FREE Life Stressor Checklist

READ THIS FIRST: Now we are going to ask you some questions about events in your life that are frightening, upsetting, or stressful to most people. Please think back over your whole life when you answer these questions. Some of these questions may be about upsetting events you don’t usually talk about. Your answers are important, but you do not have to answer any questions that you do not want to. Thank you.

 

Life Stressor Checklist-Revised Scoring Options
This measure is valid using a number of different scoring methods. We have highlighted three scoring methods that we believe to be the most useful.
Option 1: 
One method of scoring the LSC-R is to simply give one point to each positively endorsed stressor (the numbered questions), count up the total, and assign an overall Life Stressor score to each participant. The scores range from 0-30.
Option 2: 
The second option is to score the LSC-R by assigning weights to the person’s endorsed life stressors. This score, ranging from 0-150, reflects a person’s subjective rating of how a life stressor affected the person’s life in the past year. Each positively endorsed life stressor would be assigned points ranging from 1-5 according to the marked number in lettered question “e.”
Option 3: 
This method identifies the person’s number of positively endorsed life stressors that reflect the DSM-IV Posttraumatic Stress Disorder Criteria A for having experienced a traumatic event. Points are assigned only when a life stressor is positively endorsed as well as questions “c” and “d,” reflecting the DSM-IV criteria for experiencing a traumatic life event. You will notice that options c and d are only available for selected questions as appropriate for DSM-IV criteria. Some researchers have found it useful to use this scoring option in conjunction with Option 1, where there is a score for high magnitude stressors (criteria A stressors) and low magnitude stressors (other significant stressful events).
LSC-

 

 

Name
Email
Country/ State

1.Have you ever been in a serious disaster (for example, an earthquake, hurricane,large fire, explosion)?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

2.Have you ever seen a serious accident (for example, a bad car wreck or an on-the-job accident)?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

3. Have you ever had a very serious accident or accident-related injury (for example, a bad car wreck or an on-the-job accident)?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

4.Was a close family member ever sent to jail?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

5.Have you ever been sent to jail?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

6.Were you ever put in foster care or put up for adoption?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

7.Did your parents ever separate or divorce while you were living with them?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

8.Have you ever been separated or divorced?Yes. No.

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

9. Have you ever had serious money problems (for example, not enough money for food or place to live)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

10.Have you ever had a very serious physical or mental illness (for example, cancer,heart attack, serious operation, felt like killing yourself, hospitalized because of nerve problems)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

11. Have you ever been emotionally abused or neglected (for example, being frequently shamed, embarrassed, ignored, or repeatedly told that you were “no good”)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

12. Have you ever been physically neglected (for example, not fed, not properly clothed, or left to take care of yourself when you were too young or ill)?Yes. No.

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

13.WOMEN ONLY: Have you ever had an abortion or miscarriage (lost your baby)?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

14.Have you ever been separated from your child against your will (for example, the loss of custody or visitation or kidnapping?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

15. Has a baby or child of yours ever had a severe physical or mental handicap (for example, mentally retarded, birth defects, can’t hear, see, walk)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

16.Have you ever been responsible for taking care of someone close to you (not your child) who had a severe physical or mental handicap (for example, cancer, stroke,AIDS, nerve problems, can’t hear, see, walk)

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

17. Has someone close to you died suddenly or unexpectedly (for example, sudden heart attack, murder or suicide)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

18. Has someone close to you died (do NOT include those who died suddenly or unexpectedly)?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

19. When you were young (before age 16). did you ever see violence between family members (for example, hitting, kicking, slapping, punching)?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

20.Have you ever seen a robbery, mugging, or attack taking place?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

21.Have you ever been robbed, mugged, or physically attacked (not sexually) by someone you did not know?

a.How old were you when this happened? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

22.Before age 16, were you ever abused or physically attacked (not sexually) by someone you knew (for example, a parent, boyfriend, or husband, hit, slapped,choked, burned, or beat you up?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

23.After age 16, were you ever abused or physically attacked (not sexually) by someone you knew (for example, a parent, boyfriend, or husband hit, slapped,choked, burned, or beat you up)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

24.Have you ever been bothered or harassed by sexual remarks, jokes, or demands for sexual favors by someone at work or school (for example, a coworker, a boss, a customer, another student, a teacher)?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

25.Before age 16, were you ever touched or made to touch someone else in a sexual way because he/she forced you in some way or threatened to harm you if you didn’t?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

26.After age 16, were you ever touched or made to touch someone else in a sexual  way because he/she forced you in some way or threatened to harm you if you didn’t?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

27.Before age 16, did you ever have sex (oral, anal, genital) when you didn’t want to because someone forced you in some way or threatened to hurt you if you didn’t?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

28.After age 16, did you ever have sex (oral, anal, genital) when you didn’t want to because someone forced you in some way or threatened to harm you if you didn’t?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

29.Are there any events we did not include that you would like to mention?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?

30.Have any of the events mentioned above ever happened to someone close to you so that even though you didn’t see it yourself, you were seriously upset by it?

a.How old were you when this happened? __________

b.How old were you when this ended? __________

c. At the time of the event did you believe that you or someone else could be killed or
seriously harmed?

d.At the time of the event did you experience feelings of intense helplessness, fear, or horror?

e.How much has this affected your life in the past year?