Appendix 1. Interview Protocol

I consent to participate in this study which is being conducted by Professor Alan Carr, University College Dublin at the invitation of the Child Abuse Commission.

I understand that the study will involve an interview; that participation is voluntary; that the interview will be fully confidential, that I may withdraw at any time; and that I may be invited to participate in a follow-up interview.

Signature of participant Witnessed by interviewer
Date

Demographic Questionnaire
Thank you for agreeing to do this interview. We will start with some fairly straightforward questions.
D1 Name
Put case number in box
Address
Phone Number
D2 Gender
Male 0
Female 1
D3 What age are you now?
Record in years
D4 In what year were your born?
Record year
D5 How long did you live with your family before you lived in an institution? Record in years with 0 if never lived in family
D6 What institution did you enter?

Name____________
1. Orphanage
2. Reformatory
3. Industrial school
4. Children’s home
5. Boarding school
6. Hospital
D7 Who ran the institution? 1. Nuns
2. Brothers
3. Priests
4. Other
D8 Now long did you live in an institution? Record in years
D9 Why did you enter an institution? 1. I was illegitimate and given to the orphanage
2. My mother died in childbirth
3. Put in by authorities for petty crime (theft, truancy or misdemeanour)
4. Put in by parents because they could not look after me
5. Put in by parent because other parent died
6. I was sick or disabled
D10 Why did you leave the institution? 1. I was too old to stay on
2. The institution closed down
3. My short sentence was over
4. My family wanted to take me home
5. I ran away
7. Other specify
D11 Were you happy to leave the institution? 2. Yes
1. Mixed feelings
0. No
D12 Code group Group 1. Raised in institution from birth and left when too old to stay
Group 2. Raised by parents and put in institution because parents couldn’t cope
or died and left when too old to stay
Group 3. Raised by parents and put in institution by authorities because of petty crime and left when too old to stay
Group 4. Raised by parents, put in institution and escaped or taken out within 1-4 years
Other: specify.
D13 What is your current job ?
Name of job and put SES rating in box
D14 What was the best job you had since leaving school? Name of job and put SES rating in box
SES Rating scale Unemployed 0
Unskilled manual 1
Semi-skilled manual and farmers owning less than 30 acres 2
Skilled manual and farmers owning 30-49 acres 3
Other non-manual and farmers owning 50-99 acres 4
Lower professional and lower managerial; farmers owning 100-199 acres 4
Higher professional and higher managerial; farmers owning 200 or more acres 6
D15 What was the highest exam None 0
you passed? (circle number) Junior school exam in 5th or 6th class (e.g. primary cert) 1
Mid high school exam (e.g. Inter or junior cert) 2
Leaving cert 3
Certificate or diploma or apprenticeship exam 4
Primary degree (e.g. BA) 5
Higher degree (e.g. MA) 6
D16 Are you single or married? Single and never married of cohabited 1
(Probe and Circle number) Single and separated from first cohabiting partner 2
Single and separated from first marital partner 3
Single and divorced from first married partner 4
Single and separated or divorced from second or later partner 5
Single and widowed 6
Cohabiting in second or later long term relationship 7
Married in second or later marriage 8
Cohabiting in first long term relationship 9
Married in first long term relationship 10
D17 How many long term relationships or marriages have you had that have ended/ Record number in box
D18 How long have you lived with your current partner? Record number in box or give 0 if not in relationship

Marital satisfaction (KMS, Schumm et al., 1986)
The next three questions are about your current marriage or long-term relationship. Give your answers on a 7 point scale from 1= Extremely dissatisfied to 7=extremely satisfied. SHOW 7 POINT SCALE (Circle 0 if the person is not in a relationship at present)
KMS1 How satisfied are you with your marriage or main relationship? Not applicable
0
Extremely dissatisfied
1
Very dissatisfied
2
Somewhat dissatisfied
3
Mixed

4
Some what satisfied
5
Very satisfied
6
Extremely satisfied
7
KMS2 How satisfied are you with your partner as a spouse? Not applicable
0
Extremely dissatisfied
1
Very dissatisfied
2
Somewhat dissatisfied
3
Mixed

4
Some what satisfied
5
Very satisfied
6
Extremely satisfied
7
KMS3 How satisfied are you with your relationship with your partner? Not applicable
0
Extremely dissatisfied
1
Very dissatisfied
2
Somewhat dissatisfied
3
Mixed

4
Some what satisfied
5
Very satisfied
6
Extremely satisfied
7
Experiences in Close Relationships Inventory (ECR, Brennan, Clark, & Shaver (1998)
The following statements concern how you feel in romantic relationships. We are interested in how you generally experience relationships, not just in what is happening in a current relationship. Respond to each statement by indicating how much you agree or disagree with it on a 7 point scale from 1=Disagree strongly to 7=Agree strongly. SHOW 7 POINT SCALE. Complete this section even if the person is not in a relationship now.
E1 I prefer not to show a partner how I feel deep down. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E2 I worry about being abandoned. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E3 I am very comfortable being close to romantic partners. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E4 I worry a lot about my relationships. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E5 Just when my partner starts to get close to me I find myself pulling away. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E6 I worry that romantic partners won’t care about me as much as I care about them. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E7 I get uncomfortable when a romantic partner wants to be very close. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E8 I worry a fair amount about losing my partner. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E9 I don’t feel comfortable opening up to romantic partners. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E10 I often wish that my partner’s feelings for me were as strong as my feelings for him/her. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E11 I want to get close to my partner, but I keep pulling back. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E12 I often want to merge completely with romantic partners, and this sometimes scares them away. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E13 I am nervous when partners get too close to me. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E14 I worry about being alone. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E15 I feel comfortable sharing my private thoughts and feelings with my partner. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E16 My desire to be very close sometimes scares people away. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E17 I try to avoid getting too close to my partner. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E18 I need a lot of reassurance that I am loved by my partner. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E19 I find it relatively easy to get close to my partner. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E20 Sometimes I feel that I force my partners to show more feeling, more commitment. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E21 I find it difficult to allow myself to depend on romantic partners. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E22 I do not often worry about being abandoned. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E23 I prefer not to be too close to romantic partners. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E24 If I can’t get my partner to show interest in me, I get upset or angry. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E25 I tell my partner just about everything. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E26 I find that my partner(s) don’t want to get as close as I would like. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E27 I usually discuss my problems and concerns with my partner. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E28 When I’m not involved in a relationship, I feel somewhat anxious and insecure. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E29 I feel comfortable depending on romantic partners. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E30 I get frustrated when my partner is not around as much as I would like. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E31 I don’t mind asking romantic partners for comfort, advice, or help. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E32 I get frustrated if romantic partners are not available when I need them. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E33 It helps to turn to my romantic partner in times of need. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E34 When romantic partners disapprove of me, I feel really bad about myself. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E35 I turn to my partner for many things, including comfort and reassurance. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7
E36 I resent it when my partner spends time away from me. Disagree strongly
1
Disagree

2
Disagree
a little
3
Neutral

4
Agree
a little
5
Agree

6
Agree strongly
7

D19 How many children have you? Record number in box and score 0 if none
D20 At what age did you have your first child? Record age in years in box and 0 if none
D21 Have your children always lived with you ? I have none 0
No they have spent some time living with their other parent 1
No they have spent some time living with their relatives 2
No they have spent some time living in care 3

Parenting satisfaction KPS, (James et al., 1985)
The next three questions are about your relationship with your children. Give your answers on a 7 point scale from 1= Extremely dissatisfied to 7=extremely satisfied. SHOW 7 POINT SCALE. Circle 0 if person has no children.
KPS1 How satisfied are you with your children’s behaviour? Not applicable
0
Extremely dissatisfied
1
Very dissatisfied
2
Somewhat dissatisfied
3
Mixed

4
Some what satisfied
5
Very satisfied
6
Extremely satisfied
7
KPS2 How satisfied are you with yourself as a parent? Not applicable
0
Extremely dissatisfied
1
Very dissatisfied
2
Somewhat dissatisfied
3
Mixed

4
Some what satisfied
5
Very satisfied
6
Extremely satisfied
7
KPS3 How satisfied are you with your relationship(s) with your children? Not applicable
0
Extremely dissatisfied
1
Very dissatisfied
2
Somewhat dissatisfied
3
Mixed

4
Some what satisfied
5
Very satisfied
6
Extremely satisfied
7

WHOQOL-100-UK (Skevington, 2005)
This set of questions asks how you feel about your quality of life in the last two weeks. There are no right or wrong answers. Please keep in mind your standards, hopes, pleasures and concerns. The following questions ask about how much you have experienced certain things in the last two weeks, for example, positive feelings such as happiness or contentment. Please use this 5 point scale to give your answer (SHOW A 5 POINT SCALE FROM 1=Not at all to 5=An extreme amount). Questions refer to the last two weeks.
1 F1.2 How much do you worry about pain or discomfort? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
2 F1.3 How difficult is it for you to handle pain or discomfort? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
3 F1.4 How much do you feel that pain prevents you from doing what you need to do? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
4 F2.2 How easily do you get tired? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
5 F2.4 How much are you bothered by fatigue? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
6 F3.2 To what extent do you have difficulty sleeping? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
7 F3.4 How much do sleep problems worry you? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
8 F4.1 How much do you enjoy life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
9 F4.3 How positive do you feel about the future? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
10 F4.4 How much do you feel positive about your life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
11 F5.3 How well are you able to concentrate? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
12 F6.1 How much do you value yourself? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
13 F6.2 How much confidence do you have in yourself? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
14 F7.2 How much do you feel inhibited by your looks? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
15 F 7.3 Is there any part of your appearance which makes you feel uncomfortable? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
16 F8.2 How worried do you feel? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
17 F8.3 How much do feelings of sadness or depression interfere with your everyday functioning? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
18 F 8.4 How much do feelings of depression bother you? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
19 F10.2 To what extent do you have difficulty in performing your routine activities? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
20 F10.4 How much are you bothered by limitations in performing everyday living activities?
Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
21 F11.2 How much do you need medication to function in your daily life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
22 F11.3 How much do you need medical treatment to function in your daily life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
23 F 11.4 How much does your quality of life depend on the use of medical substances or medical aids? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
24 F13.1 How alone do you feel? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
25 F15.2 How well are your sexual needs fulfilled? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
26 F15.4 How bothered are you by difficulties in your sex life? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
27 F16.1 How safe do you feel in your daily life? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
28 F16.2 To what extent do you feel you are living in a safe and secure environment? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
29 F16.3 How much do you worry about safety and security? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
30 F17.1 How comfortable is the place where you live? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
31 F17.4 How much do you like where you live? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
32 F18.2 To what extent do you have financial difficulties? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
33 F18.4 How much do you worry about money? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
34 F19.1 How easily are you able to get good medical care? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
35 F21.3 How much do you enjoy your free time? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
36 F22.1 How healthy is your physical environment? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
37 F22.2 How concerned are you with the noise in the area where you live? Not at all
1
Not much
2
Moderately
3
Very well
4
Extremely
5
38 F23.2 To what extent do you have problems with transport? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
39 F23.4 How much do difficulties with transport restrict your life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
40 F8N How fed up do you feel? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5

The following questions ask about how completely you experienced, or were able to do certain things in the last two weeks, for example activities of daily living like washing, dressing or eating. Please use this 5 point scale to give your answer (SHOW A 5 POINT SCALE FROM 1=Not at all to 5=Completely). Questions refer to the last two weeks
41 F2.1 Do you have enough energy for everyday life? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
42 F7.1 How much are you able to accept your bodily appearance? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
43 F10.1 To what extent are you able to carry out your daily activities? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
44 F11.1 How dependent are you on medications? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
45 F14.1 To what extent do you get the kind of support from others that you need? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
46 F14.2 How much can you count on your friends when you need them? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
47 F17.2 To what degree does the quality of your home meet your needs? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
48 F18.1 To what extent do you have enough money to meet your needs? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
49 F20.1 How available to you is the information that you need in your day-to-day life? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
50 F20.2 To what extent do you have the opportunities for acquiring the information that you need? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
51 F21.1 To what extent do you have the opportunity for leisure activities? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
52 F21.2 How much are you able to relax and enjoy yourself? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
53 F23.1 To what extent do you have adequate means of transport? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5

The following questions ask you to say how satisfied, happy or good you have felt about various aspects of your life over the last two weeks, for example, about your family life or your energy level. Please use this 5 point scale to give your answer (SHOW A 5 POINT SCALE FROM 1=Very dissatisfied to 5=Very satisfied). Questions refer to the last two weeks.
54 G2 How satisfied are you with the quality of your life? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
55 G3 In general, how satisfied are you with your life? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
56 G4 How satisfied are you with your health? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
57 F2.3 How satisfied are you with your energy? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
58 F3.3 How satisfied are you with your sleep? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
59 F5.2 How satisfied are you with your ability to learn new information? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
60 F5.4 How satisfied are you with your ability to make decisions? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
61 F6.3 How satisfied are you with yourself? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
62 F6.4 How satisfied are you with your abilities? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
63 F7.4 How satisfied are you with the way your body looks? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
64 F10.3 How satisfied are you with your ability to perform daily living activities? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
65 F13.3 How satisfied are you with your personal relationships? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
66 F15.3 How satisfied are you with your sex life? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
67 F14.3 How satisfied are you with the support you get from your family? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
68 F14.4 How satisfied are you with the support you get from your friends? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
69 F13.4 How satisfied are you with your ability to provide for, or support others? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
70 F16.4 How satisfied are you with your physical safety and security? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
71 F17.3 How satisfied are you with the conditions of your living place? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
72 F18.3 How satisfied are you with your financial situation? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
73 F19.3 How satisfied are you with your access to health services? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
74 F19.4 How satisfied are you with the social care services? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
75 F20.3 How satisfied are you with your opportunities for acquiring new skills? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
76 F20.4 How satisfied are you with your opportunities to learn new information? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
77 F21.4 How satisfied are you with the way you spend your spare time? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
78 F22.3 How satisfied are you with your physical environment e.g. pollution, climate, noise, attractiveness? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
79 F22.4 How satisfied are you with the climate of the place where you live? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
80 F23.3 How satisfied are you with your transport? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
81 F13.2 How happy do you feel about your relationships with your family? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5

For the next set of questions use this 5 point scale to rate how good things have been in the past 2 weeks. (SHOW A 5 POINT SCALE FROM 1=very poor to 5=Very good).
82 G1 How would you rate your quality of life? Very poor

1
Poor


2
Neither poor nor good
3
Good


4
Very good


5
83 F15.1 How would you rate your sex life? Very poor

1
Poor


2
Neither poor nor good
3
Good


4
Very good


5
84 F3.1 How well do you sleep? Very poor

1
Poor


2
Neither poor nor good
3
Good


4
Very good


5
85 F5.1 How would you rate your memory? Very poor

1
Poor


2
Neither poor nor good
3
Good


4
Very good


5
86 F19.2 How would you rate the quality of social services available to you? Very poor

1
Poor


2
Neither poor nor good
3
Good


4
Very good


5
87 F4N How satisfied are you with your level of happiness? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5

The following questions refer to how often you have felt or experienced certain things, for example the support of your family or friends, or negative experiences such as feeling unsafe. Use the 5 point scale to who how often they have occurred in the last 2 weeks (SHOW A 5 POINT SCALE FROM 1=Never to 5-=Always). So for example if you have experienced pain all the time in the last two weeks, use the answer 5=always".
88 F1.1 How often do you suffer pain? Never
1
Seldom
2
Quite often
3
Very often
4
Always
5
89 F4.2 Do you generally feel content? Never
1
Seldom
2
Quite often
3
Very often
4
Always
5
90 F8.1 How often do you have negative feelings, such as blue mood, despair, anxiety, depression? Never
1
Seldom
2
Quite often
3
Very often
4
Always
5

The following questions refer to any work that you do. Work here means any major activity that you do. This includes voluntary work, studying full-time, taking care of the home, taking care of children, paid work, or unpaid work. So work, as it is used here, means the activities you feel take up a major part of your time and energy. Questions refer to the last two weeks.
91 F12.1 How much are you able to work? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
92 F12.2 To what extent do you feel able to carry out your duties? Not at all
1
Not much
2
Moderately
3
A great deal
4
Completely
5
93 F12.4 How satisfied are you with your capacity for work? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5
94 F12.3 How would you rate your ability to work? Very poor

1
Poor

2
Neither poor nor good
3
Good

4
Very good

5
The next few questions ask about how well you were able to move around in the last two weeks. This refers to your physical ability to move your body in such a way as to allow you to move about and do the things you would like to do, as well as the things that you need to do. Questions refer to the last two weeks.
95 F9.1 How well are you able to get around? Very poor

1
Poor

2
Neither poor nor good
3
Good

4
Very good

5
96 F9.3 How much do any difficulties in mobility bother you? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
97 F9.4 To what extent do difficulties in movement affect your way of life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
98 F9.2 How satisfied are you with your ability to move around? Very dissatisfied

1
Dissatisfied


2
Neither satisfied nor dissatisfied
3
Satisfied


4
Very satisfied


5

The following questions are concerned with your personal beliefs and how these affect your quality of life. These questions refer to religion, spirituality and any other personal beliefs you may hold. Once again these questions refer to the last two weeks.
99 F24.1 How much do personal beliefs give meaning to your life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
100 F24.2 To what extent do you feel life to be meaningful? Not at all

1
Not much

2
Moderately
3
Very well

4
Extremely
5
101 F24.3 How much do your personal beliefs give you the strength to face difficulties? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
102 F24.4 To what extent do your personal beliefs help you to understand the difficulties in life? Not at all

1
Not much

2
A moderate amount
3
Very much

4
An extreme amount
5
Childhood Trauma Questionnaire (CTQ, Bernstein & Fink, 1998)
Use a five point scale from1=never true to 5=very often true to show how true these statements were about living in your family .
SHOW 5 POINT SCALE
Score the next 36 questions as 0 if the respondent did not live with his or her family 0
CTQF1 I didn’t have enough to eat Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF2 I knew that there was someone to take care of me and protect me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF3 People in my family called me things like “stupid”, “lazy”, or “ugly”. Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF4 My parents were too drunk or high to take care of the family Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF5 There was someone in my family who helped me feel that I was important or special Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF6 I had to wear dirty clothes Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF7 I felt loved Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF8 I thought that my parents wished I had never been born Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF9 I got hit so hard by someone in my family that I had to see a doctor or go to the hospital Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF10 There was nothing I wanted to change about my family Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF11 People in my family hit me so hard that it left me with bruises or marks Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF12 I was punished with a belt (a strap), a board (a stick), a chord, or some other hard object Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF13 People in my family looked out for each other Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF14 People in my family said hurtful or insulting things to me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF15 I believe that I was physically abused Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF16 I had the perfect childhood Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF17 I got hit or beaten so badly that it was noticed by someone like a teacher, neighbour or doctor Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF18 I felt that someone in my family hated me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF19 People in my family felt close to each other Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF20 Someone tried to touch me in a sexual way Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF21 Someone threatened to hurt me or tell lies about me unless I did something sexual with them Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF22 I had the best family in the world Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF23 Someone tried to make me do sexual things or watch sexual things Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF24 Someone molested me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF25 I believe that I was emotionally abused Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF26 There was someone to take me to the doctor if I needed it Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF27 I believe that I was sexually abused Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQF28 My family was a source of strength and support. Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
AF1 What was the most severe form of physical abuse you experienced in your family? None


0
Being hit without being bruised

1
Being hit to leave bruises

2
Being assaulted to lead to cuts

3
Being assaulted to lead to medical attention
4
AF2 How often did this severe form happen? Never

0
Once

1
2-10 times

2
11-100 times

3
More than 100 times
4
AF3 How young were you when this first began?
AF4 How many years did it last?
AF5 What was the most severe form of sexual abuse that you experienced in your family? None



0
Non-Contact
Flashing Exposure

1
Contact
Fondling and masturbation

2
Attempted penetration
(oral, anal or vaginal sex)
3
Penetration
(oral, anal or vaginal sex)

4
AF6 How often did this severe form happen? Never

0
Once

1
2-10 times

2
11-100 times

3
More than 100 times
4
AF7 How young were you when this first began?
AF8 How many years did it last?

Childhood Trauma Questionnaire (CTQ, Bernstein & Fink, 1998)
Use a five point scale from1=never true to 5=very often true to show how true these statements were about living in institutional care. SHOW SCALE.
CTQI1 I didn’t have enough to eat Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI2 I knew that there was someone to take care of me and protect me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI3 My carers called me things like “stupid”, “lazy”, or “ugly”. Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI4 My carers were too drunk or high to take care of us Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI5 There was someone in my institution who helped me feel that I was important or special Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI6 I had to wear dirty clothes Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI7 I felt loved (by the carers) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI8 I thought that my carers wished I had never been born Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI9 I got hit so hard by a carer in my institution that I had to see a doctor or go to the hospital Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI10 There was nothing I wanted to change about my institution Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI11 Carers in my institution hit me so hard that it left me with bruises or marks Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI12 I was punished with a belt (a strap), a board (a stick), a chord, or some other hard object Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI13 Carers and others in my institution looked out for each other Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI14 Carers in my institution said hurtful or insulting things to me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI15 I believe that I was physically abused Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI16 I had the perfect childhood Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI17 I got hit or beaten so badly that it was noticed by someone like a teacher, neighbour or doctor Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI18 I felt that carers in my institution hated me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI19 People in my institution felt close to each other Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI20 A carer tried to touch me in a sexual way Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI21 A carer threatened to hurt me or tell lies about me unless I did something sexual with them Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI22 I was reared in the best institution in the world Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI23 A carer tried to make me do sexual things or watch sexual things Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI24 A carer molested me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI25 I believe that I was emotionally abused in the institution Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI26 There was someone to take me to the doctor if I needed it Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI27 I believe that I was sexually abused in the institution Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
CTQI28 My institution was a source of strength and support. Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H1 I was terrified of my carers Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H2 I was punished unfairly by my carers Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H3 I could never predict when I would be punished by my carers Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H4 My carers separated me from my brother(s) or sister(s) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H5 My carers took away my own clothes Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H6 My carers destroyed my treasured possessions (pictures, teddy bears, mementoes etc) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H7 My carers told me I was bad Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H8 My carers said my mother was bad Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H9 My carers said my father was bad Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H10 My carers told me my mother did not love me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H11 My carers told me my father did not love me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H12 My carers tried to take away my hope Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H13 My carers tried to break me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
H14 What was the worst thing that happened to you in the institution?
H15 How young were you when this first began?
H16 How many years did it last?
AI1 What was the most severe form of physical abuse you experienced in your institution? None


0
Being hit without being bruised

1
Being hit to leave bruises

2
Being assaulted to lead to cuts

3
Being assaulted to lead to medical attention
4
AI2 How often did this severe form happen? Never

0
Once

1
2-10 times

2
11-100 times

3
More than 100 times
4
AI3 How young were you when this first began?
AI4 How many years did it last?
AI5 What was the most severe form of sexual abuse that you experienced in your institution? None



0
Non-Contact
Flashing Exposure

1
Contact
Fondling and masturbation

2
Attempted penetration
(oral, anal or vaginal sex)
3
Penetration
(oral, anal or vaginal sex)

4
AI6 How often did this severe form happen? Never

0
Once

1
2-10 times

2
11-100 times

3
More than 100 times
4
AI7 How young were you when this first began?
AI8 How many years did it last?

Institutional Abuse Processes And Coping Inventory
Lets talk now about your immediate reaction to the abuse and neglect you experienced
AS A CHILD OR YOUNGSTER and also YOUR CURRENT REACTIONS TO IT.
Use a five point scale from1=never true to 5=very often true to show how true these statements are about your reactions. (SHOW SCALE)
Traumatization
1TP1 I felt hurt then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
2TC1 I feel hurt now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
3TP2 I felt frightened then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
4TC2 I feel frightened now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
5TP3 I felt sad then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
6TC3 I feel sad now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
7TP4 I felt humiliated then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
8TC4 I feel humiliated now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Betrayal and loss of trust
9BP1 I trusted everyone then (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
10BC1 I trust everyone now (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
11BP2 I felt betrayed then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
12BC2 I feel betrayed now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
13BP3 I cut myself off from other people then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
14BC3 I cut myself off from other people now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Disrespect of authority
15DP1 I was angry at everyone in authority then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
16DC1 I am angry with everyone in authority now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
17DP2 I liked people in authority then (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
18DC2 I like people in authority now (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
19DP3 I respected everyone in authority then (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
20DC3 I respect everyone in authority now (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Religious Disengagement
21RP1 I had faith in God then (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
22PC1 I have faith in God now (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
23RP2 I had faith in the church then (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
24RC2 I have faith in the church now (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
25RP3 I stopped praying then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
26RC3 I do not pray now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
27RP4 I only went to mass then because I would be punished if I did not to Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
28RC4 I do not go to mass now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Stigmatization shame and guilt
29SP1 I felt I was worthless then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
30SC1 I feel I am worthless now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
31SP2 I felt I was dirty then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
32SC2 I feel I am dirty now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
33SP3 I felt ashamed then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
34SC3 I feel ashamed now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
35SP4 I felt guilty and believed the abuse was my fault then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
36SC4 I feel guilty and believe the abuse is my fault now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Powerlessness
37PP1 I believed I had full control over my life then (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
38PC1 I believe I have full control over my life now (-) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
39PP2 I believed that my life was controlled by others then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
40PC2 I believe that my life is controlled by others now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
41PP3 I thought I could do nothing to change my situation then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
42PC3 I think I can do nothing to change my situation now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Avoidance of reminders of abuse
43AP1 I avoid thinking about the abuse then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
44AC1 I avoid thinking about the abuse now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
45AP2 I avoided situations that reminded me of abuse then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
46AC2 I avoid situations that remind me of abuse now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
47AP3 I avoided people who reminded me of the abuse then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
48AC3 I avoid people who remind me of the abuse now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Re-enactment
49XP1 I felt the urge to attack or abuse other people then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
50XC1 I feel the urge to attack or abuse other people now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
51XP2 I hurt other people then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
52XC2 I hurt other people now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
53XP3 I felt the urge to harm or injure myself then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
54XC3 I feel the urge to harm or injure myself now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
55XP4 I harmed or injured myself then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
56XC4 I harm or injure myself now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping through spiritual support
57CSP1 I prayed to God then, and that made the abuse bearable Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
58CSPC1 I pray to God now, and that makes the abuse bearable Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
59CSP2 I talked to a priest then and that made the abuse bearable Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
60CSC2 I talk to a priest now and that makes the abuse bearable Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping by complying
61CCP1 I tried to behave well for the teachers /nuns /brothers /priests so I would not be punished then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
62CCC1 I try to behave well and fit in with people at work and in my family now to avoid conflict and arguments Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
63CCP2 I was careful never to break a rule then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
64CCC2 I am careful never to break a rule now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
65CCP3 I was careful always to show respect to the brothers, priests, nuns and teachers then (even if I didn’t feel respect) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
66CCC3 I am careful always to show respect to people in authority now (even if I do not feel respect) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping by opposing
67COP1 I stood up to my abusers then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
68COC1 I am standing up to my abusers and anyone in authority who tries to hurt me now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
69COP2 I ran away from the institution then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
70COC2 I leave situations where people in authority hurt me or take advantage of me Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
71COP3 I planned revenge on my abusers then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
72COC3 I am planning revenge on my abusers now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping through social support
73CTP1 I had a good friendship with a close friend I could trust and this made the abuse bearable then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
74CTC1 I have a good friendship with a close friend I can trust and this makes the abuse bearable now (This friend is not my partner, husband or wife) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
75CTP2 I had a good friendship with an adult I could trust and this made the abuse bearable then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
76CTC2 I have a good friendship with a person I trust and look up to and this makes the abuse bearable now (this could be doctor or counsellor but not a partner) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
77CTP3 I reminded myself that my mother or father was still alive, cared about me, and this made the abuse bearable then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
78CTC3 I have a good relationship with my partner who I know cares about me and who I can tell my troubles to now and this makes the abuse bearable ( A partner is a wife /husband /cohabitee/lover) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping though skill mastery
79CMP1 I put my energy into my school work and that made me feel better then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
80CMC1 I put my energy into my work and that makes me feel better now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
81CMP2 I put my energy into sports or music and that made me feel better then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
82CMC2 I put my energy into sport or music and that makes me feel better now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
83CMP3 I put my energy into a skill that I could do well that made me feel better then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
84CMC3 I put my energy into a skill that I can do well that makes me feel better now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping through planning
85CLP1 Then I planned each day very carefully to avoid abuse and make good things happen (like having a laugh, getting well fed, and keeping warm) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
86CLC1 Now I plan each day very carefully to avoid bad feelings and make good things happen (like having a laugh, getting well fed, and keeping warm) Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
87CLP2 When I was leaving school I followed a plan to get a job that would suit me and make my situation better Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
88CLC2 Now I still follow a plan to make sure my job suits me and makes my situation better Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
89CLP3 When I was settling down with my partner, I waited for at least 6 months to make sure we were well suited to live together Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
90CLC3 When my partner and I are planning something important we take time to plan it very carefully Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
Coping by alcohol, drugs and food
91CDP1 I drank alcohol to cope then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
92CDC1 I drink alcohol to cope now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
93CDP2 I took other drugs to cope then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
94CDC2 I take other drugs to cope now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
95CDP3 I comforted myself by eating a lot then Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5
96CDC3 I comfort myself by overeating now Never true
1
Rarely True
2
Sometimes true
3
Often true
4
Very often true
5

Life Problem List
I am going to ask you if any of a series of major life problems have happened to you. Please answer yes or no
P1 Unemployment: Have there been periods as long as a year since you left school where you have not worked? Yes
1
No
0
P2 Homelessness: Have you ever had periods as long as a year where you were homeless? Yes
1
No
0
P3 Frequent illness: Have you had frequent physical illness throughout your life? (seriously ill more than 5 times) Yes
1
No
0
P4 Frequent hospitalization for physical health: Have you been frequently hospitalized for physical illness throughout your life? (more than 5 times) Yes
1
No
0
P5 Mental health: Have you had periods of very bad anxiety or depression during your life? Yes
1
No
0
P6 Substance use: Have you had had problems with drinking or taking drugs during your life? Yes
1
No
0
P7 Self-harm: Have you been hospitalized because you tried to harm yourself? Yes
1
No
0
P8 Hospitalization for mental health: Have you been hospitalized more than twice for mental health problems (including anxiety depression, substance use, self harm etc)? Yes
1
No
0
P9 Anger control in intimate relationships: Have you ever hit your partner and bruised him or her? Yes
1
No
0
P10 Anger control with children: Have you ever hit your children and bruised them? Yes
1
No
0
P11 Violent crime: Have you been charged with violent offences? Yes
1
No
0
P12 Incarceration for violent crime: Have you been imprisoned for violent offences? Yes
1
No
0
P13 Non-violent crime: Have you been charged with non-violent offences? Yes
1
No
0
P14 Incarceration for non-violent crime: Have you been imprisoned for non-violent offences? Yes
1
No
0

Trauma Symptom Inventory (TSI)
This next set of items describes experiences that may or may not have happened to you. Please indicate how often each of the following experience has happened to you in the last 6 months on a 4 point scale where 0=Never and 3= Often. (SHOW SCALE)
TSI1 Nightmares or bad dreams Never
0
Rarely
1
Sometimes
2
Often
3
TS!2 Trying to forget about a bad time in your life Never
0
Rarely
1
Sometimes
2
Often
3
TS!3 Irritability Never
0
Rarely
1
Sometimes
2
Often
3
TSI4 Stopping yourself from thinking about the past Never
0
Rarely
1
Sometimes
2
Often
3
TSI5 Getting angry about something that wasn’t very important Never
0
Rarely
1
Sometimes
2
Often
3
TSI6 Feeling empty inside Never
0
Rarely
1
Sometimes
2
Often
3
TSI7 Sadness Never
0
Rarely
1
Sometimes
2
Often
3
TSI8 Flashbacks (sudden memories or images of upsetting things) Never
0
Rarely
1
Sometimes
2
Often
3
TSI9 Not being satisfied with your sex life Never
0
Rarely
1
Sometimes
2
Often
3
TSI10 Feeling like you were outside of your body Never
0
Rarely
1
Sometimes
2
Often
3
TSI11 Lower back pain Never
0
Rarely
1
Sometimes
2
Often
3
TS!12 Sudden disturbing memories when you were not expecting them Never
0
Rarely
1
Sometimes
2
Often
3
TS!13 Wanting to cry Never
0
Rarely
1
Sometimes
2
Often
3
TSI14 Not feeling happy Never
0
Rarely
1
Sometimes
2
Often
3
TSI15 Becoming angry for little or no reason Never
0
Rarely
1
Sometimes
2
Often
3
TSI16 Feeling like you don’t know who you really are Never
0
Rarely
1
Sometimes
2
Often
3
TSI17 Feeling depressed Never
0
Rarely
1
Sometimes
2
Often
3
TSI18 Having sex with someone you hardly knew Never
0
Rarely
1
Sometimes
2
Often
3
TSI19 Thoughts or fantasies about hurting someone Never
0
Rarely
1
Sometimes
2
Often
3
TSI20 Your mind going blank Never
0
Rarely
1
Sometimes
2
Often
3
TSI21 Fainting Never
0
Rarely
1
Sometimes
2
Often
3
TS!22 Periods of trembling or shaking Never
0
Rarely
1
Sometimes
2
Often
3
TS!23 Pushing painful memories out of your mind Never
0
Rarely
1
Sometimes
2
Often
3
TSI24 Not understanding why you did something Never
0
Rarely
1
Sometimes
2
Often
3
TSI25 Threatening or attempting suicide Never
0
Rarely
1
Sometimes
2
Often
3
TSI26 Feeling like you were watching yourself from far away Never
0
Rarely
1
Sometimes
2
Often
3
TSI27 Feeling tense or ‘on edge’ Never
0
Rarely
1
Sometimes
2
Often
3
TSI28 Getting into trouble because of sex Never
0
Rarely
1
Sometimes
2
Often
3
TSI29 Not feeling like your real self Never
0
Rarely
1
Sometimes
2
Often
3
TSI30 Wishing you were dead Never
0
Rarely
1
Sometimes
2
Often
3
TSI31 Worrying about things Never
0
Rarely
1
Sometimes
2
Often
3
TS!32 Not being sure of what you want in life Never
0
Rarely
1
Sometimes
2
Often
3
TS!33 Bad thoughts or feelings during sex Never
0
Rarely
1
Sometimes
2
Often
3
TSI34 Being easily annoyed by other people Never
0
Rarely
1
Sometimes
2
Often
3
TSI35 Starting arguments or picking fights to get your anger out Never
0
Rarely
1
Sometimes
2
Often
3
TSI36 Having sex or being sexual to keep from being lonely or sad Never
0
Rarely
1
Sometimes
2
Often
3
TSI37 Getting angry when you didn’t want to Never
0
Rarely
1
Sometimes
2
Often
3
TSI38 Not being able to feel your emotions Never
0
Rarely
1
Sometimes
2
Often
3
TSI39 Confusion about your sexual feelings Never
0
Rarely
1
Sometimes
2
Often
3
TSI40 Using drugs other than marijuana Never
0
Rarely
1
Sometimes
2
Often
3
TSI41 Feeling jumpy Never
0
Rarely
1
Sometimes
2
Often
3
TS!42 Absent-mindedness Never
0
Rarely
1
Sometimes
2
Often
3
TS!43 Feeling paralysed for minutes at a time Never
0
Rarely
1
Sometimes
2
Often
3
TSI44 Needing other people to tell you what to do Never
0
Rarely
1
Sometimes
2
Often
3
TSI45 Yelling or telling people off when you felt you shouldn’t have Never
0
Rarely
1
Sometimes
2
Often
3
TSI46 Flirting or ‘coming on’ to someone to get attention Never
0
Rarely
1
Sometimes
2
Often
3
TSI47 Sexual thoughts or feelings when you thought you shouldn’t have them Never
0
Rarely
1
Sometimes
2
Often
3
TSI48 Intentionally hurting yourself ( for example by scratching, cutting, or burning) even though you weren’t trying to commit suicide Never
0
Rarely
1
Sometimes
2
Often
3
TSI49 Aches and pains Never
0
Rarely
1
Sometimes
2
Often
3
TSI50 Sexual fantasies about being dominated or overpowered Never
0
Rarely
1
Sometimes
2
Often
3
TSI51 High anxiety Never
0
Rarely
1
Sometimes
2
Often
3
TS!52 Problems in your sexual relations with another person Never
0
Rarely
1
Sometimes
2
Often
3
TS!53 Wishing you had more money Never
0
Rarely
1
Sometimes
2
Often
3
TSI54 Nervousness Never
0
Rarely
1
Sometimes
2
Often
3
TSI55 Getting confused about what you thought or believed Never
0
Rarely
1
Sometimes
2
Often
3
TSI56 Feeling tired Never
0
Rarely
1
Sometimes
2
Often
3
TSI57 Feeling mad or angry inside Never
0
Rarely
1
Sometimes
2
Often
3
TSI58 Getting into trouble because of your drinking Never
0
Rarely
1
Sometimes
2
Often
3
TSI59 Staying away form certain people or places because they remind you of something Never
0
Rarely
1
Sometimes
2
Often
3
TSI60 One side of your body going numb Never
0
Rarely
1
Sometimes
2
Often
3
TSI61 Wishing you could stop thinking about sex Never
0
Rarely
1
Sometimes
2
Often
3
TS!62 Suddenly remembering something upsetting from your past Never
0
Rarely
1
Sometimes
2
Often
3
TS!63 Wanting to hit someone or something Never
0
Rarely
1
Sometimes
2
Often
3
TSI64 Feeling hopeless Never
0
Rarely
1
Sometimes
2
Often
3
TSI65 Hearing someone talk to you who wasn’t really there Never
0
Rarely
1
Sometimes
2
Often
3
TSI66 Suddenly being reminded of something bad Never
0
Rarely
1
Sometimes
2
Often
3
TSI67 Trying to block out certain memories Never
0
Rarely
1
Sometimes
2
Often
3
TSI68 Sexual problems Never
0
Rarely
1
Sometimes
2
Often
3
TSI69 Using sex to feel powerful or important Never
0
Rarely
1
Sometimes
2
Often
3
TSI70 Violent dreams Never
0
Rarely
1
Sometimes
2
Often
3
TSI71 Acting ‘sexy’ even though you didn’t really want sex Never
0
Rarely
1
Sometimes
2
Often
3
TS!72 Just for a moment seeing or hearing something upsetting that happened earlier in your life Never
0
Rarely
1
Sometimes
2
Often
3
TS!73 Using sex to get love or attention Never
0
Rarely
1
Sometimes
2
Often
3
TSI74 Frightening or upsetting thoughts popping into your mind Never
0
Rarely
1
Sometimes
2
Often
3
TSI75 Getting your own feelings mixed up with someone else’s Never
0
Rarely
1
Sometimes
2
Often
3
TSI76 Wanting to have sex with someone who you knew was bad for you Never
0
Rarely
1
Sometimes
2
Often
3
TSI77 Feeling ashamed about your sexual feelings or behaviour Never
0
Rarely
1
Sometimes
2
Often
3
TSI78 Trying to keep from being alone Never
0
Rarely
1
Sometimes
2
Often
3
TSI79 Losing your sense of taste Never
0
Rarely
1
Sometimes
2
Often
3
TSI80 Your feelings or thoughts changing when you were with other people Never
0
Rarely
1
Sometimes
2
Often
3
TSI81 Having sex that had to be kept secret from other people Never
0
Rarely
1
Sometimes
2
Often
3
TS!82 Worrying that someone is trying to steal your ideas Never
0
Rarely
1
Sometimes
2
Often
3
TS!83 Not letting yourself feel bad about the past Never
0
Rarely
1
Sometimes
2
Often
3
TSI84 Feeling like things weren’t real Never
0
Rarely
1
Sometimes
2
Often
3
TSI85 Feeling like you were in a dream Never
0
Rarely
1
Sometimes
2
Often
3
TSI86 Not eating or sleeping for 2 or more days Never
0
Rarely
1
Sometimes
2
Often
3
TSI87 Trying not to have any feelings about something that once hurt you Never
0
Rarely
1
Sometimes
2
Often
3
TSI88 Daydreaming Never
0
Rarely
1
Sometimes
2
Often
3
TSI89 Trying not to think or talk about things in your life that were painful Never
0
Rarely
1
Sometimes
2
Often
3
TSI90 Feeling like life wasn’t worth living Never
0
Rarely
1
Sometimes
2
Often
3
TSI91 Being startled or frightened by sudden noises Never
0
Rarely
1
Sometimes
2
Often
3
TS!92 Seeing people form the spirit world Never
0
Rarely
1
Sometimes
2
Often
3
TS!93 Trouble controlling your temper Never
0
Rarely
1
Sometimes
2
Often
3
TSI94 Being easily influenced by others Never
0
Rarely
1
Sometimes
2
Often
3
TSI95 Wishing you didn’t have any sexual feelings Never
0
Rarely
1
Sometimes
2
Often
3
TSI96 Wanting to set fire to a public building Never
0
Rarely
1
Sometimes
2
Often
3
TSI97 Feeling afraid you might die or be injured Never
0
Rarely
1
Sometimes
2
Often
3
TSI98 Feeling so depressed that you avoided people Never
0
Rarely
1
Sometimes
2
Often
3
TSI99 Thinking that someone was reading your mind Never
0
Rarely
1
Sometimes
2
Often
3
TSI100 Feeling worthless Never
0
Rarely
1
Sometimes
2
Often
3

SCID I for DSM IV-TR

Follow these rules for all disorders

If the first criterion is not met in the past month then there is no current disorder, check for lifetime disorder by asking the first criterion questions again beginning with Has there ever ...

If the first criterion is not met for a current or lifetime disorder, code the current and lifetime disorders as absent and go to next disorder.

If the first criterion is met for a current or lifetime disorder, for each criterion, always ask the first question and then ask probes as required until you have enough information to rate the criterion as 3= true; 1=absent or false; or 2=subthreshold.

After completing ratings for all criteria for a disorder, if the criteria for a current disorder in the past month are met, code the current disorder as present and go to next disorder.

After completing ratings for all criteria for a disorder, if the criteria for a lifetime disorder (but not a current disorder) are met, code ‘disorder ever’ as present and go to next disorder.

Do not code both a current and lifetime disorder as present.

Summarize the final list of diagnoses on the summary SCID grid.

Major Depression Questions Major Depression Criteria
A Now I am going to ask you some more questions about your mood. 5 or more of the following symptoms have been present during the same 2 week period and represent a change from previous functioning:
At least one of the symptoms is either
1. depressed mood or
2. loss of interest or pleasure
A1 In the last month has there been a period of time when you were feeling depressed or down most of the day nearly every day?
What was it like?
(If yes) how long did it last? As long as 2 weeks?
1. Depressed mood most of the day, nearly every day as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). 1 2 3
A2 What about losing interest or pleasure in things you usually enjoyed?
(If yes) Was it nearly every day?
How long did it last? As long as two weeks?
2. Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly everyday (as indicated by either subjective account or observation made by others) 1 2 3
If Neither A1 nor A2 is present, check for lifetime episodes by asking questions A1 and A2 again beginning with
Has there ever ...
If Neither A1 nor A2 was ever present, skip this section and go to next disorder.
When rating the following items code 1 if clearly due to a general medical condition or to mood-incongruent delusions or hallucinations.
For the following questions focus on the worst 2 weeks in the past month (or else the past 2 weeks if equally depressed for entire month)
For a lifetime disorder, focus on the worst two weeks ever.
A3 During this two week period how was your appetite?
What about compared to your usual appetite?
Did you have to force yourself to eat?
Did you eat less/more than usual
Was that nearly every day?
Did you loose or gain any weight?
How much?
Were you trying to loose or gain weight?
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day.
1 2 3
A4 During this two week period how were you sleeping?
Trouble falling asleep, waking frequently, troubles staying asleep, waking too early or sleeping too much?
How many hours per night compared to usual?
Was that nearly every night?
4. Insomnia or hypersomnia nearly every day 1 2 3
A5 During this two week period were you so fidgety and restless that you were unable to sit still?
Was it so bad that other people noticed it?
What did they notice?
Was that nearly every day?
(If no) what about the opposite...talking or moving more slowly than is normal for you?
Was it so bad that other people noticed it?
What did they notice?
Was that nearly every day?
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 1 2 3
A6 During this two week period what was your energy like?
Tired all the time?Nearly every day?
6. Fatigue or loss of energy nearly every day 1 2 3
A7 During this two week period how did you feel about yourself?
Worthless?
Nearly every day?
What about feeling guilty about things you had done or not done?
Nearly every day?
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 1 2 3
A8 During this two week period did you have trouble thinking or concentrating?
What kinds of things did it interfere with?
Nearly every day?
(If no) Was it hard to make decisions about everyday things?
Nearly every day?
8.Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 1 2 3
A9 During this two week period were things so bad you were thinking a lot about death or that you would be better off dead?
What about thinking of hurting yourself?
(If yes) Did you do anything to hurt yourself?
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 1 2 3
B Criterion B – Does not meet criteria for a mixed episode) is omitted from SCID
C Has (your depression/use own words) made it hard for you to do your work, take care of things at home or get along with people? C. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. 1 2 3
If the current symptoms are not clinically significant ask:
Have there been any other times when you have been depressed and it had more of an effect on your life?
If – Yes – go back to A1 and ask about this lifetime episode.
D Just before (your depression/use own words) began were you physically ill?
(if yes) What did the doctor say?
Just before this began were you taking any medications?
Just before this began, were you drinking or using any street drugs?
D. The symptoms are not due to the direct physiological effect of a substance. 1 3
E Did (your depression/use own words) begin soon after someone close to you died? E. The symptoms are not better accounted for by simple bereavement. After loss of a loved one, depression is diagnosed if the symptoms persist longer than two months or are characterised by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms or psychomotor retardation. 1 3
For a major depressive episode (MDE) criteria A,C,D and E must be met. 1 3
Screening for Manic or hypomanic episode
Have you ever had a period of time when you were feeling so good, high, excited, or hyper that other people thought you were not your normal self or you were so hyper that you got in trouble?
Did anyone else say you were manic?
Was that more than you feeling good?
(If no) What about a period of time where you were so irritable that you found yourself shouting at people or starting fights or arguments ?
Did you find yourself shouting at people you really didn’t know?
When was that?
What was it like?
How long did that last? At least a week?
There has never been a manic episode, a mixed episode, a hypomanic episode

For a manic episode there must be a distinct period of a least a week of abnormally and persistently elevated, expansive or irritable mood.
1 3
For a current diagnosis of Major Depressive Disorder
The participant must meet the criteria for MDE in the past month, have no history of a manic episode, a mixed episode, or a hypomanic episode and the MDE is not better accounted for by a psychotic disorder.
1 3
For a lifetime diagnosis of Major Depressive Disorder
The participant must meet the criteria for Lifetime MDE, have no history of a manic episode, a mixed episode, or a hypomanic episode and the MDE is not better accounted for by a psychotic disorder.
1 3

Dysthymia Questions Dysthymia Criteria
A (If participant has no major depressive episode now, check for dysthymia)
For the past couple of years have you been bothered by depressed mood most of the day, more days than not?
More than half the time?
(If yes) What was it like?
Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation made by others, for a least two years. 1 2 3
If criterion A is not met, skip this section and go to the next disorder.
Do not check for lifetime episodes of dysthymia because this diagnosis cannot reliably be made.
B Presence while depressed of 2 or more of the following symptoms B1-B6
B1 During these periods of (use own words for chronic depression) do you also
Loose your appetite?
What about overeating?
B1. Poor appetite or overeating
1 2 3
B2 During these periods of (use own words for chronic depression) do you also
Have trouble sleeping or sleep too much?
B2. Insomnia or hypersomnia 1 2 3
B3 During these periods of (use own words for chronic depression) do you also have little energy to do things or feel tired a lot? B3. Low energy or fatigue 1 2 3
B4 During these periods of (use own words for chronic depression) do you also
Feel down on yourself?
Feel worthless or a failure?
B4. Low self-esteem 1 2 3
B5 During these periods of (use own words for chronic depression) do you also have trouble concentrating or making decisions?
B5. Poor concentration or difficulty making decisions 1 2 3
B6 During these periods of (use own words for chronic depression) do you also
Feel hopeless?
B6. Feelings of hopelessness 1 2 3
C What is the longest period of time during this period of long lasting depression that you felt OK (No dysthymic symptoms)? C. During the 2 year period of the disturbance the person has never been without the symptoms in criteria A and B for more than 2 months at a time.
D How long have you been feeling this way?
Did it begin gradually or did it start with a bad period of depression?
(If a major depressive episode occurred in the past) Now I want to know whether you got completely back to your usual self after that (major depressive episode/ use own words) before this long period of being mildly depressed?
Were you back to yourself for at least two months?
D. No major depressive episode has been present during the first 2 years of the dysthymia. 1 2 3
E Have you ever had a period of time when you were feeling so good, high, excited, or hyper that other people thought you were not your normal self or you were so hyper that you got in trouble?
Did anyone else say you were manic?
Was that more than you feeling good?
(If no) What about a period of time where you were so irritable that you found yourself shouting at people or starting fights or arguments ?
Did you find yourself shouting at people you really didn’t know?
When was that?
What was it like?
How long did that last? At least a week?
E. There has never been a manic episode, a mixed episode, a hypomanic episode and the criteria have never been met for cyclothymic disorder.

For a manic episode there must be a distinct period of a least a week of abnormally and persistently elevated, expansive or irritable mood.
1 2 3
F Did this begin soon after someone close to you died? F. The disorder does not occur exclusively during the course of chronic psychotic disorders such as schizophrenia or delusional disorder. 1 3
G Just before (your depression/use own words) began were you physically ill?
(If yes) What did the doctor say?
Just before this began were you taking any medications?
(If yes) any change in the amounts you were using?
Just before this began, were you drinking or using any street drugs?
G. The symptoms are not due to the direct physiological effect of a substance. 1 2 3
H How much do your depressed feelings interfere with your life? H. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. 1 2 3
For a current diagnosis of Dysthymia criteria A, B,C,D, E, F, G, & H must be coded 3 and cover the past 2 year period. 1 3
A lifetime diagnosis of Dysthymia cannot reliably be made so do not try to make one.

Panic disorder without agoraphobia Question Panic Disorder without agoraphobia Criteria
A1 Have you ever had a panic attack when you suddenly felt frightened, or anxious or suddenly developed a lot of physical symptoms?
(If yes) Have these attacks ever come on completely out of the blue in situations where you didn’t expect to feel nervous or uncomfortable?
How many of these kinds of attacks have you had?
At least two?
A. 1. Recurrent unexpected panic attacks 1 2 3
If criterion A1 is not met, skip this section and go to next disorder.
A2 After any of these attacks did you worry that there might be something terrible wrong with you, like you were having a heart attack or were going crazy?
How long did you worry?
At least a month?
(If no) Did you worry lot about having another one?
How long did you worry?
At least a month?
(If no) Did you do anything differently because of the attacks like avoiding certain places or not going out alone ?
What about avoiding certain types of activities like exercise?
What about things like always making sure you were near a bathroom or exit?
A 2. At least one of the attacks has been followed by a month or more of one of the following:
a. Persistent concern about having additional attacks
b. Worry about the implications of the attack or its consequences (losing control, having a heart attack, going crazy)
c. A significant change in behaviour is related to the attacks
1 2 3
When was the last bad one?
What was the first thing you noticed? Then what?
Did the symptoms come on all of a sudden?
(If yes) How long did it take from when it began to when it got really bad?
Less than 10 minutes?
Four or more of the 13 panic attack symptoms listed below developed abruptly and reached a peak within ten minutes 1 2 3
1 During the attack did your heart race, pound or skip? 1.Palpitations, pounding heart, accelerated heart rate 1 2 3
2 During the attack did you sweat? 2. Sweating 1 2 3
3 During the attack did you tremble or shake? 3. Trembling or shaking 1 2 3
4 During the attack were you short of breath?
Did you have trouble catching your breath?
4.Sensations of shortness of breath or smothering 1 2 3
5 During the attack did you feel as if you were choking? 5. Feeling of choking 1 2 3
6 During the attack did you have chest pain or pressure? 6.Chest pain or discomfort
7 During the attack did you have nausea or upset stomach or the feeling that you were going to have diarrhoea? 7. Nausea or abdominal distress 1 2 3
8 During the attack did you feel dizzy or unsteady or like you might faint? 8. Feeling dizzy, unsteady, light-headed or faint 1 2 3
9 During the attack did things around you seem unreal or did you feel detached from things around you or detached from part of your body? 9.Derealization (feelings of unreality) or depersonalisation (being detached from oneself) 1 3
10 During the attack were you afraid you were going crazy or might lose control? 10. Fear of losing control, going crazy 1 2 3
11 During the attack were you afraid that you might die? 11.Fear of dying 1 2 3
12 During the attack did you have tingling or numbness in parts of your body? 12. Paresthesias (numbness or tingling sensations)
13 During the attack did you have hot flushes (flashes) or chills? 13. Chills or hot flushes. 1 2 3
B Agoraphobia questions are asked in next section B. Absence of agoraphobia 1 2 3
C Just before you began having panic attacks, were you taking any drugs, caffeine, diet pills or other medicines?
How much coffee, tea or caffeinated soda do you drink per day?
Just before the panic attacks were you physically ill?
(If yes) what did the doctor say?
C. Not due to the direct physiological effect of a substance (e.g., a drug of abuse or medication) or to a general medical condition. 1 3
D Social phobia, specific phobia, OCD, PTSD questions are asked in later sections. D. Panic attacks not better accounted for by another disorder such as social phobia, specific phobia, OCD, PTSD or separation anxiety. 1 3
Have you had panic attacks in the past month? For a current diagnosis of panic disorder 4 or the 13 panic attack symptoms must be coded 3 and criteria A, B, C & D must be met in the past month 1 3
For a lifetime diagnosis of panic disorder 4 or the 13 panic attack symptoms must be coded 3 and criteria A, B , C & D must be met prior to the last month 1 3

Agoraphobia Questions Agoraphobia Criteria
A Are there situations that make you nervous because you are afraid that you might have a panic attack?
If yes -Tell me about that?
What about being uncomfortable if you are more than a certain distance from home?
What about being in a crowded place like a busy store, movie theatre or restaurant?
What about standing in a queue?
What about being on a bridge?
What about using public transportation like a bus, train or driving a car?
A. Anxiety about being in places or situations from which escape might be difficult(or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone: being in a crowd or standing in line; being on a bridge; and travelling in a bus, train or automobile. 1 2 3
If criterion A is not met – go back and code panic disorder without agoraphobia if appropriate and skip this section.
B Do you avoid these situations?
(If no) When you are in one of these situations, do you feel very uncomfortable or like you might have a panic attack?
Can you go into one of these situations only if you are with someone you know?
B. Agoraphobic situations are avoided (e.g. travel is restricted) or else endured with marked distress or with anxiety about having a panic attack or panic like symptoms or require the presence of a companion 1 2 3
C Social phobia, specific phobia, OCD, PTSD questions are asked in later sections. C. The anxiety disorder is not better accounted for by another disorder such as social phobia, specific phobia, OCD, PTSD or separation anxiety. 1 3
Have you had these problems (AGORAPHOBIA) in the past month? For a current diagnosis of panic disorder with agoraphobia, a diagnosis of panic disorder must first be made and them criteria A, B & C above must be met in the past month 1 3
For a lifetime diagnosis of panic disorder with agoraphobia, a diagnosis of panic disorder must first be made and them criteria A, B & C above must be before the past month 1 3
For a current diagnosis of agoraphobia (without panic disorder), there must be no history of panic disorder and criteria A, B & C above must be met in the past month 1 3
For a lifetime diagnosis of agoraphobia (without panic disorder) there must be no history of panic disorder and criteria A, B & C above must be before the past month 1 3

Social Phobia Questions Social Phobia Criteria
A Was there anything that you have been afraid to do or felt uncomfortable doing in front of other people, like speaking, eating or writing?
Tell me about it?
What were you afraid would happen when ...(feared action)?
(If public speaking only) Do you think that your are more uncomfortable than most other people in that situation?
A. Marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. 1 2 3
If criterion A is not met – skip this section and go to next disorder.
B Have you always felt anxious when you ..(confronted phobic stimulus)? B. Exposure to the feared social situation almost invariably provokes anxiety which may take the form of situationally bound or situationally predisposed panic attack 1 2 3
C Did you think that you were more afraid of ....(phobic activity) than you should have been or than made sense? C. The person recognises that the fear is excessive or unreasonable 1 3
D Did you go out of your way to avoid ..(phobic activity)?
(If no) How hard was is it for you to (do feared activity)?
D. The feared social or performance situations are avoided or else endured with intense anxiety or distress 1 2 3
E How much did (feared activity) interfere with your life?
How much has the fact that you have this fear bothered you?
E. The avoidance, anxious anticipation or distress in the feared social or performance situations interferes significantly with the persons normal routine occupational (academic) functioning or social activities or relationships, or there is marked distress about having the phobia. 1 2 3
F (If under 18 years) For how long have you had these fears? F. In individuals under 18 years the duration is at least 6 months 1 2 3
G Just before you began having these fears, were you taking any drugs, caffeine, diet pills or other medicines?
How much coffee, tea or caffeinated soda do you drink per day?
Just before the panic attacks were you physically ill?
(If yes) what did the doctor say?
G. The fear or avoidance is not due to the direct physiological effect of a substance (e.g., a drug of abuse or medication) or to a general medical condition, and is not better accounted for by another disorder (e.g., panic disorder without agoraphobia, separation anxiety disorder, body dysmorphic disorder, PDD, or schizoid personality disorder) 1 3
H If a general medical condition or other mental disorder is present, the fear in A. is unrelated to it. 1 3
Have you had these problems in the past month? For a current diagnosis of Social Phobia criteria A, B,C,D, E, F, G, & H must be coded 3 in the past month 1 3
For a lifetime diagnosis of Social Phobia criteria A, B,C,D, E, F, G, & H must be coded 3 prior to the past month 1 3

Specific Phobia Questions Specific Phobia Criteria
A Are there any other things that you have been especially afraid of like flying, seeing blood, getting an injection, heights, closed places or certain kinks of animals or insects
Tell me about it?
What were you afraid would happen when ...(confronted with phobic stimulus)?
A. Marked and persistent fear that is excessive and unreasonable cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). 1 2 3
If criterion A is not met – skip this section and go to next disorder.
B Did you always feel frightened when you ..(confronted with phobic stimulus)? B. Exposure to the feared stimulus almost invariably provokes an immediate anxiety response which may take the form of situationally bound or situationally predisposed panic attack 1 2 3
C Did you think that you were more afraid of ....(phobic stimulus) than you should have been or than made sense? C. The person recognises that the fear is excessive or unreasonable 1 3
D Did you go out of your way to avoid ..(phobic stimulus)?
(If no) How hard was is it for you to (\confront phobic stimulus)?
D. The phobic situation(s) is avoided or else endured with intense anxiety or distress 1 2 3
E How much did (phobia) interfere with your life?
Is there anything you’ve avoided because of being afraid of the (phobic stimulus)?
How much has the fact that you have this fear bothered you?
E. The avoidance, anxious anticipation or distress in the feared situation(s) interferes significantly with the person’s normal routine occupational (academic) functioning or social activities or relationships, or there is marked distress about having the phobia. 1 2 3
F (If under 18 years) For how long have you had these fears? F. In individuals under 18 years the duration is at least 6 months 1 2 3
G Questions for OCD, PTSD, Social Phobia, Panic disorder with or without agoraphobia, or agoraphobia with or without panic disorder are else where in this part of the interviews G. The anxiety, panic attacks or phobic avoidance associated with the specific object or situation are not better accounted for by another disorder (e.g., OCD, PTSD, Social Phobia, Panic disorder with or without agoraphobia, or agoraphobia with or without panic disorder) 1 3
Have you had these problem in the past month? For a current diagnosis of Specific Phobia criteria A, B,C,D, E, F, G, & H must be coded 3 in the past month 1 3
For a lifetime diagnosis of Specific Phobia criteria A, B,C,D, E, F, G, & H must be coded 3 prior to the last month 1 3

Obsessive Compulsive Disorder (OCD) Questions OCD Criteria
A Now I would like to ask you if you have ever been bothered by thoughts that didn’t make any sense and kept coming back to you even when you tried not to have them?
What were they?
(If participant is not sure what is meant) Thoughts like hurting someone even though you really didn’t want to or being contaminated by germs or dirt?




When you had these thoughts did you try hard to get them out of your head?
What would you try to do?

Where did you think these thoughts were coming from?






Was there ever anything that you had to do over and over again and couldn’t resist doing like washing your hands again and again, counting up to a certain number, or checking something several times to make sure that you’d done it right?
What did you have to do?

Why did you have to do (COMPULSIVE ACT)?
What would happen if you did not do it?
How many times would you do (Compulsive Act)?
How much time a day would you spend doing it?

A. Either obsessions or compulsions.

Obsessions are defined by 1, 2, 3, & 4.

1. Recurrent or persistent thoughts impulses or images that are experienced as intrusive or inappropriate and cause marked anxiety or distress.

2. The thoughts, images or impulse are not excessive worries about real life problems.

3. The person attempts to ignore or suppress these thoughts, impulses or images or to neutralize them with some other thought or action.

4. The person recognises that the thoughts images or impulses are the product of his or her own mind (and not imposed from without as in thought insertion).

Compulsions are defined by 1 & 2.

1. Repetitive behaviours (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to performing in response to an obsession or according to rules that must be applied rigidly.

2. The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviours or mental acts either are not connected in a realistic way with what they are designed to neutralise or prevent or are clearly excessive.
1





1





1



1




1







1








1
2





2





2



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2







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2
3





3





3



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3







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3
If criterion A is not met, skip this section and go to next disorder.
B Have you thought about (OBSESSIVE THOUGHTS) or done (COMPULSIVE ACTS) more than you should have or more than made sense?
(If no) How about when you first started having this problem?
B. The person has at one time recognised that the obsessions or compulsions are unreasonable but this condition does not apply to children 1 3
C What effect did this (OBSESSIVE THOUGHTS AND/OR COMPULSIVE ACTS) have on your life?
Did it bother you a lot?
How much time do you spend on (Obsessive Thoughts And/Or Compulsive Acts) ?
C. The obsessions or compulsions cause considerable distress, are time consuming (more than 1 hour a day), and impair social and academic functioning 1 2 3
D D. If another Axis 1 disorder is present the content of the obsessions or compulsions is not restricted to it (e.g. food and eating disorder or drugs and substance abuse disorder?
1 2 3
E Just before you began having (OBSESSIONS OR COMPULSIONS) were you taking any drugs or medicines?
Just before the (OBSESSIONS OR COMPULSIONS) started, were you physically ill?
E. The disorder is not due to the direct physiological effect of a substance or to a general medical condition. 1 2 3
Have you had these (OBSESSIONS OR COMPULSIONS) in the past month? For a current diagnosis of OCD criteria A, B,C,D, & E must be coded 3 for the past month 1 3
For a lifetime diagnosis of OCD criteria A, B,C,D, & E must be coded 3 before the past month 1 3

Post Traumatic Stress Disorder (PTSD) Questions PTSD Criteria
A Sometimes things happen to people that are extremely upsetting, things like being in a life threatening situation like a major disaster, every serious accident or fire; being physically assaulted or raped, seeing another person killed or dead, or badly hurt, or hearing about some thing horrible that has happened to someone you are close to. At any time during your life, have any of these kinds of things happened to you?
(If any events are mentioned, list them and ask) Sometimes these things keep coming back in nightmares, flashbacks, or thoughts that you cant get rid of. Has that ever happened to you?
(If no) What about being very upset when you were in a situation that reminded you of one of these terrible things?
Which (traumatic event if there was more than one) of these do you think affected you most?
How did you react when (the trauma) happened?
Were you afraid or did you feel terrified or helpless?
A. The person has been exposed to a traumatic event in which both of the following were present:

1. The person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury of self or others



2. The person’s response involved intense fear, helplessness or horror or in the case of children disorganised behaviour
1 2 3
If criterion A is not met, skip this section and go to next disorder
B Now I’d like to ask about specific ways it may have affected you, for example...

Did you think about (TRAUMA) when you didn’t want to or did thoughts about (TRAUMA) come to you suddenly when you didn’t want them to?



What about having dreams about (TRAUMA)?



What about finding yourself acting or feeling as if you were back in the situation?
What about getting very upset when something reminded you of (TRAUMA)?


What about having physical symptoms like breaking out in a sweat, breathing heavily, or irregularly, or your heart pounding or racing?
B. The traumatic event is persistently re-experienced in one or more of the following ways
1.Recurrent and intrusive distressing recollections of the event including thoughts, images, or in children repetitive play in which the themes of the trauma are re-enacted

2. Recurrent distressing dreams of the event or in children the dreams may have unrecognizable fearful content

3. Acting or feeling as if the traumatic event were recurring (including, hallucinations, illusions and dissociative flashbacks, or in children re-enactments)

4. Intense psychological distress to exposure to internal or external cues that symbolize the traumatic event
5. Physiological reactivity to exposure to internal or external cues that symbolize the traumatic event
1 2 3
C Since the TRAUMA have you made a special effort to avoid thinking or talking about what happened?



Have you stayed away from things or people that reminded you of (TRAUMA)?

Have you been unable to remember some important part of what happened?

Have you been much less interested in doing things that used to be important to you, like seeing friends, reading books or watching TV?
Have you felt distant or cut off from others?


Have you felt “numb” or like you no longer had strong feelings about anything or loving feelings for anyone?
Did you notice a change in the way you think about or plan for the future?
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by 3 of the following:

1. Avoidance of thought feelings or conversations associated with the trauma

2. Avoidance of activities, places or people that arouse recollection of the trauma

3. Inability to recall an important aspect of the trauma

4. Markedly diminished interest or participation in significant activities

5. Restricted range of affect

6. Sense of foreshortened future
1 2 3
D
Since the trauma have you had trouble sleeping?
What kind of trouble?
Have you been unusually irritable?
What about outbursts of anger?
Have you had trouble concentrating?

Have you been watchful or on guard even though there was no reason to be?
Have you been jumpy or easily startled. Like by sudden noises?
D. Persistent symptoms of increased arousal as indicated by 2 of the following:
1. Sleep difficulties

2. Irritability or outbursts of anger

3. Difficulty concentrating

4. Hypervigilance

5. Exaggerated startle response
1 2 3
E About how long did these problems (SUCH AS PTSD SYMPTOMS) last? E. Duration of disturbance longer than 1 month 1 2 3
F F. The disturbance causes clinically significant distress and impairment of social or academic functioning. 1 2 3
Have you had these (PTSD SYMPTOMS) in the past month? For a current diagnosis of PTSD criteria A, B,C,D, E, & F must be coded 3 for the past month 1 3
For a lifetime diagnosis of PTSD criteria A, B,C,D, E, & F must be coded 3 before the past month 1 3

Generalised Anxiety Disorder (GAD) Questions GAD Criteria
A In the last 6 months have you been particularly nervous or anxious?
Do you worry a lot about bad things that might happen?
What do you worry about?
How much do you worry about (Events or activities)?
During the past 6 months would you say that you have been worrying more days than not?
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for 6 months about a number of events or activities (such as school or work performance). 1 2 3
If criterion A is not met, check for lifetime disorder by asking
Was there ever a period of about 6 months when .....
If criterion A is not met for a lifetime disorder, skip the section and go to next disorder
B When you are worrying this way do you find it hard to stop yourself? B. The person finds it difficult to control the worry. 1 2 3
C Now I’m going to ask you some questions that often go along with being nervous.
Thinking about those periods in the past six months when you’re feeling nervous or anxious

Do you often feel physically restless –can’t sit still?
Do you often feel keyed up or on edge?

Do you often tire easily?

Do you have trouble concentrating or does your mind go blank?

Are you often irritable?

Are your muscles often tense?

Do you often have trouble falling or staying asleep?
C. The anxiety or worry is associated with 3 of the following in adults or 1 of the following in children for more days than not in the past 6 months.

1. Restlessness or feeling keyed up or on edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank.

4. Irritability

5. Muscle tension

6. Sleep disturbance
1 3
D D. The focus of the anxiety or worry is not confined to features of an Axis 1 disorder (panic disorder, OCD, PTSD, social phobia, eating disorders) 1 2 3
E What effect has the anxiety, worry or (physical symptoms) had on your life?
Has it made it hard to do your work or be with your friends?
E. The anxiety or physical symptoms cause clinically significant distress or impairment in social, occupational, school and other important area of functioning 1 2 3
F When did this worrying start? F. The disturbance is not due to the direct physiological effect of a substance or to a general medical condition.
Does not occur exclusively during the course of a mood disorder, psychotic disorder or pervasive developmental disorder
1 2 3
For a current diagnosis of GAS criteria A, B,C,D, E, & F must be coded 3 for the past 6 months 1 3
For a lifetime diagnosis of GAS criteria A, B,C,D, E, & F must be coded 3 for a period before the past 6 months 1 3

Alcohol Abuse Question Alcohol Abuse Criteria
A What are your drinking habits like
How much do you drink?
How often?
What do you drink?

A. A maladaptive pattern of alcohol use leading to clinically significant impairment or distress as manifested by one or more of A1-A4 occurring within a 12 month period: 1 2 3
If not currently drinking heavily to check for lifetime disorder ask...
Was there ever a time in your life when you were drinking a lot more?
How often were your drinking?
What were you drinking?
How much?
How long did that period last?
If there is no evidence of past or current heavy drinking skip this section and the alcohol dependence section and got the substance abuse section.
Currently (or during the time when you were drinking heavily did...) does your drinking cause problems for you?
Does/did anyone object to your drinking?
Let me ask you a few more questions about the time when you were drinking most or had most drink-related problems.
A1 Did you miss work or school because you were intoxicated, high or very hung over?
How Often?
What about doing a bad job at work or failing courses at school because of your drinking?
(If appropriate) What about not keeping your house clean or not taking proper care of your children because of your drinking?
How often?
A1. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol related absences, suspensions, or expulsions from school; neglect of children or household) 1 2 3
A2 Did you ever drink in a situation in which it was dangerous to drink at all?
Did you ever drive while you were really too drunk to drive?
How many times?
A2. Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use). 1 2 3
A3 Did your drinking get you into trouble with the law?
Tell me more about that?
How many times?
A.3. Recurrent alcohol related legal problems (e.g., arrests for alcohol-related disorderly conduct) 1 2 3
A4 Did your drinking cause problems with other people, such as with family members, friends, or people at work?
Did you ever get into physical fights when you were drinking?
What about having bad arguments about your drinking?
Did you keep on drinking anyway?
A4. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication, physical fights) 1 2 3
B B. Symptoms have never met the criteria for alcohol dependence.
For a current diagnosis of Alcohol Abuse, criteria A and B are met for the past month 1 3
For a lifetime diagnosis of Alcohol Abuse, criteria A and B are met before the past month 1 3

Alcohol Dependence Question Alcohol Dependence Criteria
A Now I would like to ask you some more questions about the time when you were drinking most or had most drink-related problems. A. A maladaptive pattern of alcohol use leading to clinically significant impairment or distress as manifested by three or more of the following occurring at any time in the same 12 month period 1 2 3
A3 During that time did you often find that when you started drinking you ended up drinking much more than you were planning to?
If No – What about drinking over a much longer period of time than you were planning to?
3. Alcohol is often taken in larger amounts or over a longer period than was intended 1 2 3
A4 Did you try to cut down or try to stop drinking alcohol?
If yes – Did you ever actually stop drinking altogether?
How many times did your try to cut down or stop altogether?
If no – Did you want to stop or cut down?
Is this something you kept worrying about?
4. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use 1 2 3
A5 Did you spend a lot of time drinking being high, or hung over? 5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects 1 2 3
A6 Did you often have times when you would drink so often that you started to drink instead of working, spending time with your family, or friends or engaging in other important activities such as sports, gardening or playing music? 6. Important social, occupational, or recreational activities are given up or reduced because of alcohol use 1 2 3
A7 Did your drinking cause any psychological problems such as making you depressed or anxious, making it hard to sleep, or causing blackouts?
Did your drinking cause significant physical problems or make a physical problem worse?
Did you keep on drinking anyway?
7. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (e.g., continued drinking despite recognition than an ulcer was made worse by alcohol consumption). 1 2 3
A1 Did you find that you needed to drink a lot more in order to get the feeling you wanted than you did when you first started drinking?
If yes - How much more?
If no – What about finding that when you drank the same amount, it had much less effect than before?
1. Tolerance, as defined by either or the following:
A. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect
B. Markedly diminished effect with continued use of the same amount of alcohol
1 2 3
A2 Did you ever have any withdrawal symptoms when you cut down or stopped drinking such as
Sweating or racing heart
hand shakes
trouble sleeping
feeling nauseated or vomiting
Feeling agitated
Feeling anxious
How about having a seizure or seeing, feeling, or hearing things that weren’t really there?
If no- Did you ever start the day with a drink, or did you often drink or take some other drug or medication to keep yourself from getting the shakes or becoming sick?
2. Withdrawal as manifested by either A or B.
A. At least two of the following developing within several hours to a few days after cessation of (or reduction in) heavy and prolonged alcohol use
Sweating or pulse rate over 100bpm
Increased hand tremor
Insomnia
Nausea or vomiting
Psychomotor agitation
Anxiety
Grand mal seizures
Transient visual, tactile or auditory hallucinations or illusions
B. alcohol or tranquillizers taken to relieve or avoid withdrawal symptom
1 2 3
For a current diagnosis of alcohol dependence 3 of the 7 criteria were present in past month 1 3
For a lifetime diagnosis of alcohol dependence 3 of the 7 criteria were present prior to the past month 1 3

Substance Abuse Question Substance Abuse Criteria
Have you ever taken any of these drugs to get high, to sleep better, or lose weight, or the change you mood.
Which one caused you the most problems? (Circle)
Which one did you use the most? (Circle)

If no significant drug use occurred – skip substance use and substance dependence sections and go the personality disorder section


Downers - Sedative-Hypnotics-Anxiolytics
Quaalude (ludes)
Seconol (reds)
Valium (roche 5)
Xanex, librium, barbiturates, Miltown, Ativan, Dalmane, Halcion, Restoril
Cannabis
Marijuana, hashish (Hash), THC, pot, grass, weed, reefer
Uppers – Stimulants
Amphetamine, speed, crystal meth, dexadrine, Ritalin, diet pills, ice
Opiods
Heroin, morphine, opium, Methadone, Darvon, codine, Percodan, Demerol, Dilaudid
Cocaine
Snorting, IV, freebase, crack, speedball
Hallucinogens- Psychedelics
LSD (Acid), mescaline, peyote, psilocybin, STP, mushrooms, Extacy, MDMA
PCP – Phencyclidine
Angel dust, Special K, ketamine
Other
Steroids, glue, ethyl chloride, paint, inhalants, nitrous oxide (laughing gas), amyl or butyl nitrate (poppers), sleep or diet pills
A Now I’d like to ask you some questions about your use of (DRUG USED THE MOST OR CASUSED MOST PROBLEMS). During that time.. A. A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one or more of A1-A4 occurring within a 12 month period: 1 2 3
A1 Did you miss work or school because you were intoxicated, high or very hung over?
How Often?
What about doing a bad job at work or failing courses at school because you used DRUG?
(If appropriate) What about not keeping your house clean or not taking proper care of your children because of DRUG?
How often?
A1. Recurrent substance use resulting in a failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance related absences, suspensions, or expulsions from school; neglect of children or household) 1 2 3
A2 Did you ever use DRUG in a situation in which it might have been dangerous?
How often?
A2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use). 1 2 3
A3 Did your use of DRUG get you into trouble with the law?
How often and when?
A.3. Recurrent substance related legal problems (e.g., arrests for substance-related disorderly conduct) 1 2 3
A4 Did your use of DRUG cause problems with other people, such as with family members, friends, or people at work?
Did you ever get into physical fights when you were using DRUG?
What about having bad arguments about your drug use?
Did you keep on using DRUG anyway?
A4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of substance (e.g., arguments with spouse about consequences of intoxication, physical fights) 1 2 3
B B. Symptoms have never met the criteria for substance dependence.
For a current diagnosis of Substance Abuse, criteria A and B are met for the past month 1 3
For a lifetime diagnosis of Substance Abuse, criteria A and B are met prior to the past month 1 3

Substance Dependence Question Substance Dependence Criteria
A I would like to ask you some more questions about (TIME WHEN USING THE MOST DRUGS/TIME WHEN DRUGS CAUSED THE MOST PROBLEMS).
A. A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three or more of the following occurring at any time in the same 12 month period 1 2 3
A3 During that time did you often find that when you started using DRUG you ended up using much more than you were planning to?
If No – What about using it over a much longer period of time than you were planning to?
3. Substance is often taken in larger amounts or over a longer period than was intended 1 2 3
A4 Did you try to cut down or stop using DRUG?
If yes – Did you ever actually stop using DRUG altogether?
How many times did your try to cut down or stop altogether?
If no – Did you want to stop or cut down?
Is this something you kept worrying about?
4. There is a persistent desire or unsuccessful efforts to cut down or control substance use 1 2 3
A5 Did you spend a lot of time using DRUG or doing what ever you had to get to it?
Did it take you a long time to get back to normal?
5. A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances) use the substance or recover from its effects 1 2 3
A6 Did you often have times when you would use DRUG so often that you started to use DRUG instead of working, spending time with your family, or friends or engaging in other important activities such as sports, gardening or playing music? 6. Important social, occupational, or recreational activities are given up or reduced because of substance use 1 2 3
A7 Did your drug use cause any psychological problems such as making you depressed or anxious, making it hard to sleep, or causing blackouts?
Did your drug use cause significant physical problems or make a physical problem worse?
If yes - Did you keep on using anyway?
7. Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance(e.g., current cocaine use despite recognition of cocaine induced depression). 1 2 3
A1 Did you find that you needed to use a lot more DRUG in order to get the feeling you wanted than you did when you first started using it?
If yes - How much more?
If no – What about finding that when you used the same amount, it had much less effect than before?
1. Tolerance, as defined by either or the following:
A. A need for markedly increased amounts of the substance to achieve intoxication or desired effect
B. Markedly diminished effect with continued use of the same amount of the substance
1 2 3
A2 Did you ever have any withdrawal symptoms when you cut down or stopped suing DRUG?
If yes- what symptoms did you have?
If withdrawal symptoms occurred - After not using DRUG for a few hours or more, did you often use it to keep yourself from getting sick with WITHDRAWAL SYMPTOMS?
What about using NAME ANOTHER DRUG IN THE SAME CLASS when you were feeling sick with WITHDRAWAL SYMPTOMS so that you would feel better?

2. Withdrawal as manifested by either A or B
A. A characteristic withdrawal syndrome for the substance
B. the same or a closely related substance is taken to relieve or avoid withdrawal symptoms

Sedatives
2 or more of the following: sweating, high pulse rate, increased hand tremor, insomnia, nausea and vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures.
Stimulants & Cocaine
Dysphoric mood and 2 of the following: fatigue, vivid unpleasant dreams, insomnia, hypersomnia, increased appetite, psychomotor retardation or agitation.
Opiods
3 or more of the following: dysphoric mood, nausea and vomiting, muscle aches, lacrimation, rhinorrhea, pupillary dilation, piloerection, sweating, diarrhoea, yawning, fever, insomnia.
Cannabis, Hallucinogens and PCP
No withdrawal syndrome occurs
1 2 3
For a current diagnosis of substance dependence 3 of the 7 criteria were present in past month 1 3
For a lifetime diagnosis of substance dependence 3 of the 7 criteria were present within a 1 year period excluding the past month 1 3

SCID II for DSM IV-TR

Follow these rules for all rating all 4 personality disorders

For each criterion, always ask the first question and then ask probes as required until you have enough information to rate the criterion as 3= true; 1=absent or false; or 2=subthreshold.

After completing ratings for all criteria for a personality disorder, if the criteria for a current personality disorder are met, code the personality disorder as present and go to next disorder.

Do not rate lifetime personality disorders which are no longer current (as you did for mood, anxiety and substance use disorders).

Summarize the final list of diagnoses on the summary SCID grid.

Avoidant PD Questions Avoidant PD Criteria
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following
1 Have you avoided jobs or tasks that involved having to deal with a lot of people?
Give me some examples?
What was the reason that you avoided these?
Have you ever refused a promotion because it would involve dealing with more people than you would be comfortable with?
(1) avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.
To score 3- must give 2 examples.
1 2 3
2 Do you avoid getting involved with people unless you are certain they will like you?
If you don’t know someone likes you would you ever make the first move?
(2) is unwilling to get involved with people unless certain of being liked
To score 3 – almost never takes initiative in a social relationship
1 2 3
3 Do you find it hard to be open even with people your are close to?
Why is this?
Are you afraid of being made fun of or embarrassed?
(3) shows restraint within intimate relationships because of the fear of being shamed or ridiculed
To score 3 – true for almost all relationships
1 2 3
4 Do you often worry about being criticized or rejected in social situations?
Give me some examples.
Do you spend a lot of time worrying about this?
(4) is preoccupied with being criticized or rejected in social situations
To score 3 – a lot of time is spent worrying about social situations
1 2 3
5 Are you usually quiet when you meet new people?
Why is that?
Is it because you feel in some way inadequate or not good enough?
(5) is inhibited in new interpersonal situations because of feelings of inadequacy
To score 3 – Acknowledges trait and gives many (3) examples
1 2 3
6 Do you believe that you are not as good, as smart, or as attractive as most other people?
Tell me about that?
(6) views self as socially inept, personally unappealing, or inferior to others
To score 3 – acknowledges belief.
1 2 3
7 Are you afraid to try new things?
Is that because you are afraid of being embarrassed?
Give me some examples
(7) is usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
To score 3 – several examples (3) of avoiding activities because of fear of embarrassment
1 2 3
Avoidant PD - 4 items or more are coded 3. 1 3

Dependent PD Questions Dependent PD Criteria
A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1 Do you need a lot of advice or reassurance from others before you can make everyday decisions – like what to wear or what to order in a restaurant?
Can you give me some example of the kinds of decision you would ask for advice or reassurance about?
Does this happen most of the time?
(1) has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
To score 3 – several (3) examples
1 2 3
2 Do you depend on other people to handle important areas in your life such as finances, child care, or living arrangements?
Give me some examples.
Is this more than just getting advice from people?
Has this happened with most important areas of your life?
(2) needs others to assume responsibility for most major areas of his or her life
Do not include just getting advice from others or sub culturally expected behaviour
To score 3 – several (3) examples
1 2 3
3 Do you find it hard to disagree with people even when you think they are wrong?
Give me some examples of when you found it hard to disagree.
What are you afraid will happen if you disagree`?
(3) has difficulty expressing disagreement with others because of fear of loss of support or approval.
Do not include realistic fears of retribution.
To score 3 – acknowledges trait or several (3) examples
1 2 3
4 Do you find it hard to start work on tasks when there is no one to help you?
Give me some examples.
Why is that?
Is this because you are not sure you can do it right?
(4) has difficulty initiating projects or doing things on his or her own (because of lack of self-confidence in judgement or abilities rather than a lack of motivation or energy)
To score 3 – acknowledges trait
1 2 3
5 Have you often volunteered to do things that are unpleasant?
Give me some examples of these types of things.
Why is that?
(5) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
Do not include behaviour intended to achieve goals other than being liked, such as job advancement.
To score 3 – acknowledges trait or gives one example
1 2 3
6 Do you usually feel uncomfortable when you are by yourself. Why is that?
Is it because you need someone to take care of you?
(6) feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
To score 3 – acknowledges trait
1 2 3
7 When a close relationship ends do you feel you immediately have to find someone else to take care of you?
Tell me about that.
Have you reacted this way almost always when close relationships have ended?
(7) urgently seeks another relationship as a source of care and support when a close relationship ends
To score 3 – happens when most close relationships end.
1 2 3
8 Do you worry a lot about being left alone to take care of yourself?
Are there often times when you keep worrying about this?
Do you have period when you worry about this all the time?
(8) is unrealistically preoccupied with fears of being left to take care of himself or herself.
To score 3 –persistent unrealistic worry.
1 2 3
Dependent PD – 5 or more items are coded as 3 1 3

Borderline PD Questions Borderline PD Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1 Have you often become frantic when you thought that someone you really cared about was going to leave you.
What have you done?
Have you threatened or pleaded with him or her?
(1) frantic efforts to avoid real or imagined abandonment.
Do not include suicidal or self-mutilating behaviour covered in Criterion 5
To score 3 – several (3) examples
1 2 3
2 Do your relationships with people you really care about have lots of extreme ups and downs?
Tell me about them.
Were there times you thought they were everything you wanted and other times you thought they were terrible?
How many relationships were like this?
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
To score 3 – either one prolonged relationship or several briefer relationships in which the alternating pattern occurs at least twice.
1 2 3
3 Have you all of a sudden changed your sense of who you are and where you are headed?
Give me some examples of this.
Does your sense of who you are often change dramatically?
Tell me more about that?
Are you different with different people or in different situations so that you sometimes don’t know who you really are?
Give me some examples of this?
Do you feel this way a lot?
Have there been lots of sudden changes in your goals, career plans. Religious beliefs, and so on?
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
Do not include normal adolescent uncertainty
To score 3 – acknowledges trait
1 2 3
4 Have you often done things impulsively?
What kind of things?
What about buying things you really couldn’t afford?
What about having sex with people you hardly know or unsafe sex?
What about drinking too much or taking drugs?
What about driving recklessly?
What about uncontrollable eating?
If yes to any of these - Tell me about that.
How often does it happen
What kinds of problems has it caused?
(4) impulsivity in at least two areas that are potentially self-damaging (for example, spending, sex, substance abuse, reckless driving, binge eating.)
Do not include suicidal or self-mutilating behaviour covered in Criterion 5.
To score 3 – several (3) examples
1 2 3
5 Have you tried to hurt or kill yourself or threatened to do so?
Have you ever cut, burned or scratched yourself on purpose?
Tell me about that
(5) recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
To score 3 – 2 or more events when not in a major depressive episode
1 2 3
6 Do you have a lot of sudden mood changes?
Tell me about that.
How long do your bad moods last?
How often do these mood changes happen?
How suddenly do your moods change?
(6) affective instability due to a marked reactivity of mood (for example, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
To score 3 – acknowledges trait
1 2 3
7 Do you often feel empty inside?
Tell me more about this.
(7) chronic feelings of emptiness
To score 3 – acknowledges trait
1 2 3
8 Do you often have temper outbursts or get so angry that you lose control?
Tell me about this. Do you hit people or throw things when you get angry?
Tell me about this.
Do even little things get you very angry? When does this happen? Does this happen often?
(8) inappropriate intense anger or difficulty controlling anger (for example, frequent displays of temper, constant anger, recurrent physical fights)
To score 3 – acknowledges trait and gives one example
1 2 3
9 When you are under a lot of stress do you get suspicious of other people or feel especially spaced out?
Tell me about that.
(9) transient, stress-related paranoid ideation or severe dissociative symptoms
To score 3 – several (3) examples that do not occur during a psychotic disorder or a mood disorder with psychotic features.
Borderline PD – 5 or more items are coded as 3 1 3

Antisocial PD Questions Antisocial PD Criteria 1 3
B Are you currently over 18? B. The individual is at least age 18 years. 1 2 3
D D. The occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or a manic episode. 1 2 3
If the person meets criterion B (over 18 years) and criterion D (antisocial behaviour not due to mania or schizophrenia) proceed to ask about conduct problems before age 15 (criterion C – items C1-C15 below) until at least 2 of the 15 criteria are met.
C C. There is evidence of Conduct Disorder with onset before age 15 years. 1 2 3
C1 Before you were 15 would you bully or threaten other kids?
Tell me about that.
(1) Before the age of 15 often bullied threatened or intimidated others
C2 Before you were 15 would you start fights?
How often?
(2) Before the age of 15 often initiated physical fights
C3 Before you were 15 did you hurt or threaten someone with a weapon like a bat, brick, broken bottle, knife or gun?
Tell me about that?
(3) Before the age of 15 used a weapon that can cause serious physical harm to others (e.g., bat, brick, broken bottle, knife, gun)
C4 Before you were15 did you deliberately torture someone or cause someone physical pain and suffering?
What did you do?
(4) Before the age of 15 was physically cruel to people
C5 Before you were 15 did you torture or hurt animals on purpose?
What did you do?
(5) Before the age of 15 was physically cruel to animals
C6 Before you were 15 did you rob, mug or forcibly take something from someone by threatening him or her?
Tell me about that.
(6) Before the age of 15 stole while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
C7 Before you were 15 did you force someone to have sex with you, to get undressed in front of your, or to touch you sexually?
Tell me about that.
(7) Before the age of 15 forced someone into sexual activity
C8 Before you were 15 did you set fires?
Tell me about that.
(8) Before the age of 15 deliberately engaged in fire setting with the intention of causing serious damage
C9 Before you were 15 did you deliberately destroy things that weren’t yours?
What did you do?
(9) Before the age of 15 deliberately destroyed others’ property (other than by fire setting)
C10 Before you were 15 did you break into houses, other buildings, or cars?
Tell me about that.
(10) Before the age of 15 broke into someone else’s house, building or car
C11 Before you were 15 did you lie a lot or con other people?
Want would you lie about?
(11) Before the age of 15 often lied to obtain goods or favours or to avoid obligations (i.e., cons others)
C12 Before you were 15 did you sometimes steal or shoplift things or forge someone’s signature?
Tell me about it.
(12) Before the age of 15 stole items of nontrivial value without confronting the victim (e.g., shoplifting, stealing but without breaking and entering, forgery)
C13 Before you were 15 did you run away and stay away overnight?
Was that more than once?
With whom were you living at the time?
(13) Before the age of 15 ran away from home overnight at least twice while living in parental or parental surrogate home ( or once without returning for a lengthy period)
C13 Before you were 13 did you often stay out very late, long after the time you were supposed to be home?
How often?
(14) Before the age of 13 often stayed out at night despite parental prohibitions
C15 Before you were 13 did you often skip school or mitch?
How often?
(15) Before the age of 13 often truanted from school
If two items from C1-C15 are present criterion C is met, so proceed to questions about criterion A
A A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
A1 Now, since you were 15 have you done things that are against the law – even if you weren’t caught – like stealing, using or selling drugs, writing bad checks, or having sex for money ?
If no – Have you ever been arrested for anything?
(1) Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest
To score 3 – several (3) examples
1 2 3
A2 Since you were 15, do you often find you have to lie to get what you want?
Have you ever used an alias or pretended you were someone else?
Have you ever conned others to get what you want?
(2) Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
To score 3 – several (3) examples
1 2 3
A3 Since you were 15, do you often do things on the spur of the moment without thinking how it will affect you or other people?
What kind of things?
Was there ever a time when you had no regular place to live?
For how long?
(3) Impulsivity or failure to plan ahead
To score 3 – several (3) examples
1 2 3
A4 Since you were 15, have you been in many fights?
How often?
Have you ever hit or thrown things at your spouse or partner?
How often?
Have you ever hit a child, yours or someone else’s – so hard that he or she had bruises or had to stay in bed or see a doctor?
Tell me about that.
Have you physically threatened or hurt someone?
Tell me about that.
(4) Irritability and aggressiveness, as indicated by repeated physical fights or assaults
To score 3 – several (3) examples
1 2 3
A5 Since you were 15, did you ever drive a car when you were drunk or high?
How many speeding tickets or penalty points for speeding have you gotten or car accidents have you been in?
Do you always use protection if you have sex with someone you don’t know well?
Has anyone ever said that you allowed a child that you were taking care of to be in a dangerous situation?
(5) Reckless disregard for safety of self or others
To score 3 – several (3) examples
1 2 3
A6 How much of the time in the last 5 years were you not working?
If for a prolonged period – Why? Was there work available?
When you were working did you miss a lot of work?
If yes- Why?
Did you ever walk off a job without having another one to go to?
If yes –How many times did this happen?
Have you ever owed people money and not paid them back?
How often?
What about not paying child support, or not giving money to children or someone else who depended on you?
(6) Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
To score 3 – several (3) examples
1 2 3
A7 How do you feel about (LIST SOME ANTSOCIAL ACTS THAT THE PERSON DID)?
Do you think what you did was wrong in any way?
(7) Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
To score 3 –lacks remorse about several (3) antisocial acts
1 2 3
Antisocial PD – 3 or more items from A1-A7 are coded as 3 and criterion B (over 18) criterion C (conduct disorder before 15) and criterion D (absence of current mania or schizophrenia) are met. 1 3

Global Assessment of Functioning (GAF)
Base your GAF rating on all available information and put GAF rating below and on the SCID grid
Consider psychological, social and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical or environmental limitations.
100
|
91
Superior functioning in a wide rage of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms.

90
|
81

Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range or activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.

80
|
71

If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning

70
|
61

Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.

60
|
51

Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.

50
|
41

Serious symptoms OR any serious impairment in social, occupational, or school functioning.

40
|
31

Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.

30
|
21

Behaviour is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas.

20
|
11

Some danger or hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.

10
|
0

Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death

SCID GRID
Summarize the results of the SCID I and SCID II and the Global Assessment of Functioning on this Grid
Any DSM IV Axis 1 psychological Disorder
ANYC Any axis 1 disorder current Yes
1
No
0
ANYE Any axis 1 disorder ever Yes
1
No
0
Mood Disorders
MC Any mood disorder current Yes
1
No
0
ME Any mood disorder ever Yes
1
No
0
MDC Major depression current Yes
1
No
0
MDE Major depression ever Yes
1
No
0
DC Dysthymia current Yes
1
No
0
Anxiety disorders
AC Any anxiety disorder current Yes
1
No
0
AE Any Anxiety disorder ever Yes
1
No
0
PDC Panic disorder without agoraphobia current Yes
1
No
0
PDE Panic disorder without agoraphobia ever Yes
1
No
0
PDAC Panic disorder with agoraphobia current Yes
1
No
0
PDAE Panic disorder with agoraphobia ever Yes
1
No
0
AGC Agoraphobia without panic disorder current Yes
1
No
0
AGE Agoraphobia without panic disorder ever Yes
1
No
0
SPC Social phobia current Yes
1
No
0
SP Social phobia ever Yes
1
No
0
PC Specific phobia current Yes
1
No
0
PE Specific phobia ever Yes
1
No
0
OCDC Obsessive compulsive disorder current Yes
1
No
0
OCDE Obsessive compulsive disorder ever Yes
1
No
0
PTSDC Posttraumatic stress disorder current Yes
1
No
0
PTSDE Posttraumatic stress disorder ever Yes
1
No
0
GADC Generalized anxiety disorder current Yes
1
No
0
GADE Generalized anxiety disorder ever. Yes
1
No
0
Substance induced disorders
ASDC Any alcohol or substance use disorder current Yes
1
No
0
ASDE Any alcohol and substance use disorder ever Yes
1
No
0
ALCC Alcohol abuse current Yes
1
No
0
ALCE Alcohol abuse ever Yes
1
No
0
ALCDC Alcohol dependence current Yes
1
No
0
ALCDE Alcohol dependence ever Yes
1
No
0
SAC Other substance abuse current Yes
1
No
0
SAE Other substance abuse ever Yes
1
No
0
SDC Other substance dependence current Yes
1
No
0
SDE Other substance dependence ever Yes
1
No
0
Personality disorders
ANYPDC Any personality disorder Yes
1
No
0
AVPD Avoidant current Yes
1
No
0
DPPD Dependent current Yes
1
No
0
BPD Borderline current Yes
1
No
0
ANPD Antisocial current Yes
1
No
0
Overall functioning Yes
1
No
0
GAF Global assessment of functioning Yes
1
No
0

Personal Strengths
We are coming to the end of the interview now. There are three final questions. These are about your own strengths and people or things that have given you strength in your life.
S1 You have shown great strength in your life facing very difficult situations.
Have you any ideas about where this strength comes from?
Relationship with current partner





1
Relationship with a friend including other survivors




2
Relationship with therapist or counsellor




3
Relationship with god or spiritual force




4
Self-reliance
My work
My skills
My character strengths like
Optimism
Etc
5
Other
Specify





6
S2 You have faced very difficult challenges in your life.
What has helped you most in facing these?
Relationship with current partner





1
Relationship with a friend including other survivors




2
Relationship with therapist or counsellor




3
Relationship with god or spiritual force




4
Self-reliance
My work
My skills
My character strengths like
Optimism
Etc
5
Other
Specify





6
S3 What is the thing that means most to you in your life? Relationship with current partner





1
Relationship with a friend including other survivors




2
Relationship with therapist or counsellor




3
Relationship with god or spiritual force




4
Self-reliance
My work
My skills
My character strengths like
Optimism
Etc
5
Other
Specify





6

Thank you for your help with this interview.
By Christmas we will be giving our independent report of the results of this study of 400 survivors of institutional living to the Commission to Inquire into Child Abuse and this will be referred to in the final Report of the Commission.
As a routine procedure we give all participants in the study this leaflet on how to contact a counsellor, just in case this is something you want to do it the future.
Is there anything you would like to add or ask before I show you out?
Would you like me to call you in a few days to check that you are OK and that there is nothing further you wish to add or ask at that point?
Thank you again for your help.

Appendix 2. Scripts and Information Sheets

Telephone recruitment script


TELEPHONE RECRUITMENT SCRIPT

Hello, this is X from UCD. I am contacting you in connection with the Child Abuse Commission.
We are conducting an independent study of the adjustment of adult survivors of institutional living.
The commission said that you would be interested in taking part in a study like this.
Can I just check with you if you would like to take part in a study?

Pause for answer. If the participant declines the invitation, say:
That is fine. Thank you for taking our call. Goodbye.

If the participant says that they would like more information or would like to take part in the study, say:
Let me tell you a little bit about the study. It involves taking part in a confidential interview at INTERVIEW SITE.
We will meet you at INTERVIEW SITE
We will then bring you to the interviewing room.
The interview will involved talking to a researcher for about 2 hours.
There will be opportunities to take breaks during the interview if you wish, and you may end the interview at any time you wish. You will not be asked to read any material or write any answers down during the interview.
We are only interested in what you have to say about your past and present situation.
Your travelling expenses will be paid.
Do you think that you would like to participate in the study, or would you like more information about the study at this point?

If the participant says they would like to participate, then set up a time.
Give directions to the INTERVIEW SITE.
Give and take a contact number in case the participant is late or gets lost.
Tell them the name of their interviewer and that the interviewer will carry a large white card saying INTERVIEWER.

If the participant requires more information, say the following:
About 400 people who attended the Child Abuse Commission will be taking part in this study or survey.
The study aims to find out the effects of living in an institution during childhood on adult life.
It will be the first study of its kind in Ireland.
Your name will not be mentioned in the report of the study.
Rather the results will state how the overall group of 400 participants were affected by institutional living.
How it affected their psychological adjustment, their quality of life and how survivors coped with the challenges they faced.
The independent report of the study will submitted to the Commission to Inquire into Child Abuse and reference will be made to it in the final report of the Commission. This will be published in a couple of years and have a major impact on how children in institutions in the future are protected from harm.
Do you think that you would like to participate in the study?

Pause for answer. If the participant declines the invitation, say:
That is fine. Thank you for taking our call. Goodbye.

If the participant says they would like to participate, then set up a time.
Give directions to the INTERVIEW SITE.
Give and take a contact number in case the participant is late or gets lost.
Tell them the name of their interviewer and that the interviewer will carry a large white card saying INTERVIEWER.

Follow-up phone call script


FOLLOW-UP PHONE CALL SCRIPT

Hello this is NAME from the research study. We met the other day in LOCATION.
When you were leaving there was an arrangement that I would call you, just to check in and see how you are doing?
Is that still OK with you?
I was wondering how you are right now?
REFLECT BACK WHAT IS SAID IN SUMMARY, BUT NOT PARROT FORM.
I also wanted to check how you have been since we spoke a few days ago, if that’s OK with you?
REFLECT BACK WHAT IS SAID IN SUMMARY, BUT NOT PARROT FORM.
IF THE PERSON IS DOING OK SAY,
Anything you want to add or ask now?
Can we leave it there then?
Thank you again for your help. Goodbye NAME.
IF THE PERSON IS DISTRESSED SAY
I’m wondering if you would like to talk to someone about this? Maybe a counsellor?
IF THE PERSON SAYS YES, OFFER A COUNSELLOR NUMBER THEY CAN CALL.

Information leaflet on contacting the National Counselling Service


HOW DO I TO CONTACT A COUNLELLOR?

Thank you for participating in this research project. If you require counselling for abuse-related issues including any issues arising from the research interview you may contact the National Counselling Service (NCS) in Ireland or the Immigrant Counselling and Psychotherapy service (ICAP) in England and request an appointment. The National Counselling Service, which is free and confidential, has been set up as part of the Government Strategy for victims of institutional abuse. If you are in England you can contact the Immigrant Counselling and Psychotherapy service (ICAP). Here is a list of NCS centres in Ireland and ICAP centres in the UK.

Ms. Isolde Blau, Director of Counselling, Laragh Counselling Service, NHE, Prospect House, Prospect Road, Glasnevin, Dublin 9. Phone 1800 234 110 or 01-8824100. Covers Dublin - North of the Liffey

Ms. Rachel Mooney, Director of Counselling, AVOCA Counselling Service, NHE, Baggot Street Hospital, Lower Baggot Street, Dublin 4. Phone: 1800 234 111 or 01 6681740. Covers Dublin - South of the Liffey (Ringsend-Crumlin), Dun Laoghaire etc., Wicklow

Ms. Marion Rackard, Director of Counselling, Alba Counselling Service, NHE, 2 McElwain Terrace, Newbridge, Co. Kildare. Phone 1800 234 112 or 045 448176. Covers Kildare, South West Dublin (Tallaght, Walkinstown, Drimnagh, Crumlin, Clondalkin, Lucan), Parts of Wicklow (e.g. Blessington, Baltinglass)
Mr. Jonathan Egan, Director of Counselling, The Arches, NHE, 21 Church Street, Tullamore, Co. Offaly. Phone: 1800 234 113 or 0506- 27141. Covers Laois, Longford, Offaly, Westmeath

Ms. Theresa Flacke, Director of Counselling, NHE, Woodquay Centre Counselling Service, 7 Daly’s Lane, Woodquay, Galway. Phone 1800 234 114 or 091 561336. Covers Galway, Roscommon, Mayo.

Ms. Noreen Harrington, Director of Counselling, NHE, 106 O’Connell Street, Limerick. Phone 1800 234 115 or 061 411900. Covers Clare, Limerick, North Tipperary.

Mr. Philip Moore, Director of Counselling, Harbour Counselling Service, NHE, Penrose Wharf, Penrose Quay, Cork. Phone 1800 234 116 or 021 4861360. Covers Cork, Kerry

Ms. Fiona Ward, Director of Counselling, Rian Counselling Service, NHE, 34 Brew’s Hill, Navan, Co. Meath. Phone 1800 234 117 or 046 9067010. Covers Cavan, Monaghan, Meath. Louth
Mr. Gerard O’Neill, Director of Counselling, COMHAR, Adult Counselling Service, South Eastern Health Board, 49 O’Connell Street, Waterford. Phone 1800 234 118 or 051 852122. Covers Waterford, Kilkenny, Wexford, South TipperaryMr. Tom McGrath, Director of Counselling, NHE, 68 John Street, Sligo. Phone 1800 234 119 or 071 9142161. Covers Donegal, Sligo, Leitrim.

London. ICAP Immigrant Counselling and Psychotherapy, 79 1/2 Tollington Park, London N4 3AG , UK Phone 0207-272-7906

Birmingham. ICAP: Immigrant Counselling and Psychotherapy, 72 Digbeth, Birmingham, B5 6DH, UK, Phone 0121-666-7707

Briefing for directors of NCS centres


BRIEFING FOR DIRECTORS OF NCS CENTRES

Dear Colleagues
From May to September 2005, a study of adult survivors of institutional living commissioned by the Child Abuse Commission will be conducted at UCD, under the direction of Professor Alan Carr. I have been appointed as a consultant to the project. The study will provide important information on the impact of institutional living on adult adjustment and quality of life. This will be the first large scale study of its kind to be conducted in Ireland, and one of the first of its kind to be conducted in the English speaking world. The study will be conducted with ethical approval of the Child Abuse Commission and UCD, and informed consent of all participants. For this project about 400 adult survivors will be interviewed over about 4 months in the Summer of 2005. This time scale for data collection has been requested by the Child Abuse Commission. Interviews will be carried out in UCD by trained and supervised interviewers. The structured interview protocol will cover demographic and historical information, experiences of institutional living, mental health, and quality of life. Recalling abusive experiences and giving accounts of current life problems may be distressing for some participants. In view of this, all participants will be informed about the National Counselling service using the leaflet below. It is anticipated that some participants in the study will refer themselves to the NCS to address the issues raised by the research interview through counselling. Please contact Alan Carr at 01-716-8740 if you require more information on the study. If you have specific inquires about responding to self-referrals arising form the study, please contact Jonathon Egan at 0506- 27141.

Jonathan Egan, M Psych Sc

Director of Counselling,
The Arches, 21 Church Street,
Tullamore, Co. Offaly.
Phone: 0506- 27141

Summary of the institutional abuse survey

What follows is a summary of key findings from the survey contained in chapter 1, which was commissioned by CICA and conducted by Professor Alan Carr, from the UCD School of Psychology.

Past research

Past international research on child abuse, institutional living, institutional abuse and clerical abuse suggests that children brought up in institutions and abused as children may show a range of problems as adults. However, no large-scale studies have been conducted to investigate whether or not these tentative findings from the international literature reflect the experiences of survivors of institutional living in Ireland.

Aims of the current study

The aim of the present study was to profile survivors of institutional child abuse in industrial and reformatory schools on demographic, historical and psychological variables.

Methodology

Between May 2005 and February 2006 just under 250 adult survivors of institutional living recruited through CICA were interviewed in Ireland and the UK by a team which included 29 trained interviewers, all of whom had degrees in psychology. The overall exclusion rate was 26% (326 of 1267). The participation rate was 20% (246 of 1267). The response rate for the study was 26% (246 of 941). (This low response rate is not unusual. A response rate of 9% was obtained in the Time to Listen Report on Confronting Child Sexual Abuse by Catholic Clergy (Goode, McGee & O’Boyle, 2003)).

The sample of participants interviewed was not representative of all CICA attenders, or indeed of adult survivors of institutional living. It is probable that participants were better adjusted than CICA attenders who did not take part, because the old and the ill were excluded from the study. The interview protocol covered demographic characteristics, history of family and institutional living, recollections of child abuse within the family and institutions, psychological processes associated with institutional life, coping strategies used to deal with institutional life, current trauma symptoms, current and past diagnoses of psychological and personality disorders, relationships with partners and children, adult attachment style, main life problems, current quality of life, and global level of functioning. Interviews were conducted in an ethical way that safeguarded participants’ wellbeing. Data were managed in a way to safeguard participants’ anonymity.

Profile of overall sample

Demographic characteristics

The 247 participants in this study included roughly equal numbers of men and women of about 60 years of age, who had entered institutions run by nuns, religious brothers or priests due to family adversity or petty criminality. Participants had spent an average of 5.4 years living with their families before entering an institution and on average spent 10 years living in an institution. The majority were of lower socioeconomic status and low educational attainment. The majority had been, or were currently married or in a long-term relationships, with a high rate of relationship stability. Most married participants had children, with three children being the average, and most had brought up their own children.

Institutional abuse

From Figure 1 it may be seen that on the institutional version of the Childhood Trauma Questionnaire, more than 90% of participants were classified as having experienced physical and emotional child abuse and neglect within institutions, and about half as having experienced institutional child sexual abuse. For about 40% of participants, severe physical abuse was the worst thing that happened to them in an institution. For a further third it was humiliation and degradation. For 16% it was sexual abuse and for about a tenth it was combined physical and sexual abuse. Worst institutional abusive experiences began at about 9 years and lasted for 5 about years.

Figure 1. Rates of institutional child maltreatment on the institutional version of the childhood trauma scale among all 247 participants

Family-based child abuse

From Figure 2 it may be seen that on the family version of the Childhood Trauma Questionnaire almost half of the 121 participants who had memories of having lived with their families were classified as having experienced physical neglect; about a quarter as having suffered emotional neglect or physical abuse; about a fifth as having suffered emotional abuse; and under a tenth as having suffered sexual abuse.

Figure 2. Rates of family-based child maltreatment on the family version of the childhood trauma scale among the 121 participants who had memories of having lived with their families.

Life problems

All participants had experienced one or more significant life problems. From Figure 3 it may be seen that mental health problems, unemployment and substance use were the three most common difficulties and were reported by a third to three quarters of participants.

Figure 3. Rates of life problems among all 247 participants.

Strengths

From figure 4 it may be seen that self-reliance, optimism, work and skills were the most frequently reported resources that helped participants most in facing life challenges.

Figure 4. Factors that helped participants most in facing life challenges

Psychological disorders

81.78% of participants at some point in their life had had a psychological disorder and only under a fifth had never had any psychological disorder. Anxiety disorders were the most common, followed by mood disorders. From Figure 5 it may be seen that rates of current anxiety, mood and substance use disorders were more than double those found in community surveys in Europe and the USA.

Figure 5. Rates of current psychological disorders among survivors of institutional living compared with rates in normal community samples in Europe and the USA.

Trauma symptoms

From Figure 6 it may be seen that the majority of participants showed clinically significant posttraumatic symptomatology on the Trauma Symptom Inventory, indicative of continuing posttraumatic adjustment difficulties.

Figure 6. Rates of trauma symptoms on the Trauma Symptom Inventory

Adult attachment styles

On the Experiences in Close Relationships Inventory more than four fifths (93.41%) of participants were classified as having an insecure adult attachment style, indicative of having problems making and maintaining satisfying intimate relationships. A fearful attachment style characterized by high interpersonal anxiety and avoidance was by far the most common. Less than a fifth of cases (16.59%) were classified as having a secure adult attachment style.

Male and female survivors

Male (N=135) and female (N=112) participants had different profiles. Male participants spent longer living with their families before entering institutions and fewer years in institutions. More entered institutions run by religious brothers or priests for petty crime and left because their sentence was over, while more females lived in institutions run by nuns. Male participants achieved a higher socio-economic status than females, and more had children who spent time living separately from them with the child’s other parent. While worst abusive experiences began at an older age, for male participants, they reported more institutional sexual abuse. While female participants had significantly more current panic disorder with agoraphobia, significantly more male participants had lifetime diagnoses of alcohol and substance use disorders, especially alcohol dependence. Male participants had significantly higher numbers of life problems, but also higher levels of global functioning and marital satisfaction than females.

Older and younger survivors

Older participants (N=134) in their 60s and younger participants in their 50s (N=113) had distinct profiles. More older participants left their institutions because they were too old to stay on and more were now retired. They had longer relationships with their current partners and were older when their first children were born. Younger participants reported greater institutional, physical, sexual and emotional abuse. More had current anxiety, mood and personality disorders, especially PTSD, generalized anxiety disorder and avoidant personality disorder. Younger participants had more trauma symptoms, adult life problems, a lower quality of life and lower level of global functioning compared with older participants.

Participants from the CICA confidential and investigation committees

Participants from the confidential (N=175) and investigation (N=71) committees had distinct profiles. Participants from the confidential committee had spent fewer years with their families before entering an institution and more years in institutions run by nuns. More entered because they were illegitimate and left because they were too old to stay on. They were younger when their worst experiences began. More had maintained stable long-term relationships with their partners and provided their own children with a stable family in which to grow up. More participants from the investigation committee entered intuitions run by religious brothers or priests through the courts for petty crime and left because their sentences were over. They reported greater institutional sexual abuse than participants from the confidential committee. More participants from the investigation committee had a current diagnosis of major depression.

Subgroups defined by duration of time in an institution and circumstances of entry

The following four subgroups, defined by duration of time in an institution and circumstances of entry, were compared:

In the analysis of these four groups the most poorly adjusted as adults were not those who had spent longest living in institutions (more than 12 years), but rather those who had spent less time in institutions (under 11 years), entered institutions through the courts, and reported institutional sexual abuse, in addition to physical abuse within their families. These had more antisocial personality disorders, substance use disorders and life problems such as unemployment and criminality. What follows is a summary of the profiles of the four groups from this analysis.

Group 1 included those who had spent more than 12 years in an institution and entered before 5 years of age They had spent the least time with their families (under one and a half years) and the longest time living in institutions (about fifteen years) of any of the four groups. Compared to groups 3 and 4, more were girls placed in orphanages run by nuns because they were illegitimate, or because their parents had died or could not look after them. More left because they were too old to stay on, and more had mixed feelings about leaving. More had experienced physical abuse which began at a younger age and persisted longer than in group 4. Severe emotional abuse was most commonly cited as the worst thing that happened to this group and it began at an earlier age and lasted longer than worst experiences of other groups. Compared with groups 3 and 4, this group reported fewer psychological disorders and life problems. They identified relationships with friends, self-reliance, optimism, and their work and skills as the sources of their strength.

Group 2 included participants who had spent 5-11 years in institutions because of family problems Participants in this group entered institutions run predominantly by nuns because their parents could not cope or died, and left when they were too old to stay. Compared with groups 3 and 4, more members of group 2 were female, younger when their most severe form of sexual abuse began, and more identified severe emotional abuse as the worst thing that had happened to them. Compared with group 4 more identified self-reliance, optimism, and their work and skills as the source of their strength.

Group 3 included participants who had spent 5-11 years in institution and entered through the courts Compared with groups 1 and 2, more members of this group were male, lived in institutions run by religious brothers or priests, and were survivors of institutional sexual abuse. Compared to the other three groups they identified sexual abuse as the worst thing that had happened to them, and more had experienced physical abuse within their families. Compared with groups 1 and 2, this group had more alcohol and substance use disorders, antisocial personality disorders, violent and non-violent crime, imprisonment for violent and non-violent crime, and unemployment. For this group, their self-reliance, optimism, and their work and skills were identified as the main sources of their strength in adulthood, compared with group 4.

Group 4 included participants who had spent 4 or fewer years in institution Participants in this group spent the most time with their families (more than ten and a half years) and the shortest time living in an institution (just under three years) compared with the other three groups. Most were boys placed in institutions run by religious brothers or priests because of petty crime and left because their short sentences were over, or because their families wanted them back, and few had mixed feelings about leaving. Institutional sexual abuse was the form of maltreatment that distinguished this group, and compared with groups 1 and 2, they showed more alcohol and substance use disorders, antisocial personality disorders, non-violent crime, imprisonment for non-violent crime and unemployment. Their relationships with their partners was identified as the main source of their strength in adulthood.

Subgroups defined by worst form of institutional abuse

The following subgroups, defined by worst form of institutional abuse, were compared:

In this analysis the most poorly adjusted as adults were not those who reported severe combined physical and sexual abuse, but rather, those who pinpointed severe sexual abuse as the worst thing that had happened to them while living in an institution. In this analysis, the best adjusted were those who had suffered severe emotional abuse. What follows is a summary of the profiles of the four groups from this analysis.

Group 1 included participants for whom severe sexual and physical abuse was the worst thing they had experienced

Participants in this group had experienced more physical and sexual institutional abuse than at least two of the other 3 groups (in this analysis). They had spent less time with their families before entering an institution than group 3. Like members of group 3, more had children who spent some time living separately with the child’s other parent. Compared with groups 2 and 4, more had a current diagnosis of posttraumatic stress disorder (PTSD) and multiple trauma symptoms.

Group 2 included participants for whom severe physical abuse was the worst thing they had experienced

Participants in this group had the lowest educational achievement, were older than groups 1 and 3 (in this analysis), and more had put their own children up for adoption. Compared with group 3, their worst abusive experience had lasted longer. Like group 4, fewer had PTSD than groups 1 and 3, and they had fewer life problems than group 3.

Group 3 included participants for whom severe sexual abuse was the worst thing they had experienced

Compared with group 4 (in this analysis), more participants in group 3 were male and were admitted through the courts to institutions run by religious brothers for petty crime. Like group 1, more had children who spent time with their other parent who lived separately compared to group 4. Also, compared to group 4, more had PTSD, multiple trauma symptoms, lifetime alcohol and substance use disorders, antisocial personality disorders and multiple life problems.

Group 4 included participants for whom severe emotional abuse was the worst thing they had experienced

Compared to group 3 (in this analysis), more participants in this group were female and on average had spent the longer living in institutions run by nuns. Their worst experiences began at an earlier age than any other group and more had mixed feelings about leaving.

Profiles associated with patterns of adult psychological disorders

There was an association between having psychological disorders and reporting both institutional and family-based child abuse and neglect. Certain patterns of psychological disorders were associated with institutional abuse alone, and other patterns were associated with institutional family-based child abuse and neglect. For participants with 4 or more co-existing diagnoses, and for those with mood disorders, greater institutional, but not family-based physical, sexual and emotional abuse was reported. Participants with PTSD, alcohol and substance use disorders, avoidant and antisocial personality disorder reported both institutional and family-based abuse or neglect. Participants with multiple diagnoses had the poorest adult psychological adjustment and those with no diagnoses were the best adjusted. Subgroups selected by diagnosis showed an intermediate level of adult psychological adjustment between these extremes. What follows are brief profiles of groups with different patterns or types of psychological disorders.

Multiple diagnoses

Participants with 4 or more diagnoses (N=83), were compared with those who had 1-3 diagnoses (N=119), and with those who had no diagnoses (N=45). Those with 4 or more diagnoses reported greater institutional sexual and emotional abuse (but not more family-based abuse) than participants with fewer diagnoses. Participants with 4 or more diagnoses had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with 1-3 diagnoses, who in turn were less well adjusted than participants with no diagnoses. More participants with 4 or more diagnoses had a fearful adult attachment style, and fewer had secure or dismissive adult attachment styles. On average more participants with 4 or more diagnoses were in their 50s compared with those with no diagnoses who where were in their 60s. Also, more participants with 4 or more diagnoses were unemployed and of lower socio-economic status than participants with fewer diagnoses.

Mood disorders

Participants with mood disorders (N=142), more than half of whom had co-existing anxiety disorders, reported greater institutional sexual and emotional abuse and greater institutional severe physical and sexual abuse (but not family-based child abuse) than participants with no diagnoses (N=45). Participants with mood disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. More participants with mood disorders had a fearful adult attachment style, and fewer had a secure adult attachment style. On average participants with mood disorders were in their late 50s while those with no diagnoses were in their 60s. Also, on average, participants with mood disorders had had their first child in their mid-20s, while those with no diagnoses had their first children a couple of years later.

Posttraumatic stress disorder

Participants with PTSD (N=63), more than half of whom had other co-existing anxiety disorders and alcohol or substance use disorders, reported greater institutional physical, sexual and emotional abuse, and greater institutional severe physical and sexual abuse than participants with no diagnoses (N=45). They also reported having experienced greater family-based emotional abuse. Participants with PTSD had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with no diagnoses. Fewer participants with PTSD had a dismissive adult attachment style. On average participants with PTSD were in their 50s while those with no disorders were in their 60s.

Alcohol and substance use disorders

Participants with alcohol and substance use disorders (N=99), more than half of whom had a co-existing anxiety disorder, reported greater institutional sexual and emotional abuse, and greater institutional severe sexual abuse than participants with no diagnoses (N=45). They also reported having experienced greater family-based physical and emotional abuse. Participants with alcohol and substance use disorders had more trauma symptoms and life problems, and a lower quality of life and global level of functioning than participants with no diagnoses. Compared with those with no diagnoses, participants with alcohol and substance use disorders were younger (in their 50s not their 60s); had had their first children at a younger age (in early, not their late 20s); were of lower socio-economic status; and fewer had entered an institution because their parents had died.

Avoidant personality disorder

Participants with avoidant personality disorders (N=52) reported greater institutional and family-based emotional abuse than those with no diagnoses (N=45). Almost all participants with an avoidant personality disorder had a co-existing anxiety, mood or substance use disorder. Participants with avoidant personality disorder had more trauma symptoms and life problems, and a lower quality of life and global level of functioning, than participants with no diagnoses. Compared to those with no diagnoses, more participants with an avoidant personality disorder had a fearful adult attachment style and fewer had a secure adult attachment style. Compared to participants with no diagnoses, participants with avoidant personality disorder were younger (in their 50s, not their 60s) and more had been placed in institutions run by nuns because their parents could not care for them.

Antisocial personality disorder

Participants with antisocial personality disorder (N=17) reported greater institutional sexual abuse than participants with no diagnoses (N=45). All participants with antisocial personality disorder had co-existing anxiety, mood or substance use disorders. Participants with antisocial personality disorder had more trauma symptoms, more life problems, a lower quality of life, a lower global level of functioning, and lower parental satisfaction than participants with no diagnoses. Compared to those with no diagnoses, participants with antisocial personality disorder were younger (in their 50s, not their 60s); had spent fewer years in institutions (5 ½ not nearly 10 years); more were unemployed; and more were of low socio-economic status.

Borderline personality disorder

Participants with borderline personality disorder (N=14) and those with no diagnoses (N=45), did not differ in their reported levels of institutional or family-based child abuse, although both reported a high level of child abuse. All participants with borderline personality disorder had co-existing anxiety, mood or substance use disorders. Participants with borderline personality disorders had more trauma symptoms, more life problems, a lower quality of life, a lower global level of functioning, and more had a fearful adult attachment style than participants with no diagnoses. Compared to those with no diagnoses, participants with borderline personality disorder were younger (in their 50s, not 60s), more were unemployed, and on average reported being abused from an earlier age.

Institutional abuse processes and coping strategies

Scales were developed to assess the psychological processes of traumatization, re-enactment of abuse and spiritual disengagement; as well as positive and negative coping strategies. Participants completed versions of these scales to reflect their current experience and their recollection of their experiences when living in institutions as children. Participants reported a reduction in the psychological processes of traumatization, re-enactment of abuse and an increase in spiritual disengagement from childhood to adult life. Participants also reported an increase in the use of positive coping strategies and a reduction in the use of coping by complying and avoidant coping strategies from childhood to adulthood.

A model of institutional abuse, psychological processes and adult adjustment

Figure 7 represents a model which shows that a history of childhood institutional abuse is associated with current psychological processes of traumatization, re-enactment and spiritual disengagement, which in turn are associated with current adult mental health and quality of life. The model also shows that a history of having spent more childhood years within the family and current use of positive coping strategies are positively associated with quality of life and low levels of present traumatization. This model was developed by first correlating all factors within the model, and then testing the fit of the proposed model to the pattern of correlations between its constituent factors using structural equation modelling.

Figure 7. A path diagram of the model of institutional abuse

Strengths and limitations

This study had three main limitations: (1) there was a high exclusion rate and a low response rate; (2) there was no control group; and (3) the study used a crossectional not a longitudinal design. There were also four main strengths: (1) it was the largest study of its kind conducted to date; (2) an extensive reliable and valid interview protocol was used; (3) data were collected by psychologists trained in using the interview protocol; (4) in the statistical analyses, steps were taken to reduce type 1 error (interpreting non-significant results as significant)

Recommendations

Recommendations arising from this research fall into four broad categories: prevention, treatment, training and research.

Prevention

The first recommendation is that legislation, policies, practices and procedures be regularly reviewed and revised to maximize protection of children and adolescents in institutional care in Ireland from all forms of abuse and neglect. Specifically the Children First: National Guidelines for the Protection and Welfare of Children (Department of Health and Children, 1999) require regular review and revision to insure that they are being properly implemented and that children and adolescents in institutional care, and other forms of substitutive care in Ireland are being adequately protected.

Treatment

The second recommendation is that evidence-based psychological treatment continue to be made available to adult survivors of Irish institutional abuse. Specifically the National Counselling Service for adult survivors of child abuse in Ireland and similar appropriate services in the UK should continue to be accessible to Irish survivors of institutional abuse. Staff in such services should be appropriately qualified and trained to offer services to clients with complex difficulties, such as multiple co-existing disorders including anxiety disorders, mood disorders, substance use disorders and personality disorders. It is important the these services be evidence-based (Carr, 2006).

Staff training

The third recommendation is that staff at centres which provide psychological treatment for adult survivors of Irish institutional abuse have regular continuing professional education and training to keep them abreast of developments in the field of evidence-based treatment of survivors of childhood trauma.

Research

The fourth recommendation is that research be conducted to evaluate the effectiveness of psychological treatment for adult survivors of institutional abuse. The report of Survivors’ Experiences of the National Counselling Service for Adults who Experienced Childhood Abuse (Leigh et al., 2003) was an important first step in evaluating client satisfaction with the National Counselling Service. However, it did not address the critical issue of the effectiveness of the service provided. Such research is urgently required. Research is also required on levels of child abuse among looked after children (including all categories of children in care and children living in a variety of health, educational, correctional and social services institutions).

Other documents arising from the project

Three theses and a series of academic papers have been written based on this study.

  • Flanagan, E. (2006). Psychological disorders in adult survivors of institutional living. Thesis for the degree of Doctor of Psychological Science in Clinical Psychology, UCD, Dublin. In this thesis the profiles of subgroups of survivors with different psychological disorders are presented.
  • Fitzpatrick, M. (2007) Psychological profiles of adult survivors of childhood institutional living in Ireland. Thesis for the degree of Doctor of Psychological Science in Clinical Psychology, UCD, Dublin. In this thesis the profiles of subgroups of survivors who had spent different amounts of time in institutions and experienced different types of abuse are presented.
  • Flanagan-Howard, R. (2007). Psychometric Properties of the Institutional Abuse Processes and Coping Inventory. Thesis for the degree of Doctor of Psychological Science in Clinical Psychology, UCD, Dublin. In this thesis the development of scales to measure psychological processes associated with institutional abuse and coping strategies is presented.
  • Carr, A., Dooley, B., Fitzpatrick, M, Flanagan, E.,. Flanagan-Howard, R., Tierney, K., White, M., Daly, M. & Egan, J. (2007). Adult adjustment of survivors of institutional child abuse in Ireland. This paper documents the adult adjustment of survivors of childhood institutional abuse.

    Fitzpatrick, M., Carr, A., Dooley, B., Flanagan-Howard, R., Flanagan, E., Shevlin, K., Tierney, K., White, M., Daly, M. & Egan J. (2007). Profiles of adult survivors of severe sexual, physical and emotional institutional abuse in Ireland. This paper establishes the unique profiles Irish adult survivors of severe sexual, physical and emotional institutional abuse.

  • Flanagan-Howard, R., Carr, A., Shevlin, M., Dooley, B., Fitzpatrick, M. Flanagan, E., Tierney, K., White, M., Daly, M. & Egan, J. (2007). Development and Initial validation of the Institutional Child Abuse Processes and Coping Inventory among a sample of Irish adult survivors of institutional abuse. This paper documents the development a psychometric instrument to evaluate psychological processes associated with institutional abuse and coping strategies used to deal with such abuse.
  • Flanagan, E., Carr, A., Dooley, B., Fitzpatrick, M. Flanagan-Howard, R., Shevlin, M., Tierney, K., White, M., Daly, M. & Egan, J. (2007). Profiles of resilient survivors of institutional abuse in Ireland. This paper documents the profiles of resilient survivors of institutional abuse, who had no psychological disorders.
  • Carr, A., Flanagan, E., Dooley, B., Fitzpatrick, M. Flanagan-Howard, R., Shevlin, M., Tierney, K., White, M., Daly, M. & Egan, J. (2007). Profiles of Irish survivors of institutional abuse with different adult attachment styles. This paper documents the profiles of Irish survivors of institutional abuse with different adult attachment styles