Correlates and predictors of recurrent depression: Appendix
Appendix
RESPONSES TO STRESS
This is a list of things that people sometimes do, think, or feel when something stressful happens. Everybody deals with
problems in their own way - some people do a lot of the things on this list or have a bunch of feelings, other people just do
or think a few things.
Think of the situations you just checked off. For each item on the list below, circle one number from 1 (not at all) to 4 (a
lot) that shows how much you do or feel these things when you have problems with other people like the ones you just
checked off. Please let us know about everything you do, think, and feel, even if you don’t think it helps make things
better.
How much do you do this
Not at all A little Some A lot
1.
I try not to feel anything.
1
2
3
4
2.
When I have problems with other people I feel sick to my stomach or get headaches.
1
2
3
4
3.
I try to think of different ways to change the problem or fix the situation.
Write one plan you thought of :________________________________________
1
2
3
4
___________________________________________________________________
4.
When problems with other people happen I don’t feel anything at all, it’s like I have no feelings.
1
2
3
4
5.
I wish that I were stronger, smarter, or more popular so that things would be different.
1
2
3
4
6. I keep remembering what happened with other people or can’t stop thinking about what
might happen.
1
2
3
4
7. I let someone or something know how I feel. (Remember to circle a number.) --------------------------
Check all you talked to:
1
2
3
4
Parent
Friend
Boyfriend/Girlfriend
Brother/Sister
Professor
God
Pet
None of these
1
Correlates and predictors of recurrent depression: Appendix
8.
I decide I’m okay the way I am, even though I’m not perfect .
1
2
3
4
9.
When I’m around other people I act like the problems never happened.
1
2
3
4
10. I just have to get away when I have problems with other people, I can’t stop myself.
1
2
3
4
11. I deal with the problem by wishing it would just go away, that everything would work
itself out.
1
2
3
4
12. I get really jumpy when I’m having problems getting along with other people.
1
2
3
4
13. I realize that I just have to live with things the way they are.
1
2
3
4
14. When I have problems with other people, I just can’t be near anything that reminds
me of the situation.
1
2
3
4
15. I try not to think about it, to forget all about it.
1
2
3
4
16. When problems with other people come up I really don’t know what I feel.
1
2
3
4
17. I ask other people for help or for ideas about how to make the problem better. ------------------------- 1
(Remember to circle a number.)
Check all you talked to
2
3
4
1
2
3
4
1
2
3
4
20. I let my feelings out. (Remember to circle a number.) --------------------------------------------------------- 1
2
3
4
Parent
Friend
Boyfriend/Girlfriend
Professor
God
None of these
Brother/Sister
18. When I’m having problems getting along with other people, I can’t stop thinking
about them when I try to sleep, or I have bad dreams about them.
19. I tell myself that I can get through this, or that I’ll do better next time.
I do this by: (Check all that you did.)
Writing in my journal/diary
Drawing/painting
Complaining to let off steam
Being sarcastic/making fun
Listening to music
Punching a pillow
Exercising
Yelling
Crying
None of these
2
Correlates and predictors of recurrent depression: Appendix
22. I just can’t get myself to face the person I’m having problems with or the situation.
1
2
3
4
23. I wish that someone would just come and get me out of the mess.
1
2
3
4
24. I do something to try to fix the problem or take action to change things.
Write one thing you did:_______________________________________________
1
2
3
4
25. Thoughts about the problems with other people just pop into my head.
1
2
3
4
26. When I have problems with other people, I feel it in my body. (Remember to circle a number.) 
Check all that happen:
1
2
3
4
27. I try to stay away from people and things that make me feel upset or remind me of the problem.
1
2
3
4
28. I don’t feel like myself when I have problems with other people, it’s like I’m far away
1
2
3
4
29. I just take things as they are, I go with the flow.
1
2
3
4
30. I think about happy things to take my mind off the problem or how I’m feeling.
1
2
3
4
____________________________________________________________________
My heart races
My breathing speeds up
I feel hot or sweaty
My muscles get tight
None of these
from everything.
You’re half done! Before you keep working, look back at the first page so you remember what kinds of problems
with other people you told us about. Remember to answer these questions thinking about those problems.
31. When problems with other people come up, I can’t stop thinking about how I am feeling.
1
2
3
4
32. I get sympathy, understanding, or support from someone. (Remember to circle a number.) --------------
Check all you went to:
1
2
3
4
Parent
Friend
Brother/sister
Boyfriend/Girlfriend
None of these
3
Correlates and predictors of recurrent depression: Appendix
33. When problems with other people happen, I can’t always control what I do. ------------
(Remember to circle a number.)
Check all that happen:
1
2
3
4
34. I tell myself that things could be worse.
1
2
3
4
35. My mind just goes blank when I have problems with other people, I can’t think at all.
1
2
3
4
36. I tell myself that it doesn’t matter, that it isn’t a big deal.
1
2
3
4
37. When I have problems with other people right away I feel really: (Check all you feel.)
Angry
Sad
Scared
Worried/anxious
--------------------------- 1
2
3
4
I can’t stop eating
I can’t stop talking
I do dangerous things
I have to keep fixing/checking things
None of these
(Remember to circle a number.)
None of these
38. It’s really hard for me to concentrate or pay attention when I have problems with other people.
1
2
3
4
39. I think about the things I’m learning from the situation, or something good that will come
from it.
1
2
3
4
40. When I have problems with other people I can’t stop thinking about what I did or said.
1
2
3
4
41. When something goes wrong with other people, I say to myself, “This isn’t real.”
1
2
3
4
42. When I’m having problems with other people I end up just lying around or sleeping a lot.
1
2
3
4
43. I keep my mind off problems with other people by: (Remember to circle a number.) ---------------
Check all that you do:
1
2
3
4
1
2
3
4
45. I do something to calm myself down when I’m having problems with other people. ------------ 1
(Remember to circle a number.)
Check all that you do:
2
3
4
Exercising
Seeing friends
Watching TV
Playing video games
Doing a hobby
None of these
44. When problems with other people come up, I get upset by things that don’t usually bother me.
Take deep breaths
Pray
Walk
Listen to music
Take a break
Meditate
None of these
46. I just freeze when I have a problem with other people, I can’t do anything.
1
2
3
4
47. When I’m having a problem with other people, sometimes I act without thinking.
1
2
3
4
4
Correlates and predictors of recurrent depression: Appendix
48. I keep my feelings under control when I have to, then let them out when they won’t make
things worse.
1
2
3
4
49. When problems with other people happen I can’t seem to get around to doing things I’m
supposed to do.
1
2
3
4
50. I tell myself that everything will be all right.
1
2
3
4
51. When I have problems with other people, I can’t stop thinking about why they happened to me.
1
2
3
4
52. I think of ways to laugh about it so that it won’t seem so bad.
1
2
3
4
53. My thoughts start racing when I’m having a tough time with other people.
1
2
3
4
54. I imagine something really fun or exciting happening in my life.
1
2
3
4
55. When a rough situation with other people happens, I can get so upset that I can’t remember what 1
happened or what I did.
2
3
4
56. I try to believe it never happened.
1
2
3
4
57. When I have problems with other people, sometimes I can’t control what I do or say.
1
2
3
4
5
Correlates and predictors of recurrent depression: Appendix
6
Correlates and predictors of recurrent depression: Appendix
7
Correlates and predictors of recurrent depression 8
8
Correlates and predictors of recurrent depression 9
9
Correlates and predictors of recurrent depression 10
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Correlates and predictors of recurrent depression 11
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Correlates and predictors of recurrent depression 12
PODII / TEAMS
11/06/2009
CTQ
Page 1 of 2
INSTRUCTIONS: These questions ask about some of your experiences growing up as a child and a teenager.
Although these questions are of a personal nature, please try to answer as honestly as you can. For each
question, fill in the bubble under the response that best describes how you feel. If you wish to change your
response, put an X through it and fill in your new choice.
PLEASE REMEMBER that all information is strictly confidential unless we hear that you are currently in danger
of hurting yourself or someone else.
NOTE: Your specific answers on this form will not be reviewed immediately.
Never
True
Indicate whether this has ever
happened to you, and how often.
Rarely
True
Sometimes
True
Often
True
Very
Often
True
1. I didn't have enough to eat.
2. I knew that there was someone to take care of
me and protect me.
3. People in my family called me things like "stupid,"
"lazy," or "ugly."
4. My parents were too drunk or high to take
care of the family.
5. There was someone in my family who helped me
feel that I was important or special.
6. I had to wear dirty clothes.
7. I felt loved.
8. I thought that my parents wished I had never
been born.
9. I got hit so hard by someone in my family that I
had to see a doctor or go to the hospital.
10. There was nothing I wanted to change about my
family.
11. People in my family hit me so hard that it left me
with bruises or marks.
12. I was punished with a belt, a board, a cord, or
some other hard object.
Copyright © 1998 NCS Person, Inc. Reproduced with permission. All rights reserved.
11/06/2009 09:03:20 AM
ID
DATE
/
B
PI
N
PO
COHORT
TIMEPT
60
6317
/
12
Correlates and predictors of recurrent depression 13
PODII / TEAMS
11/06/2009
CTQ
Page 2 of 2
Indicate whether this has ever
happened to you and how often.
Never
True
Rarely
True
Sometimes
True
Often
True
Very
Often
True
13. People in my family looked out for each other.
14. People in my family said hurtful or insulting things
to me.
15. I believe that I was physically abused.
16. I had the perfect childhood.
17. I got hit or beaten so badly that it was noticed by
someone like a teacher, neighbor, or doctor.
18. I felt that someone in my family hated me.
19. People in my family felt close to each other.
20. Someone tried to touch me in a sexual way, or
tried to make me touch them.
21. Someone threatened to hurt me or tell lies
about me unless I did something sexual with them.
22. I had the best family in the world.
23. Someone tried to make me do sexual things or
watch sexual things.
24. Someone molested me.
25. I believe that I was emotionally abused.
26. There was someone to take me to the doctor if I
needed it.
27. I believe that I was sexually abused.
28. My family was a source of strength and support.
Copyright © 1998 NCS Person, Inc. Reproduced with permission. All rights reserved.
6317
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Correlates and predictors of recurrent depression 14
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Correlates and predictors of recurrent depression 15
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Correlates and predictors of recurrent depression 21
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Correlates and predictors of recurrent depression 22
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Correlates and predictors of recurrent depression 23
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Correlates and predictors of recurrent depression 24
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Correlates and predictors of recurrent depression 25
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Correlates and predictors of recurrent depression 28
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Correlates and predictors of recurrent depression 29
11. _____
Family member became pregnant or had a baby
_____
12. _____
Going to school or work
_____
13. _____
Hospitalization of a family member or relative
_____
14. _____
Falling in love or beginning a relationship with a boyfriend / girlfriend
_____
15. _____
Family members not getting along with your friends or romantic partner
_____
16. _____
Doing poorly on an assignment, test, or presentation at school or work.
_____
17. _____
Talking or sharing feelings with friends
_____
18. _____
Being around people who are inconsiderate or offensive (rude, selfish)
_____
19. _____
Arrest of a family member
_____
20. _____
Getting into trouble or being disciplined at school or work
_____
21. _____
Hassles, arguments or fights with other students or co-workers
_____
22. _____
Financial troubles or worries about money
_____
23. _____
Getting bad grades at school or poor performance ratings at work
_____
EVENT HAS HAPPENED
IN PAST 6 MONTHS
GOOD-BAD
RATING
24. _____
Being dissatisfied with classes, professors, work, employer
____
25. _____
Emotional worries (feeling depressed, moody, angry, uns ure of yourself, etc.)
_____
26. _____
Going to place of worship (church, temple)
_____
27. _____
Meeting new people
_____
28. _____
Parent getting married
_____
29. _____
Having few or no friends
_____
30. _____
Arguments or fights between parents
_____
31. _____
Performing well at school or work (good grades, promotion)
_____
32. _____
Having good classes, professors, co-workers, employer
_____
33. _____
Drinking or drug use
_____
29
Correlates and predictors of recurrent depression 30
30
Correlates and predictors of recurrent depression 31
57. _____
Brother or sister getting separated or divorced
_____
58. _____
Not spending enough time with family members or friends
_____
59. _____
School or job change of a family member (drops out of school, gets a job, etc.)
_____
60. _____
Started a new school year or new job
_____
61. _____
Living with a roommate or romantic partner
_____
62. _____
Talking on the telephone, text messaging
_____
63. _____
Discussions or long talks with parents
_____
64. _____
Homework, studying, working long hours or overtime
_____
65. _____
Taking care of your brother(s) or sister(s)
_____
66. _____
Problems or arguments with parents, siblings, or family members
_____
67. _____
Problems or arguments with a professor or employer
_____
68. _____
Spending time at home
_____
70. _____
Being recognized for an achievement at school or work
_____
71. _____
Negative feelings or worrying about appearance
_____
72. _____
Negative feelings or worrying about personal health or fitness
_____
73. _____
Doing chores (e.g., laundry, cleaning room, mow lawn)
_____
74. _____
Something good happened to a friend
_____
75. _____
Alcohol or drug use by family members or relatives
_____
76. _____
Breaking up with or being rejected by your boyfriend or girlfriend
_____
77. _____
Death of a friend
_____
78. _____
Family moves (to a new home or apartment)
_____
79. _____
Parent loses a job
_____
80. _____
Returning to school after time off
_____
81. _____
Parents getting divorced
_____
82. _____
Not getting along with the parents of a friend or romantic partner
_____
31
Correlates and predictors of recurrent depression 32
32
Correlates and predictors of recurrent depression 33
33