Deep Dive Questionnaire 2 "*" indicates required fields Step 1 of 7 14% Welcome to your personalized Warfighter Scuba Deep Dive assessment! Why Take This anyway? Our intent is to give you insight into where you are currently as it relates to relationships, trauma and resilience as well as assess for any changes you make over time. When you speak, we listen. Your feedback is also vital in helping us improve the Warfighter Scuba program. Our Deep Dive, depending on your experiences and your answers, this survey may take only about 5 minutes or may require as much as 10 minutes to complete. Regardless, please do your best to answer as completely and as frankly as you can. About the survey: I. You are eligible to complete this survey If you are a member of the Warfighter Scuba program. You can take it as many times as you would like to track your progress. II. This survey is in no way affiliated with the U.S. Government, Department of Defense, Department of Veterans Affairs, or any other government organization. III. This survey is 100% CONFIDENTIAL. IV. The purpose of this survey is to determine what challenges you currently face in regards to trauma and its impact on your life. V. All we ask is for honest responses to the following questions to include any recommendations you have as to anything we may have left out, need to add, or change. We sincerely thank you for completing this survey. We've got your six!When are you taking this questionnaire?* Before Warighter Scuba Trip During Warfighter Scuba Trip After Warfighter Scuba Trip Adult Hope Scale (AHS)Directions: Read each item carefully. Using the scale shown below, please select the number that best describes YOU and put that number in the blank provided.I can think of many ways to get out of a jam.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I energetically pursue my goals.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True feel tired most of the time.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True There are lots of ways around any problem.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I am easily downed in an argument.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I can think of many ways to get the things in life that are important to me.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I worry about my health.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True Even when others get discouraged, I know I can find a way to solve the problem.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True My past experiences have prepared me well for my future.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I’ve been pretty successful in life.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I usually find myself worrying about something.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True I meet the goals that I set for myself.* Definitely False Mostly False Somewhat False Slightly False Slightly True Somewhat True Mostly True Definitely True Number Health QuestionnaireLittle interest or pleasure in doing things* Not at all Several days More than half the days Nearly every day Feeling down, depressed, or hopeless* Not at all Several days More than half the days Nearly every day Trouble falling or staying asleep, or sleeping too much* Not at all Several days More than half the days Nearly every day Feeling tired or having little energy* Not at all Several days More than half the days Nearly every day Poor appetite or overeating* Not at all Several days More than half the days Nearly every day Feeling bad about yourself — or that you are a failure or have let yourself or your family down* Not at all Several days More than half the days Nearly every day Trouble concentrating on things, such as reading the newspaper or watching television* Not at all Several days More than half the days Nearly every day Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual* Not at all Several days More than half the days Nearly every day Thoughts that you would be better off dead or of hurting yourself in some way* Not at all Several days More than half the days Nearly every day If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?* Not difficult at all Somewhat difficult Very difficult Extremely difficult Number GAD-7 AnxietyOver the last two weeks, how often have you been bothered by the following problems?Feeling nervous, anxious, or on edge* Not at all Several days More than half the days Nearly every day Not being able to stop or control worrying* Not at all Several days More than half the days Nearly every day Worrying too much about different things* Not at all Several days More than half the days Nearly every day Trouble relaxing* Not at all Several days More than half the days Nearly every day Being so restless that it is hard to sit still* Not at all Several days More than half the days Nearly every day Becoming easily annoyed or irritable* Not at all Several days More than half the days Nearly every day Feeling afraid, as if something awful might happen* Not at all Several days More than half the days Nearly every day If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?* Not difficult at all Somewhat difficult Very difficult Extremely difficult Number DTSFeeling distressed or upset is unbearable to me.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree When I feel distressed or upset, all I can think about is how bad I feel.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree I can’t handle feeling distressed or upset.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree My feelings of distress are so intense that they completely take over.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree There’s nothing worse than feeling distressed or upset.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree I can tolerate being My feelings of distress or being upset are not acceptable or upset as well as most people.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree I can tolerate being distressed or upset as well as most people.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree I’ll do anything to avoid feeling distressed or upset.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree Other people seem to be able to tolerate feeling distressed or upset better than I can.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree Being distressed or upset is always a major ordeal for me.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree I am ashamed of myself when I feel distressed or upset.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree My feelings of distress or being upset scare me.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree I’ll do anything to stop feeling distressed or upset.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree When I feel distressed or upset, I must do something about it immediately.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree When I feel distressed or upset, I cannot help but concentrate on how bad the distress actually feels.* Strongly Disagree Mildly Disagree Agree and Disagree Equally Mildly Agree Strongly Agree Number Pain ScaleCurrent pain level 0 being no pain and 10 being worst possible pain* 0 1 2 3 4 5 6 7 8 9 10 Health-Related Quality of LifeCore Healthy Days Module Would you say that in general your health is:* Excellent Very Good Good Fair Poor Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930Activity Limitations ModuleThese next questions are about physical, mental, or emotional problems or limitations you may have in your daily life.Are you LIMITED in any way in any activities because of any impairment or health problem?* Yes No What is the MAJOR impairment or health problem that limits your activities?* Arthritis/rheumatism Back or neck problem Fractures, bone/joint injury Walking problem Lung/breathing problem Hearing problem Eye/vision problem Heart problem Stroke problem Hypertension/high blood pressure Diabetes Cancer Depression/anxiety/emotional problem Other impairment/problem For HOW LONG have your activities been limited because of your major impairment or health problem?* Days Weeks Months Years How many?*Select one123456789101112131415161718192021222324252627282930Because of any impairment or health problem, do you need the help of other persons with your PERSONAL CARE needs, such as eating, bathing, dressing, or getting around the house?* Yes No Because of any impairment or health problem, do you need the help of other persons in handling your ROUTINE needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?* Yes No Healthy Days Symptoms ModuleDuring the past 30 days, for about how many days did PAIN make it hard for you to do your usual activities, such as self-care, work, or recreation?* None Number of Days During the past 30 days, for about how many days did PAIN make it hard for you to do your usual activities, such as self-care, work, or recreation?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930During the past 30 days, for about how many days have you felt SAD, BLUE, or DEPRESSED?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930During the past 30 days, for about how many days have you felt WORRIED, TENSE, or ANXIOUS?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930During the past 30 days, for about how many days have you felt you did NOT get ENOUGH REST or SLEEP?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930During the past 30 days, for about how many days have you felt VERY HEALTHY AND FULL OF ENERGY?* None Number of Days How many days?*Select one123456789101112131415161718192021222324252627282930NumberName* First Last Δ
Warfighter Scuba’s mission is to serve veterans and gold star families affected by the traumas of war and create opportunities to prevent divorce and suicide. No one left behind. No one left alone
