Global Check Set

    

I drink alcoholic beverages daily.





  

I feel sad, empty, or become tearful.





  
    
    

I feel hopeless and worthless.





  

I have been exposed directly or indirectly(i.e. family, friend, colleagues) to a traumatic event..





  
    

I worry and feel anxious.





  

My body is usually pain free.





  

I cannot recall details of a trauma I experienced.





  
    

I use illegal drugs daily.





  
    

My sleep is disrupted or I feel tired when I wake up.





  
  

I have a positive and cheerful attitude toward life.





  

Thoughts of a traumatic event keep coming to my mind (i.e. thoughts, dreams, flashbacks).





  

I seem to be unable to control my worries or fears.





  

I worry about my health.





  

I do not know how I came to be at some place.





  
    

Drugs or alcohol interferes with what I need to get done.





  
    

I am no longer interested in activities I used to enjoy.





  

    

I think about ending my life.





  

I have not been well due to a diagnosed physical illness(es).





  
    

I easily recall important information about myself.





  
    

Drugs/alcohol have negatively impacted my personal life.





  
    

I have a lot of energy.





  

    

I have a specific plan to end my life.





  

I lose my temper easily.





  
    

I always feel on edge.





  

I have frequent headaches.





  
    

I act out of character and feel I don’t know myself.





  

Drugs or alcohol are not a problem in my life.





  
    

I have lost or gained over 10 pounds recently.





  

I fear that my life may never improve.





  
    
    

I avoid people, places, or things that are trauma reminders.





  

My concentration is good.





  

I am afraid that I will become seriously ill in the future.





  

I feel outside myself – detached like an observer.





  

I am fairly relaxed and do not startle easily.





  

I feel irritable most of the time.





  


Your depression is: __

Your substance use is: __

Your suicidality is: __

Your PTSD is: __

Your Generalized Anxiety Disorder is: __

Your somatization is: __

Your dissociation is: __

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