Global Psychotrauma Screen (GPS)|__|__|__|__|__|
Participant Identification NumberGendero Femaleo Maleo Other|__|__|__|Age (years)

Sometimes things happen to people that are unusually or especially frightening, horrible,
or traumatic.
Briefly describe the event or experience that currently affects you the most:……………………………………………………………………………………………………..

This event happened:o last montho last half yearo last year

o longer ago

This event:o was a single event occurring, at age |__|__|
o happened during a longer period / multiple times, between ages |__|__| and |__|__|
Which of the below characterize the event (more answers possible):
Physical violence:
Sexual violence:
Emotional abuse:
Serious injury:
Life threatening:o to yourself
o to yourself
o to yourself
o to yourself
o to yourself

o happened to someone elseo happened to someone elseo happened to someone elseo happened to someone elseo happened to someone elseo Sudden death of a loved one
o You causing harm to someone elseo Corona virus (COVID-19)

Considering the above event, in the past month have you….
1.

… had nightmares about the past traumatic life event(s) you haveexperienced or thought about the event(s) when you did not want to?

o No

o Yes

2.

… tried hard not to think about past traumatic life event(s) or went out ofyour way to avoid situations that reminded you of the event(s)?

o No

o Yes

3.

… been constantly on guard, watchful, or easily startled?

o Noo Yes

4.

… felt numb or detached from people, activities, or your surroundings?

o Noo Yes5.

… felt guilty or unable to stop blaming yourself or others for past traumatic
life event(s) or any problems the event(s) caused?

o Noo Yes

6.

… tended to feel worthless?

o Noo Yes

7.

… experienced angry outbursts that you could not control?

o Noo Yes

8.

… been feeling nervous, anxious, or on edge?

o Noo Yes

9.

… been unable to stop or control worrying?

o Noo Yes

10.

… been feeling down, depressed, or hopeless?

o Noo Yes

11.

… been experiencing little interest or pleasure in doing things?

o Noo Yes

12.

… had any problems falling or staying asleep?

o Noo Yes

13.

… tried to intentionally hurt yourself?

o Noo Yes14.

… perceived or experienced the world or other people differently, so that15.

… felt detached or separated from your body (for example, feeling like you are

16.
17.

o No

o Yes

o Noo Yes

… had any other physical, emotional or social problems that bothered you?

o Noo Yes

… experienced other stressful events (such as financial problems, changing jobs,o Noo Yes

things seem dreamlike, strange or unreal?

looking down on yourself from above, or like you are an outside observer of your ownbody)?

moving to another house, relational crisis in work or private life)?

18.

… tried to reduce tensions by using alcohol, tobacco, drugs or medication?

o No

o Yes

19.

… missed supportive people near you that you could readily count on forhelp in times of difficulty (such as emotional support, watch over children or pets,o Noo Yes

o Noo Yeso Noo Yeso Noo Yes

give rides to hospital or store, help when you are sick)?

20.

During your childhood (0-18 years), did you experience any traumatic
life events (e.g., a serious accident or fire, physical or sexual assault or abuse, adisaster, seeing someone be killed or seriously injured, or having a loved one die)?

21.

Have you ever received a psychiatric diagnosis or have you ever beentreated for psychological problems (for example, depression, anxiety or apersonality disorder)?

22.

Do you generally consider yourself to be a resilient person?

23.

How would you rate your present functioning (at work/home)?
Poor

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https://www.global-psychotrauma.net/gps