The questionnaire covers the following topics:
General Health:
- Functional status, including physical and mental
- Well-being
- Height and weight
Health Behaviors:
- Alcohol and tobacco use
- Eating behaviors/disorders
- Sleep duration and quality
- Physical activity
Health Conditions and Symptoms:
- Provider-diagnosed medical conditions
- Examples: migraines, stomach ulcer, irritable bowel syndrome, high cholesterol, thyroid condition, cancer, heart disease, emphysema/bronchitis, asthma, hypertension, diabetes, etc.
- Physical symptoms
- Examples: pain, headaches, fatigue, shortness of breath, cough, forgetfulness
- Mental health assessments
- Examples: PTSD, depression, anxiety
- Pregnancy and infertility
Health Care Utilization and Preventive Care:
- Outpatient and inpatient visits
- Complementary and alternative medicine use
Life Events:
- Stressful events (e.g. financial problems, divorce)
- Assault (sexual and physical)
- Adverse childhood experiences
- Spouse’s deployment, return and reunion experiences
- Military impact on work
- Military-related relocations
Military Experiences (Dual Military):
- Deployments and combat experiences
- Injuries (including head injuries and Motor Vehicle Accidents/Crashes)
- Exposures
- Burn Pits/Smoke, Chemicals/pesticides/depleted uranium
- Occupation
- Status (active duty, reserve/national guard, separated/retired)
Family:
- Family functioning (e.g. marital satisfaction, military life, spouse’s deployment)
- Children’s behaviors and medical conditions
- Healthcare utilization
Other:
- Employment
- Education
- Anger
- Self mastery
- Perception of the military
- Assessment of social support
STANDARDIZED FAMILY INSTRUMENTS
| Short-Form 36 |
Physical, mental, and functional health |
| Patient Health Questionnaire (PHQ) |
Depression, anxiety, panic syndrome, binge-eating, bulimia nervosa, and alcohol abuse |
| Posttraumatic Stress Disorder (PTSD)Checklist-Civilian Version (PCL-C) |
Post-traumatic stress disorder |
| CAGE questionnaire |
Alcohol problems |
| Insomnia Severity Index (ISI) |
Sleep |
| Family Adaptability and Cohesion Evaluation Scale (FACES IV) |
Family communication and satisfaction |
| Quality of Marriage Index (QMI)* |
Relationship with spouse |
| Adverse Childhood Experiences (ACE)* |
Childhood experiences |
| Strengths & Difficulties Questionnaire (SDQ)* |
Behavioral screening for children |
*full inventory not used
