Patient Stress, Anxiety, Alcohol, and Trauma Questionnaire Analysis

This assignment presents a comprehensive patient stress questionnaire designed to assess various aspects of a patient's well-being. The questionnaire encompasses multiple sections, including assessments for depression (PHQ-9), anxiety (GAD-7), potential trauma (PC-PTSD), and alcohol consumption (AUDIT). The questionnaire also incorporates questions about physical pain, providing a holistic view of the patient's condition. The depression section utilizes a Likert scale to gauge the frequency of depressive symptoms, while the anxiety section similarly assesses the frequency of anxious feelings and behaviors. The trauma assessment explores potential traumatic experiences and their impact, and the alcohol section evaluates drinking habits and related problems. The inclusion of pain assessment further enhances the questionnaire's ability to provide a complete overview of a patient's mental and physical health status. The questionnaire is adapted from established tools and aims to provide a detailed understanding of the patient's overall health and well-being. The questionnaire is a valuable tool for healthcare providers to assess the patient's mental and physical health.

Date:_______________ Birthdate_________________
Patient Stress Questionnaire*
Name: __________________________________________
Over the last two weeks , how often have you been bothered by
any of the following problems?
(please circle your answer & check the boxes that apply to you)
Not at all
Several
days
More than
half the
days
Nearly
Every day
1. Little interest or pleasure in doing things 0 1 2 3
2. Feeling down, depressed, or hopeless 0 1 2 3
3. Trouble falling or staying asleep, or
sleeping too much 0 1 2 3
4. Feeling tired or having little energy 0 1 2 3
5. Poor appetite or
overeating 0 1 2 3
6. Feeling bad about yourself or that you are a failure or
have let yourself or your family down 0 1 2 3
7. Trouble concentrating on things, such as reading the
newspaper or watching television 0 1 2 3
8. Moving or speaking so slowly that other people
could have noticed, or
the opposite - being so fidgety or restless that
you've been moving around a lot more than usual
0 1 2 3
9. Thoughts that you would be better off dead, or
hurting yourself in some way 0 1 2 3 Total
(10)
add
columns:
1. Feeling nervous, anxious or on edge 0 1 2 3
2. Not being able to stop or control worrying 0 1 2 3
3. Worrying too much about different things 0 1 2 3
4. Trouble relaxing 0 1 2 3
5. Being so restless that it is hard to sit still 0 1 2 3
6. Becoming easily annoyed or irritable 0 1 2 3
7. Feeling afraid as if something awful might happen 0 1 2 3 Total
(8)
*adapted from PhQ 9, GAD7, PC-PTSD and AUDIT 1/24/11
add
columns:
Provider:__________________________________ Please also complete back side

No Yes
No Yes
No Yes
No Yes
No Yes
(3)
Please circle your answer 0 1 2 3 4
How often do you have one drink containing
alcohol? Never Monthly or
less
2-4 times a
month
2-3 times
a week
4+ times per
week
How many drinks containing alcohol do you have on
a typical day when you are drinking? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more
How often do you have four or more drinks on one
occasion? Never Less than
monthly Monthly Weekly Daily or almost
daily
…found that you were not able to stop drinking
once you had started? Never Less than
monthly Monthly Weekly Daily or
almost daily
…failed to do what was normally expected from
you because of drinking? Never Less than
monthly Monthly Weekly Daily or
almost daily
…needed a first drink in the morning to get
yourself going after heavy drinking? Never Less than
monthly Monthly Weekly Daily or
almost daily
…had a feeling of guilt or remorse after drinking? Never Less than
monthly Monthly Weekly Daily or
almost daily
…been unable to remember what happened the
night before because you had been drinking? Never Less than
monthly Monthly Weekly Daily or
almost daily
0 2 4
Have you or someone else been injured as a result
of your drinking? No Yes, during
the last year
Has a relative, friend, doctor or other health worker
been concerned about your drinking or suggested
you cut down?
No Yes, during
the last year
(8)
Standard serving of one drink:
12 ounces of beer or wine cooler
1.5 ounces of 80 proof liquor
5 ounces of wine
4 ounces of brandy, liqueur or aperitif
Are you currently in any physical pain?
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that,
in the past month , you:
These questions are about your drinking habits. We’ve listed the serving size of one drink below.
How often during the last year have you……
4. Felt numb or detached from others, activities, or your surroundings?
3. Were constantly on guard, watchful, or easily startled?
2. Tried hard not to think about it or went out of your way to avoid situations
that reminded you of it?
Total:
1. Have had nightmares about it or thought about it when you did not want to?
Drinking alcohol can affect your health. This is especially important if you take certain medications. We
want to help you stay healthy and lower your risk for the problems that can be caused by drinking.
Yes, but not in
the last year
Yes, but not in
the last year