IDPs site will

ensure high cost-efficiency. The budget accounts for personnel salaries. Those are equal to the

local rates for similar involvement. The research team will include a project coordinator,

interviewers, data enterers and a statistician. The interviewers and data entry staff will receive

salaries per completed interview or data entry (1 completed interview/data entry should include

demographic questions, CAPS-5, CES-D, WHOQOL-BREF completed with one respondent).

Project coordinator and statistician will receive salaries on monthly basis. Human Research

Subject protection trainings for the interviewers and other involved staff members should be

considered. Administrative expenses consist of such basic needs as rent of the building, the cost

of utilities and transportation costs. Other costs include office supplies and printing of the

materials. The overall budget of the proposed project is estimated to be 83,700 UAH. Appendix

7 presents detailed breakdown of the estimated budget. The anticipated duration of the project is

three months. Appendix 8 presents the timeline for scheduled activities.

17

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32

Appendix 1. Map of global conflicts

33

Appendix 2. PTSD criteria in DSM-IV versus DSM-5

35

Appendix 3a. LEC-5 (Life Events Checklist for CAPS-5)

Life Events Checklist-5

Instruction on filling in the form:

Listed below are a number of difficult or stressful things that sometimes happen to people.

For each event check one or more of the boxes to the right to indicate that:

(a) it happened to you personally;

(b) you witnessed it happen to someone else;

(c) you learned about it happening to a close family member or close friend;

(d) you were exposed to it as part of your job (for example, paramedic, police, military,

or other first responder);

(e) you’re not sure if it fits;

(f) it doesn’t apply to you.

Be sure to consider your entire life (growing up as well as adulthood) as you go through the list

of events.

36

Questionnaire

# Event Happened

to me

Witnessed

it

Learned

about it

Part

of my

job

Not

sure

Does

not

apply

1 Natural disaster (e.g., flood, hurricane,

tornado, earthquake)

2 Fire or explosion

3 Transportation accident (e.g., car accident,

boat accident, train wreck, plane crash)

4 Serious accident at work/home/recreation

5 Exposure to toxic substance (e.g., dangerous chemicals, radiation)

6 Physical assault (e.g., being attacked, hit, slapped, kicked, beaten up)

7 Assault with a weapon (e.g., being shot, stabbed, threatened with a knife, gun, bomb)

8 Sexual assault (rape, attempted rape, made to perform any type of sexual act trough force or threat of harm)

9 Other unwanted or uncomfortable sexual experience

10 Combat or exposure to war-zone (in the military or as civilian)

11 Captivity (e.g., being kidnapped, abducted, held hostage, prisoner of war)

12 Life-threatened illness or injury

13 Severe human suffering

14 Sudden violent death (homicide/suicide)

15 Sudden accidental death

16 Serious injury, harm, or death you caused to someone else

17 Any other very stressful event or experience

37

Appendix 3b. LEC-5 (Life Events Checklist for CAPS-5) – Russian version

Контрольный список жизненных событий - 5

Инструкция для заполнения:

Ниже перечислен список сложных или стрессовых событий, которые иногда случаются в

жизни людей.

Для каждого события поставьте галочку в одной или несколких клеточках справа, чтобы

отметить что:

(a) это случилось с вами лично;

(б) вы стали свиделем того, как это случилось с кем-то другим;

(в) вы узнали, что это случилось с близким членом семьи или с близким другом;

(г) вы были подвержены этому в результате вашей профессиональной

деательности (например, врач скорой помощи, сотрудник полиции,

военнослужащий, сотрудник МЧС, или других служб быстрого реагирования);

(д) вы не уверены, что это применимо к вам;

(е) это неприменимо к вам.

Заполняя список событий, убедитесь в том, что вы учитываете пережитое вами в течение

всей жизни (в том числе в детстве, в подростковом возрасте и во взрослой жизни).

38

# Событие Случилось

со мной

Был

свиде

телем

Узнал

об

этом

Часть

моей

работы

Не

уверен

Не

применимо

1 Стихийное бедствие (напр., наводнение, ураган, землетрясение)

2 Пожар или взрыв

3 Транспортное происшествие (напр., ДТП,

Авария на воде; Авиакатастрофа; Ж-д катастрофа)

4 Серьезное происшествие дома/на работе/на отдыхе

5 Подвержение воздействию опасных токсичных веществ/ радиации

6 Физическое насилие (напр., подвергнуться нападение, получить удар, пощечину, пинок, укус)

7 Вооруженное нападение (напр., получить огнестрельное/ножевое ранение, запугивание оружием/ножом)

8 Сексуальное насилие (любой вид принужденного сексуального акта или попытка его совершить)

9 Другой нежеланный или дискомфортный сексуальный опыт

10 Участие в сражениях или прибывание в зоне военных действий ( в качестве военнослужащего или гражданского лица)

11 Пленение (напр., подвергнуться похищению, попасть в заложники, стать военнопленным)

12 Угрожающее жизни заболевание или травма

13 Тяжелые человеческие стратания

14 Внезапная насильная смерть (убийство/самоубийство)

15 Внезапная смерть от несчастного случая

16 Серьезная травма/вред/смерть, причиненные вами другому лицу

17 Любая другая очень стрессовая ситуация

39

Appendix 3c. CAPS-5 (CLINICIAN-ADMINISTERED PTSD SCALE FOR DSM-5)

National Center for PTSD

CLINICIAN-ADMINISTERED PTSD SCALE FOR DSM-5

PAST MONTH VERSION

Name: _______________________________

Interviewer: _______________________________

ID#: __________________

Date: __________________

Study:

_______________________________

Frank W. Weathers, Dudley D. Blake, Paula P. Schnurr,

Danny G. Kaloupek, Brian P. Marx, & Terence M. Keane

National Center for Posttraumatic Stress Disorder

May 1, 2015

40

INSTRUCTIONS

Standard administration and scoring of the CAPS-5 are essential for producing reliable and valid

scores and diagnostic decisions. The CAPS-5 should be administered only by qualified

interviewers who have formal training in structured clinical interviewing and differential

diagnosis, a thorough understanding of the conceptual basis of PTSD and its various symptoms,

and detailed knowledge of the features and conventions of the CAPS-5 itself.

ADMINISTRATION

Identify an index traumatic event to serve as the basis for symptom inquiry. Administer the Life

Events Checklist and Criterion A inquiry, or use some other structured, evidence-based method.

The index event may involve either a single incident (e.g., “the accident”) or multiple, closely

related incidents (e.g., “the worst parts of your combat experiences”).

Read prompts verbatim, one at a time, and in the order presented.

Use the respondent’s own words for labeling the index event or describing specific symptoms.

Rephrase standard prompts to acknowledge previously reported information, but return to

verbatim phrasing as soon as possible. For example, inquiry for item 20 might begin: “You

already mentioned having problems sleeping. What kinds of problems?”

If you don’t have sufficient information after exhausting all standard prompts, follow up ad lib.

In this situation, repeating the initial prompt often helps refocus the respondent.

As needed, ask for specific examples or direct the respondent to elaborate even when such

prompts are not provided explicitly.

In general, DO NOT suggest responses. If a respondent has pronounced difficulty

understanding a prompt it may be necessary to offer a brief example to clarify and illustrate.

However, this should be done rarely and only after the respondent has been given ample

opportunity to answer spontaneously.

DO NOT read rating scale anchors to the respondent. They are intended only for you, the

interviewer, because appropriate use requires clinical judgment and a thorough understanding of

CAPS-5 scoring conventions.

Move through the interview as efficiently as possible to minimize respondent burden.

Some useful strategies:

Be thoroughly familiar with the CAPS-5 so that prompts flow smoothly.

Ask the fewest number of prompts needed to obtain sufficient information to support a

valid rating.

Minimize note-taking and write while the respondent is talking to avoid long pauses.

Take charge of the interview. Be respectful but firm in keeping the respondent on task,

transitioning between questions, pressing for examples, or pointing out contradictions.

41

SCORING

As with previous versions of the CAPS, CAPS-5 symptom severity ratings are based on

symptom frequency and intensity, except for items 8 (amnesia) and 12 (diminished interest),

which are based on amount and intensity. However, CAPS-5 items are rated with a single

severity score, in contrast to previous versions of the CAPS which required separate frequency

and intensity scores for each item that were either summed to create a symptom severity score or

combined in various scoring rules to create a dichotomous (present/absent) symptom score.

Thus, on the CAPS-5 the clinician combines information about frequency and intensity before

making a single severity rating. Depending on the item, frequency is rated as either the number

of occurrences (how often in the past month) or percent of time (how much of the time in the

past month). Intensity is rated on a four-point ordinal scale with ratings of Minimal, Clearly

Present, Pronounced, and Extreme. Intensity and severity are related but distinct. Intensity refers

to the strength of a typical occurrence of a symptom. Severity refers to the total symptom load

over a given time period, and is a combination of intensity and frequency. This is similar to the

quantity/frequency assessment approach to alcohol consumption. In general, intensity rating

anchors correspond to severity scale anchors described below and should be interpreted and used

in the same way, except that severity ratings require joint consideration of intensity and

frequency. Thus, before taking frequency into account, an intensity rating of Minimal

corresponds to a severity rating of Mild / subthreshold, Clearly Present corresponds with

Moderate / threshold, Pronounced corresponds with Severe / markedly elevated, and Extreme

corresponds with Extreme / incapacitating.

The five-point CAPS-5 symptom severity rating scale is used for all symptoms. Rating scale

anchors should be interpreted and used as follows:

Absent. The respondent denied the problem or the respondent’s report doesn’t fit the DSM-5

symptom criterion.

Mild / subthreshold. The respondent described a problem that is consistent with the symptom

criterion but isn’t severe enough to be considered clinically significant. The problem doesn’t

satisfy the DSM-5 symptom criterion and thus doesn’t count toward a PTSD diagnosis.

Moderate / threshold. The respondent described a clinically significant problem. The problem

satisfies the DSM5 symptom criterion and thus counts toward a PTSD diagnosis. The problem

would be a target for intervention. This rating requires a minimum frequency of 2 X month or

some of the time (20-30%) PLUS a minimum intensity of Clearly Present.

Severe / markedly elevated. The respondent described a problem that is well above threshold.

The problem is difficult to manage and at times overwhelming, and would be a prominent target

for intervention. This rating requires a minimum frequency of 2 X week or much of the time (50-

60%) PLUS a minimum intensity of Pronounced.

Extreme / incapacitating. The respondent described a dramatic symptom, far above threshold.

The problem is pervasive, unmanageable, and overwhelming, and would be a high-priority target

for intervention.

42

In general, make a given severity rating only if the minimum frequency and intensity for that

rating are both met. However, you may exercise clinical judgment in making a given severity

rating if the reported frequency is somewhat lower than required, but the intensity is higher. For

example, you may make a severity rating of Moderate / threshold if a symptom occurs 1 X month

(instead of the required 2 X month) as long as intensity is rated Pronounced or Extreme (instead

of the required Clearly Present). Similarly, you may make a severity rating of Severe / markedly

elevated if a symptom occurs 1 X week (instead of the required 2 X week) as long as the intensity

is rated Extreme (instead of the required Pronounced). If you are unable to decide between two

severity ratings, make the lower rating.

You need to establish that a symptom not only meets the DSM-5 criterion phenomenologically,

but is also functionally related to the index traumatic event, i.e., started or got worse as a result of

the event. CAPS-5 items 1-8 and 10 (re-experiencing, effortful avoidance, amnesia, and blame)

are inherently linked to the event. Evaluate the remaining items for trauma-relatedness (TR)

using the TR inquiry and rating scale. The three TR ratings are:

Definite = the symptom can clearly be attributed to the index trauma, because (1) there is an

obvious change from the pre-trauma level of functioning and/or (2) the respondent makes the

attribution to the index trauma with confidence.

Probable = the symptom is likely related to the index trauma, but an unequivocal connection

can’t be made.

Situations in which this rating would be given include the following: (1) there seems to be a

change from the pre-

trauma level of functioning, but it isn’t as clear and explicit as it would be for a “definite;” (2)

the respondent attributes a causal link between the symptom and the index trauma, but with less

confidence than for a rating of Definite; (3) there appears to be a functional relationship between

the symptom and inherently trauma-linked symptoms such as re-experiencing symptoms (e.g.,

numbing or withdrawal increases when re-experiencing increases).

Unlikely = the symptom can be attributed to a cause other than the index trauma because (1)

there is an obvious functional link with this other cause and/or (2) the respondent makes a

confident attribution to this other cause and denies a link to the index trauma. Because it can be

difficult to rule out a functional link between a symptom and the index trauma, a rating of

Unlikely should be used only when the available evidence strongly points to a cause other than

the index trauma. NOTE: Symptoms with a TR rating of Unlikely should not be counted toward

a PTSD diagnosis or included in the total CAPS-5 symptom severity score.

CAPS-5 total symptom severity score is calculated by summing severity scores for items 1-20.

NOTE: Severity scores for the two dissociation items (29 and 30) should NOT be included in the

calculation of the total CAPS-5 severity score.

CAPS-5 symptom cluster severity scores are calculated by summing the individual item

severity scores for symptoms contained in a given DSM-5 cluster. Thus, the Criterion B (re-

experiencing) severity score is the sum of the individual severity scores for items 1-5; the

43

Criterion C (avoidance) severity score is the sum of items 6 and 7; the Criterion D (negative

alterations in cognitions and mood) severity score is the sum of items 8-14; and the Criterion E

(hyperarousal) severity score is the sum of items 15-20. A symptom cluster score may also be

calculated for dissociation by summing items 29 and 30.

PTSD diagnostic status is determined by first dichotomizing individual symptoms as “present”

or “absent,” then following the DSM-5 diagnostic rule. A symptom is considered present only if

the corresponding item severity score is rated 2=Moderate/threshold or higher. Items 9 and 11-

20 have the additional requirement of a trauma-relatedness rating of Definite or Probable.

Otherwise a symptom is considered absent. The DSM-5 diagnostic rule requires the presence of

least one Criterion B symptom, one Criterion C symptom, two Criterion D symptoms, and two

Criterion E symptoms. In addition, Criteria F and G must be met. Criterion F requires that the

disturbance has lasted at least one month. Criterion G requires that the disturbance cause either

clinically significant distress or functional impairment, as indicated by a rating of 2=moderate or

higher on items 23-25.

44

QUESTIONNAIRE

Criterion A:

Exposure to actual or threatened death, serious injury, or sexual violence

in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family member or close friend.

In cases of actual or threatened death of a family member or friend, the event(s) must

have been violent or accidental.

4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)

(e.g., first responders collecting human remains; police officers repeatedly exposed to

details of child abuse). Note: Criterion A4 does not apply to exposure through electronic

media, television, movies, or pictures, unless this exposure is work related.

[Administer Life Events Checklist or other structured trauma screen]

I’m going to ask you about the stressful experiences questionnaire you filled out.

First I’ll ask you to tell me a little bit about the event you said was the worst for you.

Then I’ll ask how that event may have affected you over the past month.

In general I don’t need a lot of information: just enough so I can understand your problems.

Please let me know if you find yourself becoming upset as we go through the questions -

so we can slow down and talk about it.

Also, let me know if you have any questions or don’t understand something.

Do you have any questions before we start?

The event you said was the worst was (EVENT).

What I’d like for you to do is briefly describe what happened.

Index event (specify):

What happened?

(How old were you?

How were you involved?

Who else was involved?

Was anyone seriously injured or killed?

Was anyone’s life in danger?

How many times did this happen?)

Exposure type:

Experienced ___

Witnessed ___

Learned about ___

Exposed to aversive details___

Life threat? NO YES

[self ___ other ___]

Serious injury? NO YES


Sexual violence? NO YES


Criterion A met?

NO PROBABLE YES

45

For the rest of the interview, I want you to keep (EVENT) in mind as I ask you about

different problems it may have caused you. You may have had some of these problems

before, but for this interview we’re going to focus just on the past month. For each problem

I’ll ask if you’ve had it in the past month, and if so, how often and how much it bothered

you.

Criterion B:

Presence of one (or more) of the following intrusion symptoms,

associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

1. (B1) Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

Note: In children older than 6 years, repetitive play may occur,

in which themes or aspects of the traumatic event(s) are expressed.

In the past month, have you had any unwanted memories of (EVENT)

while you were awake, so not counting dreams?

[Rate 0=Absent if only during dreams]

How does it happen that you start remembering (EVENT)?

[If not clear:]

(Are these unwanted memories, or are you thinking about [EVENT] on purpose?) [Rate 0=Absent unless perceived as involuntary and intrusive]

How much do these memories bother you?

Are you able to put them out of your mind and think about something else?

[If not clear:]

(Overall, how much of a problem is this for you? How so?)

Circle: Distress = Minimal Clearly Present Pronounced Extreme

How often have you had these memories in the past month?

# of times __________

Key rating dimensions = frequency / intensity of distress Moderate = at least 2 X month / distress clearly present,

some difficulty dismissing memories

Severe = at least 2 X week / pronounced distress,

considerable difficulty dismissing memories

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

46

2. (B2) Recurrent distressing dreams,

in which the content and/or affect of the dream are related to the event(s).

Note: In children, there may be frightening dreams without recognizable content.

In the past month, have you had any unpleasant dreams about (EVENT)?

Describe a typical dream. (What happens?)

[If not clear:]

(Do they wake you up?)

[If yes:]

(What do you experience when you wake up?

How long does it take you to get back to sleep?)

[If reports not returning to sleep:]

(How much sleep do you lose?)

How much do these dreams bother you?


How often have you had these dreams in the past month?

# of times __________

Key rating dimensions = frequency / intensity of distress Moderate = at least 2 X month / distress clearly present, less than 1 hour sleep loss

Severe = at least 2 X week / pronounced distress, more than 1 hour sleep loss

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

47

3. (B3) Dissociative reactions (e.g., flashbacks)

in which the individual feels or acts as if the traumatic event(s) were recurring.

(Such reactions may occur on a continuum,

with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.

In the past month, have there been times when you suddenly acted or felt

as if (EVENT) were actually happening again?

[If not clear:]

(This is different than thinking about it or dreaming about it –

now I’m asking about flashbacks,

when you feel like you’re actually back at the time of [EVENT],

actually reliving it.)

How much does it seem as if (EVENT) were happening again? (Are you confused about where you actually are?)

What do you do while this is happening? (Do other people notice your behavior? What do they say?)

How long does it last?

Circle: Dissociation = Minimal Clearly Present Pronounced Extreme

How often has this happened in the past month?

# of times __________

Key rating dimensions = frequency / intensity of dissociation Moderate = at least 2 X month / dissociative quality clearly present,

may retain some awareness of surroundings,

but relives event in a manner clearly distinct

from thoughts and memories

Severe = at least 2 X week / pronounced dissociative quality,

reports vivid reliving,

e.g., with images, sounds, smells

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

48

4. (B4) Intense or prolonged psychological distress at exposure to internal or external cues

that symbolize or resemble an aspect of the traumatic event(s).

In the past month, have you gotten emotionally upset

when something reminded you of (EVENT)?

What kinds of reminders make you upset?

How much do these reminders bother you?

Are you able to calm yourself down when this happens?

(How long does it take?)

[If not clear:]




# of times __________

Key rating dimensions = frequency / intensity of distress Moderate = at least 2 X month / distress clearly present,

some difficulty recovering

Severe = at least 2 X week / pronounced distress,

considerable difficulty recovering

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

49

5. (B5) Marked physiological reactions to internal or external cues that symbolize or

resemble an aspect of the traumatic event(s).

In the past month, have you had any physical reactions when something

reminded you of (EVENT)?

Can you give me some examples? (Does your heart race or your breathing

change? What about sweating or feeling really tense or shaky?)

What kinds of reminders trigger these reactions?

How long does it take you to recover?

Circle:

Physiological reactivity = Minimal Clearly Present Pronounced Extreme


# of times __________

Key rating dimensions = frequency / intensity of physiological arousal Moderate = at least 2 X month / reactivity clearly present,


Severe = at least 2 X week / pronounced reactivity, sustained arousal,


0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

50

Criterion C:

Persistent avoidance of stimuli associated with the traumatic event(s),

beginning after the traumatic event(s) occurred,

as evidenced by one or both of the following:

6. (C1) Avoidance of or efforts to avoid distressing memories, thoughts, or feelings

about or closely associated with the traumatic event(s).

In the past month, have you tried to avoid thoughts or feelings about (EVENT)?

What kinds of thoughts or feelings do you avoid?

How hard do you try to avoid these thoughts or feelings?

(What kinds of things do you do?)

[If not clear:]

(Overall, how much of a problem is this for you?

How would things be different if you didn’t have to avoid these thoughts/feelings?)

Circle:

Avoidance = Minimal Clearly Present Pronounced Extreme

How often in the past month?

# of times __________

Key rating dimensions = frequency / intensity of avoidance

Moderate = at least 2 X month / avoidance clearly present

Severe = at least 2 X week / pronounced avoidance

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

51

7. (C2) Avoidance of or efforts to avoid external reminders

(people, places, conversations, activities, objects, situations)

that arouse distressing memories, thoughts, or feelings associated with the traumatic event

In the past month, have you tried to avoid things that remind you of (EVENT),

like certain people, places, or situations?

What kinds of things do you avoid?

How much effort do you make to avoid these reminders?

(Do you have to make a plan or change your activities to avoid them?)

[If not clear:]


How would things be different if you didn’t have to avoid these reminders?)

Circle:

Avoidance = Minimal Clearly Present Pronounced Extreme


# of times __________

Key rating dimensions = frequency / intensity of avoidance

Moderate = at least 2 X month / avoidance clearly present

Severe = at least 2 X week / pronounced avoidance

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

52

Criterion D:

Negative alterations in cognitions and mood associated with the traumatic event(s),

beginning or worsening after the traumatic event(s) occurred,

as evidenced by two (or more) of the following:

8. (D1) Inability to remember an important aspect of the traumatic event(s)

(due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).

In the past month, have you had difficulty remembering

some important parts of (EVENT)? (Do you feel there are gaps in your memory of [EVENT]?)

What parts have you had difficulty remembering?

Do you feel you should be able to remember these things?

[If not clear:]

(Why do you think you can’t?

Did you have a head injury during [EVENT]?

Were you knocked unconscious?

Were you intoxicated from alcohol or drugs?) [Rate 0=Absent if due to head injury/loss of consciousness/intoxication during event]

[If still not clear:]

(Is this just normal forgetting?

Or do you think you may have blocked it out

because it would be too painful to remember?) [Rate 0=Absent if due only to normal forgetting]

Circle:

Difficulty remembering = Minimal Clearly Present Pronounced Extreme

In the past month, how many of the important parts of (EVENT) have you had

difficulty remembering? (What parts do you still remember?)

# of important aspects __________

Would you be able to recall these things if you tried?

Key rating dimensions = amount of event not recalled / intensity of inability to

recall Moderate = at least one important aspect / difficulty remembering clearly present,

some recall possible with effort

Severe = several important aspects / pronounced difficulty remembering,

little recall even with effort

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

53

9. (D2) Persistent and exaggerated negative beliefs or expectations about oneself/others/the world

(e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,”

“My whole nervous system is permanently ruined”).

In the past month, have you had strong negative beliefs about yourself,

other people, or the world?

Can you give me some examples?

(What about believing things like

“I am bad,”

“there is something seriously wrong with me,”

“no one can be trusted,”

“the world is completely dangerous”?)

How strong are these beliefs?

(How convinced are you that these beliefs are actually true?

Can you see other ways of thinking about it?)

Circle:

Conviction = Minimal Clearly Present Pronounced Extreme

How much of the time in the past month have you felt that way,

as a percentage? % of time __________

Did these beliefs start or get worse after (EVENT)?

(Do you think they’re related to [EVENT]? How so?)

Circle:

Trauma-relatedness = Definite Probable Unlikely

Key rating dimensions = frequency / intensity of beliefs Moderate = some of the time (20-30%) / exaggerated negative expectations

clearly present, some difficulty considering more realistic beliefs

Severe = much of the time (50-60%) / pronounced exaggerated negative

expectations, considerable difficulty considering more realistic beliefs

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

54

10. (D3) Persistent, distorted cognitions about the cause or consequences of the traumatic event(s)

that lead the individual to blame himself/herself or others.

In the past month, have you blamed yourself for (EVENT)

or for what happened as a result of it?

Tell me more about that.

(In what sense do you see yourself as having caused [EVENT]?

Is it because of something you did?

Or something you think you should have done but didn’t?

Is it because of something about you in general?)

What about blaming someone else for (EVENT)

or for what happened as a result of it?


(In what sense do you see [OTHERS] as having caused [EVENT]?

Is it because of something they did?

Or something you think they should have done but didn’t?)

How much do you blame (YOURSELF OR OTHERS)?

How convinced are you that [YOU OR OTHERS] are truly to blame for

what happened? (Do other people agree with you?

Can you see other ways of thinking about it?)

[Rate 0=Absent if only blames perpetrator, i.e., someone who deliberately

caused the event and intended harm]

Circle:

Conviction = Minimal Clearly Present Pronounced Extreme

How much of the time in the past month have you felt that way, as a

percentage? % of time __________

Key rating dimensions = frequency / intensity of blame Moderate = some of the time (20-30%) / distorted blame clearly present,

some difficulty considering more realistic beliefs

Severe = much of the time (50-60%) / pronounced distorted blame,

considerable difficulty considering more realistic beliefs

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

55

11. (D4) Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

In the past month, have you had any strong negative feelings

such as fear, horror, anger, guilt, or shame?


(What negative feelings do you experience?)

How strong are these negative feelings?

How well are you able to manage them?

[If not clear:]


Circle:

Negative emotions = Minimal Clearly Present Pronounced Extreme



Did these negative feelings start or get worse after (EVENT)?


Circle:


Key rating dimensions = frequency / intensity of negative emotions Moderate = some of the time (20-30%) / negative emotions clearly present,

some difficulty managing

Severe = much of the time (50-60%) / pronounced negative emotions,

considerable difficulty managing

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

56

12. (D5) Markedly diminished interest or participation in significant activities.

In the past month, have you been less interested in activities

that you used to enjoy?

What kinds of things have you lost interest in

or don’t do as much as you used to?

(Anything else?)

Why is that? [Rate 0=Absent if diminished participation is due to lack of opportunity, physical

inability, or developmentally appropriate change in preferred activities]

How strong is your loss of interest? (Would you still enjoy [ACTIVITIES] once you got started?)

Circle:

Loss of interest= Minimal Clearly Present Pronounced Extreme

Overall, in the past month, how many of your usual activities have you been

less interested in, as a percentage?

% of activities __________

What kinds of things do you still enjoy doing?

Did this loss of interest start or get worse after (EVENT)? (Do you think it’s related to [EVENT]? How so?)

Circle:


Key rating dimensions = percent of activities affected / intensity of loss of interest Moderate = some activities (20-30%) / loss of interest clearly present

but still has some enjoyment of activities

Severe = many activities (50-60%) / pronounced loss of interest,

little interest or participation in activities

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

57

13. (D6) Feelings of detachment or estrangement from others.

In the past month, have you felt distant or cut off from other people?


How strong are your feelings of being distant or cut off from others? (Who do you feel closest to?

How many people do you feel comfortable talking with about personal things?)

Circle:

Detachment or estrangement = Minimal Clearly Present Pronounced Extreme



Did this feeling of being distant or cut off start or get worse after (EVENT)? (Do you think it’s related to [EVENT]? How so?)

Circle: Trauma-relatedness = Definite Probable Unlikely

Key rating dimensions = frequency / intensity of detachment or estrangement Moderate = some of the time (20-30%) / feelings of detachment clearly present

but still feels some interpersonal connection

Severe = much of the time (50-60%) / pronounced feelings of detachment

or estrangement from most people,

may feel close to only one or two people

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

58

14. (D7) Persistent inability to experience positive emotions

(e.g., inability to experience happiness, satisfaction, or loving feelings).

In the past month, have there been times when you had difficulty experiencing

positive feelings like love or happiness?


(What feelings are difficult to experience?)

How much difficulty do you have experiencing positive feelings? (Are you still able to experience any positive feelings?)

Circle:

Reduction of positive emotions = Minimal Clearly Present Pronounced Extreme



Did this trouble experiencing positive feelings start or get worse after (EVENT)?

(Do you think it’s related to [EVENT]? How so?)


Key rating dimensions = frequency / intensity of reduction in positive emotions Moderate = some of the time (20-30%) / reduction of positive emotions present

but still able to experience some positive emotions

Severe = much of the time (50-60%) / pronounced reduction of experience

across range of positive emotions

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

59

Criterion E:

Marked alterations in arousal and reactivity associated with the traumatic event(s),

beginning or worsening after the traumatic event(s) occurred,

as evidenced by two (or more) of the following:

15. (E1) Irritable behavior and angry outbursts (with little or no provocation),

typically expressed as verbal or physical aggression toward people or objects.

In the past month, have there been times when you felt especially irritable

or angry and showed it in your behavior?


(How do you show it?

Do you raise your voice or yell?

Throw or hit things?

Push or hit other people?)

Circle:

Aggression = Minimal Clearly Present Pronounced Extreme


# of times __________

Did this behavior start or get worse after (EVENT)?

(Do you think it’s related to [EVENT]?How so?)


Key rating dimensions = frequency / intensity of aggressive behavior Moderate = at least 2 X month / aggression clearly present,

primarily verbal

Severe = at least 2 X week / pronounced aggression,

at least some physical aggression

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

60

16. (E2) Reckless or self-destructive behavior.

In the past month, have there been times when you were taking more

risks or doing things that might have caused you harm?


How much of a risk do you take?

(How dangerous are these behaviors?

Were you injured or harmed in some way?)

Circle:

Risk = Minimal Clearly Present Pronounced Extreme

How often have you taken these kinds of risks in the past month?

# of times __________

Did this behavior start or get worse after (EVENT)?



Key rating dimensions = frequency / degree of risk Moderate = at least 2 X month / risk clearly present, may have been harmed

Severe = at least 2 X week / pronounced risk,

actual harm or high probability of harm

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

61

17. (E3) Hypervigilance.

In the past month, have you been especially alert or watchful,

even when there was no specific threat or danger? (Have you felt as if you had to be on guard?)


(What kinds of things do you do when you’re alert or watchful?)

[If not clear:]

(What causes you to react this way?

Do you feel like you’re in danger or threatened in some way?

Do you feel that way more than most people would in the same situation?)

Circle:

Hypervigilance = Minimal Clearly Present Pronounced Extreme



Did being especially alert or watchful start or get worse after (EVENT)?


Circle:


Key rating dimensions = frequency / intensity of hypervigilance Moderate = some of the time (20-30%) / hypervigilance clearly present,

e.g., watchful in public,

heightened awareness of threat

Severe = much of the time (50-60%) / pronounced hypervigilance,

e.g., scans environment for danger,

may have safety rituals,

exaggerated concern for safety of

self/family/home

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

62

18. (E4) Exaggerated startle response.

In the past month, have you had any strong startle reactions?

What kinds of things made you startle?

How strong are these startle reactions? (How strong are they compared to how most people would respond?

Do you do anything other people would notice?)

How long does it take you to recover?

Circle: Startle = Minimal Clearly Present Pronounced Extreme


# of times __________

Did these startle reactions start or get worse after (EVENT)?



Key rating dimensions = frequency / intensity of startle Moderate = at least 2 X month / startle clearly present,


Severe = at least 2 X week / pronounced startle, sustained arousal,


0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

63

19. (E5) Problems with concentration.

In the past month, have you had any problems with concentration?


Are you able to concentrate if you really try?

[If not clear:]


How would things be different if you didn’t have problems with concentration?)

Circle:

Problem concentrating = Minimal Clearly Present Pronounced Extreme

How much of the time in the past month have you had problems with

concentration, as a percentage? % of time __________

Did these problems with concentration start or get worse after (EVENT)?

(Do you think they were related to [EVENT]? How so?)

Circle:


Key rating dimensions = frequency / intensity of concentration problems Moderate = some of the time (20-30%) / problem concentrating clearly present,

some difficulty

but can concentrate with effort

Severe = much of the time (50-60%) / pronounced problem concentrating,

considerable difficulty even with effort

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

64

20. (E6) Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

In the past month, have you had any problems falling or staying asleep?

What kinds of problems?

(How long does it take you to fall asleep?

How often do you wake up in the night?

Do you wake up earlier than you want to?)

How many total hours do you sleep each night?

How many hours do you think you should be sleeping?

Circle:

Problem sleeping = Minimal Clearly Present Pronounced Extreme

How often in the past month have you had these sleep problems?

# of times __________

Did these sleep problems start or get worse after (EVENT)?



Key rating dimensions = frequency / intensity of sleep problems Moderate = at least 2 X month / sleep disturbance clearly present,

clearly longer latency

or clear difficulty staying asleep,

30-90 minutes loss of sleep

Severe = at least 2 X week / pronounced sleep disturbance,

considerably longer latency

or marked difficulty staying asleep,

90 min to 3 hours loss of sleep

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

65

Criterion F: Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

21. Onset of symptoms

[If not clear:]

When did you first start having (PTSD SYMPTOMS)

you’ve told me about? (How long after the trauma did they start? More than six months?)

Total # months delay in onset

__________

With delayed onset

(> 6 months)?

NO YES

22. Duration of symptoms

[If not clear:]

How long have these (PTSD SYMPTOMS) lasted altogether?

Total # months duration

__________

Duration more than 1 month?

NO YES

66

Criterion G: The disturbance causes clinically significant distress or impairment

in social, occupational, or other important areas of functioning.

23. Subjective distress

Overall, in the past month,

how much have you been bothered by these (PTSD symptoms)

you’ve told me about?

[Consider distress reported on earlier items]

0 None

1 Mild, minimal distress

2 Moderate,

Distress clearly present

But still manageable

3 Severe

Considerable distress

4 Extreme

Incapacitating distress

24. Impairment in social functioning

In the past month, have these (PTSD symptoms)

affected your relationships with other people?

How so?

[Consider impairment in social functioning

reported on earlier items]

0 No adverse impact

1 Mild impact,

minimal impairment in social functioning

2 Moderate impact,

definite impairment,

many aspects of social functioning still intact

3 Severe impact,

marked impairment,

few aspects of social functioning still intact

4 Extreme impact,

little or no social functioning

25. Impairment in occupational or other important area of functioning

[If not clear:]

Are you working now?

[If yes:]

In the past month, have these (PTSD symptoms)

affected your ability to work? How so? [If no:]

Why is that?

(Do you feel that your [PTSD symptoms] are related to you not

working now? How so?)

If unable to work because of PTSD symptoms, rate at least 3=Severe.

If unemployment is not due to PTSD symptoms,

or if the link is not clear, base rating only on impairment in other

areas?] Have these (PTSD symptoms) affected any other part of your life?

[parenting, housework, schoolwork, volunteer work, etc.] How so?

0 No adverse impact

1 Mild impact,

minimal impairment

2 Moderate impact,

definite impairment,

many aspects still intact

3 Severe impact,

marked impairment,

few aspects still intact

4 Extreme impact,

little or no functioning

67

Global Ratings

26. Global validity

Estimate the overall validity of responses.

Consider factors such as:

- compliance with the interview,

- mental status:

problems with concentration,

comprehension of items,

- dissociation,

evidence of efforts to exaggerate or minimize symptoms

0 Excellent,

no reason to suspect invalid responses

1 Good,

factors present

that may adversely affect validity

2 Fair,

factors present

that definitely reduce validity

3 Poor,

substantially reduced validity

4Invalid responses,

severely impaired mental status

possible deliberate “faking bad”/

“faking good”

27. Global severity

Estimate the overall severity of PTSD symptoms.

Consider

degree of subjective distress,

degree of functional impairment,

observations of behaviors in interview,

judgment regarding reporting style.

0 No clinically significant symptoms

no distress and no functional impairment

1 Mild,

minimal distress or functional impairment

2 Moderate,

definite distress or functional impairment

but functions satisfactorily with effort

3 Severe,

considerable distress/functional impairment,

limited functioning even with effort

4 Extreme,

marked distress or marked impairment

in two or more major areas of functioning

28. Global improvement

Rate total overall improvement since the previous rating.

Rate the degree of change,

whether or not, in your judgment, it is due to treatment.

0 Asymptomatic

1 Considerable improvement

2 Moderate improvement

3 Slight improvement

4 No improvement

5 Insufficient information

68

Specify whether with dissociative symptoms:

The individual’s symptoms meet the criteria for posttraumatic stress disorder,

and in addition, in response to the stressor,

the individual experiences persistent or recurrent symptoms of either of the following:

29. (1) Depersonalization: Persistent or recurrent experiences of feeling detached from mental processes or body,

and as if one were an outside observer of one’s mental processes or body

(e.g., feeling as though one were in a dream;

feeling a sense of unreality of self or body or of time moving slowly).

In the past month, have there been times when you felt separated from yourself,

like you were watching yourself from the outside?

or observing your thoughts and feelings as if you were another person? [If no:]

(What about feeling as if you were in a dream, even though you were awake?

Feeling as if something about you wasn’t real?

Feeling as if time was moving more slowly?)


How strong is this feeling? (Do you lose track of where you actually are or what’s actually going on?)



Circle:

Dissociation = Minimal Clearly Present Pronounced Extreme

[If not clear:]

(Was this due to the effects of alcohol or drugs?

What about a medical condition like seizures?) [Rate 0=Absent if due to the effects of a substance or another medical condition]


# of times __________

Did this feeling start or get worse after (EVENT)?


Circle:


Key rating dimensions = frequency / intensity of dissociation Moderate = at least 2 X month / dissociative quality clearly present but transient,

retains some realistic sense of self and awareness of environment

Severe = at least 2 X week /pronounced dissociative quality,

marked sense of detachment and unreality

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

69

30. (2) De-realization: Persistent or recurrent experiences of unreality of surroundings

(e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).

In the past month, have there been times when things going on around you

seemed unreal or very strange and unfamiliar?

[If no:]

(Do things going on around you seem like a dream or like a scene from a movie?

Do they seem distant or distorted?)


How strong is this feeling? (Do you lose track of where you actually are or what’s actually going on?)



Circle: Dissociation = Minimal Clearly Present Pronounced Extreme

[If not clear:]

(Was this due to the effects of alcohol or drugs?

What about a medical condition like seizures?) [Rate 0=Absent if due to the effects of a substance or another medical condition]


# of times __________

Did this feeling start or get worse after (EVENT)?


Circle:


Key rating dimensions = frequency / intensity of dissociation Moderate = at least 2 X month / dissociative quality clearly present but transient,

retains some realistic sense of environment

Severe = at least 2 X week / pronounced dissociative quality,

marked sense of unreality

0 Absent

1 Mild /

subthreshold

2 Moderate /

threshold

3 Severe /

markedly

elevated

4 Extreme /

incapacitating

70

CAPS-5 SUMMARY SHEET

Name:__________ ID#:____ Interviewer:___________ Study:___________ Date:______

A. Exposure to actual or threatened death, serious injury, or sexual violence

Criterion A met? 0 = NO 1 = YES

B. Intrusion symptoms (need 1 for diagnosis) Past Month

Sev Sx (Sev > 2 )?

(1) B1 – Intrusive memories 0 = NO 1 = YES

(2) B2 – Distressing dreams 0 = NO 1 = YES

(3) B3 – Dissociative reactions 0 = NO 1 = YES

(4) B4 – Cued psychological distress 0 = NO 1 = YES

(5) B5 – Cued physiological reactions 0 = NO 1 = YES

B subtotals B Sev = # B Sx =

C. Avoidance symptoms (need 1 for diagnosis) Past Month

Sev Sx (Sev > 2 )?

(6) C1 – Avoidance of memories, thoughts, feelings 0 = NO 1 = YES

(7) C2 – Avoidance of external reminders 0 = NO 1 = YES

C subtotals C Sev = # C Sx =

D. Cognitions and mood symptoms (need 2 for diagnosis) Past Month

Sev Sx (Sev > 2 )?

(8) D1 – Inability to recall important aspect of event 0 = NO 1 = YES

(9) D2 – Exaggerated negative beliefs or expectations 0 = NO 1 = YES

(10) D3 – Distorted cognitions leading to blame 0 = NO 1 = YES

(11) D4 – Persistent negative emotional state 0 = NO 1 = YES

(12) D5 – Diminished interest or participation in activities 0 = NO 1 = YES

(13) D6 – Detachment or estrangement from others 0 = NO 1 = YES

(14) D7 – Persistent inability to experience positive emotions 0 = NO 1 = YES

D subtotals D Sev = # D Sx =

E. Arousal and reactivity symptoms (need 2 for diagnosis) Past month

Sev Sx (Sev > 2 )?

(15) E1 – Irritable behavior and angry outbursts 0 = NO 1 = YES

(16) E2 – Reckless or self-destructive behavior 0 = NO 1 = YES

(17) E3 – Hypervigilance 0 = NO 1 = YES

(18) E4 – Exaggerated startle response 0 = NO 1 = YES

(19) E5 – Problems with concentration 0 = NO 1 = YES

(20) E6 – Sleep disturbance 0 = NO 1 = YES

E subtotals E Sev = # E Sx =

PTSD totals Past month

Total Sev Total # Sx

Sum of subtotals (B+C+D+E)

71

F. Duration of disturbance Current

(22) Duration of disturbance > 1 month? 0 = NO 1 = YES

G. Distress or impairment (need 1 for diagnosis) Past Month

Sev Cx (Sev > 2 )?

(23) Subjective distress 0 = NO 1 = YES

(24) Impairment in social functioning 0 = NO 1 = YES

(25) Impairment in occupational functioning 0 = NO 1 = YES

G subtotals G Sev = # G Cx =

Global ratings Past Month

(26) Global validity

(27) Global severity

(28) Global improvement

Dissociative symptoms (need 1 for subtype) Past Month

Sev Sx (Sev > 2 )?

(29) 1 -- Depersonalization 0 = NO 1 = YES

(30) 2 – De-realization 0 = NO 1 = YES

Dissociative subtotals Diss Sev = # Diss Sx =

PTSD diagnosis Past Month

PTSD PRESENT – ALL CRITERIA (A-G) MET? 0 = NO 1 = YES

With dissociative symptoms 0 = NO 1 = YES

(21) With delayed onset (> 6 months) 0 = NO 1 = YES

72

Appendix 3d. CAPS for DSM-IV - Russian version

Пациент____________________

Дата______________

Интервьюер____________

A. ТРАВМАТИЧЕСКОЕ СОБЫТИЕ____________________

B. ПОСТОЯННО ПОВТОРЯЮЩЕЕСЯ ПЕРЕЖИВАНИЕ ТРАВМАТИЧЕСКОГО

СОБЫТИЯ

(1) Повторяющиеся навязчивые воспоминания о событии, вызывающие дистресс

Частота

Случалось ли так, что вы непроизвольно, без всякого повода, вспоминали об этих событиях?

Было ли это только во сне?

(Исключить, если воспоминания появлялись только во сне.)

Как часто это происходило в течение последнего месяца?

0 – никогда

1 – один или два раза

2 – один или два раза в неделю

3 – несколько раз в неделю

4 – ежедневно или почти каждый день

Интенсивность

Если из этих случаев взять самый тяжелый,

насколько сильны были переживания, вызванные этими воспоминаниями?

Были ли вы вынуждены прерывать дела, которыми в этот момент занимались?

В состоянии ли вы, если постараетесь, преодолеть эти воспоминания, избавиться от них?

0 – отсутствие дистресса

1 – низкая интенсивность симптома:

минимальный дистресс

2 – умеренная интенсивность:

дистресс отчетливо присутствует

3 – высокая интенсивность:

существенный дистресс,

явные срывы в деятельности,

трудности в преодолении возникших воспоминаний о событии

4 – очень высокая интенсивность:

тяжелый, непереносимый дистресс,

неспособность продолжать деятельность,

невозможность избавиться от воспоминаний о событии

73

(2) Интенсивные, тяжелые переживания при обстоятельствах,

символизирующих/напоминающих различные аспекты травматического события,

включая годовщины травмы

Частота

Были ли у вас случаи, когда вы видели что-то, напомнившее об этих событиях,

и вам становилось тяжело и грустно, вы расстраивались?

(Например: определенный тип мужчин – для жертв изнасилования,

цепочка деревьев или лесистая местность – для ветеранов войны.)

Как часто это с вами случалось в течение последнего месяца?

0 – Никогда






Если из этих случаев взять самый тяжелый,

насколько вы были взволнованы и расстроены,

насколько сильны были переживания?

0 – нисколько

1 – слабая интенсивность симптома:

минимальный дистресс

2 – умеренная интенсивности:

дистресс отчетливо присутствует, но еще контролируется


значительный дистресс


непереносимый дистресс

74

(3) Ощущение, как будто травматическое событие происходило снова,

или соответствующие внезапные действия,

включая ощущение оживших переживаний, иллюзии, галлюцинации,

диссоциативные эпизоды (флэшбэк-эффекты),

даже те, которые появляются в просоночном состоянии

Частота

Приходилось ли вам когда-нибудь внезапно совершать какое-либо действие и

чувствовать себя так, как будто бы то событие(я) происходит снова?








Если из этих случаев взять самый тяжелый, насколько реальным было это ощущение?

Насколько сильно вам казалось, что то событие(я) происходило снова?

Как долго это продолжалось?

Что вы делали при этом?

0 – никогда такого не было


ощущение чуть большей реалистичности происходящего,

чем при простом размышлении о нем


ощущения определенные, но передающие диссоциативное качество,

однако при этом сохраняется тесная связь с окружающим,

ощущения похожи на грезы наяву


в сильной степени диссоциативные ощущения –

пациент рассказывает об образах, звуках, запахах,

но все еще сохраняется некоторая связь с окружающим миром


ощущения полностью диссоциативны –

флэшбэк-эффект,

полное отсутствие связи с окружающей реальностью,

возможна амнезия данного эпизода – «затмение», провал в памяти

75

(4) Повторяющиеся сны о событии, вызывающие тяжелые переживания (дистресс)

Частота

Были ли у вас когда-нибудь неприятные сны о том событии?








Если из этих случаев взять самый худший,

как сильны были те неприятные, тяжелые переживания и чувство дискомфорта,

которые вызывали у вас эти сны?

Вы просыпались от этих снов?

(Если да, спросите: «Что вы чувствовали или делали, когда просыпались?

Через сколько времени вы обычно засыпали?»

Выслушайте рассказ и отметьте симптомы паники, громкие крики, положения тела.)

0 – отсутствовали

1 – слабо выраженная интенсивность симптома:

минимальный дистресс не вызывал пробуждении


просыпается, испытывая дистресс, но легко засыпает снова


очень тяжелый дистресс, затруднено повторное засыпание


непреодолимый дистресс, невозможность заснуть снова

76

С. УСТОЙЧИВОЕ ИЗБЕГАНИЕ РАЗДРАЖИТЕЛЕЙ,

AССОЦИИРУЮЩИХСЯ С ТРАВМОЙ,

ИЛИ «БЛОКАДА» ОБЩЕЙ СПОСОБНОСТИ К РЕАГИРОВАНИЮ (numbing - «оцепенение») (симптомы не наблюдались до травмы)

(5) Усилия, направленные на то, чтобы избежать мыслей или чувств,

ассоциирующихся с травмой

Частота

Пытались ли вы отгонять мысли о событии(ях)?

Прилагали ли вы усилия, чтобы избежать ощущений, связанных с со-бытием(ями)

(например, чувств гнева, печали, вины)?








Как велики были усилия, которые вы прилагали, чтобы не думать о том событии(ях),

чтобы не испытывать чувств, имеющих к нему (ним) отношение?

(Дайте оценку всех попыток сознательного избегания,включая отвлечение, подавление

и снижение возбужденности при помощи алкоголя или наркотиков.)

0 – никакого усилия

1 – слабая интенсивность симптома: минимальное усилие

2 – умеренная интенсивность: некоторое усилие, избегание определенно есть

3 – высокая интенсивность: значительное усилие, избегание безусловно есть

4 – очень высокая интенсивность: отчетливо выраженные попытки избегания

77

(6) Усилия, направленные на то, чтобы избегать действий или ситуаций,

которые вызывают воспоминания о травме

Частота

Пытались ли вы когда-либо избегать каких-либо действий или ситуаций,

которые напоминали бы вам о событии(ях)?





4 –. ежедневно или почти каждый день

Интенсивность:

Как велики были усилия, которые вы прилагали для того, чтобы избегать каких-то

действий или ситуаций, связанных с событием(ями)?

(Дайте оценку всех попыток поведенческого избегания;

например, ветераны войны, избегающие участия в ветеранских мероприятиях,

просмотрах военных фильмов и проч.)

0 – никакого усилия


минимальное усилие


некоторое усилие, избегание определенно есть


значительное усилие, избегание безусловно есть


отчетливо выраженные попытки избегания

78

(7) Неспособность вспомнить важные аспекты травмы (психогенная амнезия)

Частота

Случалось ли так, что вы не могли вспомнить важные обстоятельства происшедшего

(например, имена, лица, последовательность событий)?

Многое ли из того, что имело отношение к происшедшему,

вам было трудно вспомнить в прошедшем месяце?

0 – ничего, ясная память о событии в целом

1 – некоторые обстоятельства события(ий) было невозможно вспомнить

(менее чем 10%)

2 – ряд обстоятельств события(й) было невозможно вспомнить

(20–30%)

3 – большую часть обстоятельств события(й) было невозможно вспомнить

(50–60%)

4 – почти совсем невозможно было вспомнить событие^)

(более чем 80%)


Как велики были усилия, которые вам понадобилось приложить,

чтобы вспомнить о важных обстоятельствах того, что произошло с вами?

0 – какие-либо затруднения при воспоминании о событиях отсутствовали


незначительные затруднения при воспроизведении обстоятельств события


определенные затруднения,

однако при сосредоточении сохраняется способность к воспроизведению

события в памяти


несомненные затруднения при воспроизведении обстоятельств события


полная неспособность вспомнить о событии(ях)

79

(8) Заметная утрата интереса к любимым занятиям

Частота

Чувствуете ли вы, что потеряли интерес к занятиям,

которые были для вас важными или приятными,

например, спорт, увлечения, общение?

Если сравнить с тем, что было до происшедшего,

сколько видов занятий перестали вас интересовать за прошедший месяц?

0 – потери интереса вообще не было

1 – потеря интереса к отдельным занятиям (менее чем 10%)

2 – потеря интереса к нескольким занятиям (20–30%)

3 – потеря интереса к большому числу занятий (50–60%)

4 – потеря интереса почти ко всему (более чем 80%)


В самом худшем случае

насколько глубока или сильна была утрата интереса к этим занятиям?

0 – вообще не было потери интереса


только незначительная потеря интереса,

не исключающая получения удовольствия в процессе занятий,

если они все-таки начались


безусловная потеря интереса,

но все-таки сохраняется некоторое чувство удовольствия от занятия(й)


очень значительная потеря интереса к занятиям


полная потеря интереса,

не вовлекается ни в какую деятельность

80

(9) Чувство отстраненности или отчужденности от окружающих

Частота

Не было ли у вас чувства отдаленности или потери связи с окружающими?

Отличалось ли это состояние от ваших чувств перед тем, как произошло это событие(я)?

Как часто вы чувствовали себя так в течение последнего месяца?

0 – такого вообще не было

1 – редко (менее 10% времени)

2 - иногда (20-30%)

3 - часто (50-60%)

4 – почти всегда или постоянно (более чем 80%)


В самом худшем случае насколько сильно было ваше чувство отстраненности или

отсутствия связи с окружающими? Кто все-таки оставался вам близок?

0 – отсутствуют подобные чувства


эпизодически чувствует себя «идущим,не в ногу» с окружающими


определенное наличие чувства отдаленности,

но сохраняются какие-то межличностные связи,

есть чувство принадлежности к окружающему миру


значительное чувство отстраненности или отчужденности от большинства людей,

сохраняется способность взаимодействия только с одним человеком


чувствует себя полностью оторванным от других людей,

близкие отношения не поддерживает ни с кем

81

(10) Сниженный уровень аффекта,

например, неспособность испытывать чувство любви

Частота

Были ли у вас такие периоды, когда вы были «бесчувственны»

(вам было трудно испытывать такие чувства, как любовь или счастье)?





2 - иногда (20-30%)

3 - часто (50-60%)



В самом худшем случае насколько сильным у вас было ощущение «бесчувственности»?

(В оценку этого пункта включите наблюдения за уровнем аффективности в интервью.)

0 – ощущения бесчувственности нет


такое ощущение имеется, но незначительное


явное ощущение бесчувственности,

но способность испытывать эмоции все-таки сохранена


значительное ощущение бесчувственности

по отношению по крайней мере к двум основным эмоциям – любви и счастья


ощущает полное отсутствие эмоций

82

(11) Ощущение отсутствия перспектив на будущее,

напр, не ожидает продвижения по службе, женитьбы, рождения детей, долгой жизни

Частота

Было ли когда-нибудь, что вы чувствовали отсутствие необходимости строить планы

на будущее, что почему-либо у вас «нет завтрашнего дня»?

(Если да, уточните наличие реального риска, например, опасных для жизни мед. диагнозов).





2 - иногда (20-30%)

3 - часто (50-60%)



В самом худшем случае насколько сильным было чувство, что у вас не будет будущего?

Как вы думаете; как долго вы будете жить?

Какие основания у вас предполагать, что вы умрете преждевременно?

0 – ощущения сокращенного будущего нет


незначительные ощущения по поводу сокращенности жизненной перспективы

2 – умеренная интенсивность симптома:

определенно присутствует ощущение сокращенной жизненной перспективы

3 – высокая интенсивность симптома:

значительно выражены ощущения сокращенной жизненной перспективы,

могут иметь место определенные предчувствия о продолжительности жизни

4 – очень высокая интенсивность симптома:

всепоглощающее чувство сокращенной жизненной перспективы,

полная убежденность в преждевременной смерти

83

D. УСТОЙЧИВЫЕ СИМПТОМЫ ПОВЫШЕННОЙ ВОЗБУДИМОСТИ (не наблюдались до травмы)

(12) Трудности с засыпанием или с сохранением нормального сна

Частота

Были ли у вас какие-либо проблемы с засыпанием или с тем, чтобы спать нормально?

Отличается ли это от того, как вы спали перед событием(ями)?

Как часто у вас были трудности со сном в прошлом месяце?





4 – каждую ночь (или почти каждую)

Трудности с засыпанием? Да Нет

Пробуждения среди сна? Да Нет

Очень ранние пробуждения? Да Нет

Количество часов сна (без пробуждений) за ночь___________

Желательное количество часов сна для обследуемого_______


(Задайте уточняющие вопросы и оцените все перечисленные нарушения сна.)

Как много времени надо вам, чтобы заснуть?

Как часто вы просыпаетесь среди ночи?

Сколько часов подряд, не просыпаясь, вы спите каждую ночь?

0 – нет проблем со сном


несколько затруднено засыпание,

некоторые трудности с сохранением сна

(потеря сна до 30 минут)


определенное нарушение сна,

ясно выраженная увеличенная продолжительность периода засыпания,

трудности с сохранением сна

(потеря сна – 30–90 минут)


значительное удлинение времени засыпания,

большие трудности с сохранением сна

(потеря сна – 90 минут – 3 часа)


очень длительный латентный период сна,

непреодолимые трудности с сохранением сна

(потеря сна более 3 часов)

84

(13) Раздражительность или приступы гнева

Частота

Были ли такие периоды, когда вы чувствовали, что необычно раздражительн?

проявляли чувство гнева и вели себя агрессивно?

Отличается ли это состояние от ваших чувств /действий до событйй(я)?

Как часто прочвлчлись подобные чувства/поведение в прошлом месяце?







Насколько сильный гнев вы испытывали и каким образом вы его выражали?

0 – не было ни раздражительности, ни гнева


минимальная раздражительность,

в гневе – повышение голоса


явное наличие раздражительности,

в гневе с легкостью начинает спорить, но быстро «остывает»


значительная раздражительность,

в гневе – речевая или поведенческая агрессивность


непреодолимый гнев, сопровождаемый эпизодами физического насилия

85

(14) Трудности с концентрацией внимания

Частота

Не казалось ли вам трудным сосредоточиться на каком-то занятии?

На чем-то, что окружало вас?

Изменилась ли ваша способность к сосредоточению с тех пор, как случилось событие(я)?

Как часто наблюдались затруднения с сосредоточением внимания в течение прошлого месяца?

0 – вообще не было

1 – очень редко (менее 10% времени)

2 – иногда (20–30% времени)

3 – большую часть времени (50–60%)


Интенсивность:

Насколько трудно для вас было сосредоточиться на чем-либо?

(При оценке этого пункта учтите свои наблюдения в процессе интервью.)

0 – никакой проблемы не было

1 – слабая интенсивность:

для сосредоточения требовались незначительные усилия


определенная потеря способности к сосредоточению,

но при усилии может сосредоточиться


значительное ухудшение функции, даже при особых усилиях


полная неспособность к сосредоточению и концентрации внимания

86

(15) Повышенная настороженность (бдительность)

Частота

Приходилось ли вам быть как-то особенно настороженным или бдительным

даже тогда, когда для этого не было очевидной необходимости?

Отличалось ли это от того, как вы себя чувствовали перед событием(ями)?

Как часто в прошлом месяце вы были настороженны или бдительны?

0 – вообще не было

1 – очень редко (менее 10% времени)

2 – иногда (20–30% времени)

3 – большую часть времени (50–60%)



Как велики усилия, которые вы прилагаете, чтобы знать обо всем,

что происходит вокруг вас?

(При оценке этого пункта используйте свои наблюдения, полученные в ходе интервью.)

0 – симптом отсутствует


минимальные проявления гипербдительности,

незначительно повышенное любопытство


определенно имеется гипербдительность,

настороженность в общественных местах

(например, выбор безопасного места в ресторане или кинотеатре)


значительные проявления гипербдительности,

субъект очень насторожен,

постоянное наблюдение за окружающими в поисках опасности,

преувеличенное беспокойство о собственной безопасности

(а также своей семьи и дома)


гипертрофированная бдительность,

усилия по обеспечению безопасности требуют значительных затрат времени/энергии

и могут включать активные действия по проверке ее наличия;

в процессе беседы – значительная настороженность

87

(16) Преувеличенная реакция испуга («стартовая» реакция на внезапный стимул)

Частота

Испытывали ли вы сильную реакцию испуга на громкие неожиданные звуки

(например, на автомобильные выхлопы, пиротехнические эффекты, стук двери и т. п.)?

Испытавили ли вы реакцию ицпуга на что-то, что вы вдруг увидели

(например, движение, замеченное на периферии вашего поля зрения – «углом глаза»)?

Отличается ли это от того, как вы себя чувствовали до события(ий)?







Всамом худшем случае насколько сильной была эта реакция испуга?

0 – симптом отсутствовал: реакции испуга не было


минимальная реакция испуга


определенная реакция испуга на внезапный раздражитель, «подпрыгивание»


значительная реакция испуга,

сохранение возбуждения после первичной реакции


крайне выраженная реакция испуга,

явное защитное поведение

(например, ветеран войны, который «падает лицом в грязь»)

88

(17) Физиологическая реактивность при воздействии обстоятельств,

напоминающих/символизирующих различные аспекты травматического события

Частота

Приходилось ли вам отмечать у себя наличие определенных физиологических реакций,

когда вы сталкивались с ситуациями, напоминающими вам о событии(ях)?

(Выслушайте сообщение о симптомах, но не задавайте испытуемому наводящих вопросов:

Возможные симтомы:

- учащенное сердцебиение,

- мышечное напряжение,

- дрожь в руках,

- потливость )

Как часто они наблюдались в прошлом месяце?







Всамом худшем случае как сильны были эти физиологические реакции?

0 – симптом отсутствует


минимальная реакция


явное наличие физиологической реакции,

некоторый дискомфорт


интенсивная физиологическая реакция,

сильный дискомфорт


драматическая физиологическая реакция,

сохранение последующего возбуждения

Был ли какой-либо период после травмы, когда симптомы, о которых я только что вас

расспрашивал, беспокоили вас значительно больше, чем в течение последнего месяца?

Да Нет

Этот период (или эти периоды) продолжался не менее одного месяца?

89

Appendix 4a. Center for Epidemiologic Studies Depression Scale (CES-D)

90

Appendix 4b. Center for Epidemiologic Studies Depression Scale (CES-D) - Russian version

91

Appendix 5a. Demographic questions

1. ID

2. Date

3. Home address (Oblast, city/village)

4. Living (registered/displacement) address

Instructions on filling on the form:

Carefully read the questions as well as the instructions written under the questions in italic.

Choose your preferred response to each question, and draw a circle around it.

Questionnaire

1 Sex

Mark one response only 1. Male

2. Female

2 How old are you? ______________

3 What is your ethnicity? ______________

4 What is your marital status

Mark one response only 1. Single

2. Separated/divorced

3. Married

4. Living as married

5. Widowed

5 How many children do you have? ________________

6 How many people live at your house? ________________

7 How many members of your household

(including yourself)

are currently employed?

________________

8 Are you currently employed?

Mark one response only 1. Yes

2. No

9 Which of the following best describes

your situation?

Mark one response only

1. Employed

2. Unemployed, looking for work

3. Unemployed, not looking for work

4. Can't work due to (permanent) disability

5. Can't work due to inability to find/afford

child care

6. Student/attending school

7. Homemaker

8. Retired

9. Self-employed

10. Farmer

92

10 How would you rate your family’s

general standard of living?


1. Substantially below average

2. Little below average

3. Average

4. Little above average

5. Substantially above average

6. Not sure/difficult to answer

11 Indicate the highest level of education

that you have completed?


1. None at all

2. Primary school

3. Secondary school

4. College

5. University

12 Profession __________________

13 Please indicate any chronic health

problem(s) that you have

Choose all those choices

that you find suitable

1. Diabetes

2. High blood pressure

3. Heart disease

4. Lung disease (including asthma)

5. Stomach/intestine disease

6. Cancer

7. Eye/vision problems

8. Kidney problems

9. Problems with joints/bones

10. Other problems

____________________

11. No chronic health problems

14 Did you ever had any psychiatric

diseases?


1. Yes

2. No

15 Did any member of your family ever

had any psychiatric diseases?


1. Yes

2. No

16 What is your average alcohol intake

per week

______________

17 Did you ever have problems with

alcohol/other substances abuse?


1. Yes

1. No

18 Do you take any prescribed

medication?


If yes, please indicate

1. Yes ________________

2. No

.

93

Appendix 5b. Demographic questions – Russian version

Демографические вопросы

1. ID

2. Дата

3. Домашний адрес

4. Адрес нынешнего проживания

(Адрес, по которому зарегестрированы)

Инструкция по заполнению анкеты:

Внимательно прочитайте вопросы и инструкции, написанные курсивом под вопросами

Выбирите подходящий ответ на каждый вопрос и обведите кружочком.

Опросник

1 Пол

Выберите только один ответ 1. Мужчина

2. Женщина

2 Сколько вам лет? ______________

3 Ваша национальность? ______________

4 Ваше семейное положение

Выберите только один ответ 1 Одинок(а)

2 Разведен(а)/Живем раздельно

3 Женат (за мужем)

4 Проживаем нерасписанные

5 Вдовец/вдова

5 Сколько у вас детей? ________________

6 Сколько человеек в вашей семье

проживают вместе (включая вас)?

________________

7 Сколько человек в вашей семье/доме

на данный момент трудоустроены

(включая вас)?

________________

8 Вы трудоустроены на данный момент?

Выберите только один ответ 1. Да

2. Нет

9 Что из ниже перечисленного наиболее

соответствует вашей ситуации?

Выберите только один ответ

1. Не трудоустроен. Ищу работу.

2. Не трудоустроен, не ищу работу.

3. Не могу работать по причине

(постоянной) нетрудоспособности

4. Не могу работать так как забочусь

о ребенке

5. Студент/учащийся

6. Домработник (-ца)

7. Пенсионер

8. Предприниматель/свой бизнес

9. Фермер

94

10 Как бы вы оценили

ваш уровень жизни (ваши доходы)?


1. Значительно ниже среднего

2. Немного ниже среднего

3. Средний

4. Немного выше среднего

5. Значительно выше среднего

6. Не уверен/ затрудняюсс ответить

11 Уровень образования,

которое вы получили

(законченное образование)?


1. Никакого

2. Начальная школа

3. Средняя школа

4. Колледж/училище/ПТУ

5. Институт/университет

12 Профессия/специальность __________________

13 Пожалуйста, укажите, имеющиеся у

вас хронические заболевания

Выберите все, что подходит

1. Диабет

2. Высокое артериальное давление

3. Сердечные заболевания

4. Болезни легких (включая астму)

5. Болезни ЖКТ

6. Рак/онкология

7. Проблемы со зрением

8. Заболевания почек

9. Проблемы с опорно-двигательной

системой

10. Другие хронические

заболевания____________________

11. Никаких хроничских заболеваний

14 Были ли у вас когда-либо

психические заболевания?


1. Да

2. Нет

15 Были ли когда-либо у кого-либо

из ваших родственников

психические заболевания?


1. Да

2. Нет

16 Какое количество спиртных

напитков вы употребляете в

среднем в течение недели

______________

17 Были ли у вас когда-либо проблемы

с зависимостью от алкоголя или

других психотропных веществ?


1. Да

2. Нет

18 Употребляете ли вы какие-либо

лекарства в течение последнего

месяца?


Если ответ «да», укажите какие

1. Да:___________________________

___________________________

___________________________

2. Нет

95

Appendix 6a. WHOQOL-BREF

1. ABOUT YOU

Before you begin we would like to ask you to answer a few general questions about yourself:

by circling the correct answer or by filling in the space provided.

What is your gender?

Male/Female

What is your date of birth? ________ / ________ / ________

Day / Month / Year

What is the highest education you received?

None at all

Primary school

Secondary school

College

University

What is your marital status?

` Single

Separated

Married

Divorced

Living as married

Widowed

Are you currently ill?

Yes

No

If something is wrong with your health what do you think it is?

_______________________illness/ problem

96

2. Instructions

This assessment asks how you feel about your quality of life, health, or other areas of your life.

Please answer all the questions. If you are unsure about which response to give to a question,

please choose the one that appears most appropriate. This can often be your first response.

Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about

your life in the last two weeks.

For example, thinking about the last two weeks, a question might ask:

1-Not at all

2-Not much

3-Moderately

4-A great deal

5-Completely

Do you get the kind of support from others that you need? 1 2 3 4 5

You should circle the number that best fits how much support you got from others over the last

two weeks. So you would circle the number 4 if you got a great deal of support from others as

follows.

Do you get the kind of support from others that you need? 1 2 3 4 5

You would circle number 1 if you did not get any of the support that you needed from others in

the last two weeks.

97

3. Quetsionnaire

99

Appendix 6b. WHOQOL-BREF – Russian version

Следующие вопросы касаются вашей точки зрения на качество жизни,

на состояние здоровья и другие сферы вашей жизни.

Я буду вслух читать вам каждый вопрос вместе с вариантами ответов.

Пожалуйста, выберите ответ, который покажется наиболее подходящим.

Если вы не уверены, как ответить на вопрос, первый ответ, который придет вам в голову,

часто бывает наилучшим.

Пожалуйста, помните о своих стандартах, надеждах, развлечениях и интересах.

Мы спрашиваем о том, какой вы считаете свою жизнь в течение последних четырех недель.

Очень плохо Плохо Ни плохо,

ни хорошо Хорошо

Очень

хорошо

1. Как Вы

оцениваете

качество Вашей

жизни?

Очень не

удовлетворен

Не

удовлетворен

Ни то, ни

другое Удовлетворён

Очень

удовлетворён

2. Насколько

Вы удовлетворены

состоянием своего

здоровья?

100

В ответах на следующие вопросы укажите, в какой степени Вы испытывали определенные

состояния в течение последних четырех недель.

Вовсе

нет Немного Умеренно

В

значительной

степени

Чрезмерно

3. По Вашему мнению, в какой степени

физические боли мешают Вам выполнять

свои обязанности?

4. В какой степени Вы нуждаетесь

в какой-либо медицинской помощи

для нормального функционирования

в своей повседневной жизни?

5. Насколько Вы довольны своею

жизнью?

6. Насколько, по Вашему мнению, Ваша

жизнь наполнена смыслом?

7. Насколько хорошо Вы можете

концентрировать внимание?

8. Насколько безопасно Вы чувствуете

себя в повседневной жизни?

9. Насколько здоровой является

физическая среда вокруг Вас?

10. Достаточно ли у Вас энергии для

повседневной жизни?

11. Способны ли Вы смириться со своим

внешним видом?

12. Достаточно ли у Вас денег для

удовлетворения Ваших потребностей?

13. Насколько доступна для Вас

информация, необходимая в Вашей

повседневной жизни?

14. В какой мере у Вас есть возможности

для отдыха и развлечений?

101

В следующих вопросах речь идет о том, насколько полно Вы ощущали или были в

состоянии выполнять определенные функции в течение последних четырех недель.

Очень

плохо Плохо

Ни

плохо,

ни

хорошо

Хорошо Очень

хорошо

15. Насколько легко Вы можете добраться до

нужных Вам мест?

16. Насколько Вы удовлетворены своим сном?

17. Насколько Вы удовлетворены способностью

выполнять свои повседневные обязанности?

18. Насколько Вы удовлетворены своею

трудоспособностью?

19. Насколько Вы довольны собой?

20. Насколько Вы удовлетворены личными

взаимоотношениями?

21. Насколько Вы удовлетворены своею

сексуальной жизнью?

22. Насколько Вы удовлетворены поддержкой,

которую Вы получаете от своих друзей?

23. Насколько Вы удовлетворены условиями в

месте Вашего проживания?

24. Насколько Вы удовлетворены доступностью

медицинского обслуживания для Вас?

25. Насколько Вы удовлетворены транспортом,

которым Вы пользуетесь?

Следующие вопросы касаются того, насколько часто Вы ощущали или переживали

определенные состояния в течение последних четырех недель.

Никогда Изредка Довольно

часто

Очень

часто Всегда

26. Как часто у Вас были отрицательные

переживания, например плохое настроение,

отчаяние, тревога, депрессия?

102

Appendix 7. Budget

Cost type Unit cost (UAH) Number of units subtotal

Personnel

Project coordinator 7,500 per month 3 months 22,500

Data collectors 30 per respondent 385 respondents 11,550

Data enterers 20 per respondent 385 respondents 7,700

Statistician 7500 per month 1 month 7,500

Administrative expenses

Office rent 5,000 per month 3 months 15,000

Office supplies 1,250 per month 3 months 3,750

Utility costs 1,250 per month 3 months 3,750

Transportation 200 per day 60 days 12,000

total 83,700

103

Appendix 8. Timeline

1st month 2nd month 3rd month

W1

W2

W3

W4

W1

W2

W3

W4

W1

W2

W3

W4

Training of the interviewers X X

Pilot study X X

Questionnaire pretest X X

Questionnaire printing X

Data collection X X X X X

Data enterers training X

Data entry and cleaning X X X X X X

Data analysis X X

Preparation of the final report X X

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