Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Assessment Instruments for First Responders
and Public Health Emergency Workers
First responders and public health
Work/Life BalanceFirst responders and public healthemergency workers can experience
Work/Life Balance is a 1-item
a variety of stressors and potentiallyself-report measure that assesses
emergency workers can experience
traumatic events, which increase thethe impact of balancing home anda variety of stressors and potentiallyrisk for distress and mental healthwork responsibilities during, anddisorders. Effective recognition andin the aftermath of, a stressful ortraumatic events, which increase the risk for
management of these stressors cantraumatic experience (Herbermandistress and mental health disorders.
enhance the health, well-being, andMash, Fullerton, Kowalski-Trakofler,
occupational functioning of these
Reissman, Scharf, Shultz, & Ursano,personnel. Below are instruments that2013). Respondents are asked “How difficult was it toassess a broad range of work-life stressors.
balance your concerns for your family while performingyour job during the [stressful or traumatic experience]?”
Career Satisfaction
and provided with six answer choices: Not at all, A little bit,Professional Quality of Life (PROQOL-V)
Moderately, Very, Extremely, and Not applicable.
The Professional Quality of Life is a 30-item self-reportmeasure that assesses the positive and negative effects ofFatigue
working with people who have experienced extremely
Fatigue Checklist
stressful events (Stamm, 2010). Response choice range
The Fatigue Checklist is a 10-item self-report measurefrom 1 = Never to 5 = Very Often.
developed to examine fatigue and performance (Pearson& Bryars, 1956). Respondents indicate the degree to which
Family/Friends
they feel Better than, Same as, or Worse than, at the present
Conflict Tactics Scale
moment. Scores on the Fatigue Checklist are correlated
The Conflict Tactics Scale is a self-report measurewith performance and have been shown to change withthat assesses both the extent to which partners in a
performance demands and decreased sleep.
dating, cohabitating, or marital relationship engage in
psychological and physical attacks on each other, andIdentification & Sensitivity
also their use of reasoning or negotiation to deal withIdentification with the Deadconflicts (Straus, Hamby, Boney-McCoy, & Sugarman,
The Identification with the Dead is a 5-item self-report1996). Originally a 19-item scale, and later broadened to ameasure that assesses a respondent’s identification with
78-item version, the scale has been modified to a 23-item
deceased victims (Ursano, Fullerton, Vance, & Kao, 1999).
measure at the Center for the Study of Traumatic Stress
The measure contains three subscales: Identification(McCarroll, Ursano, Liu, Thayer, Newby, Norwood, &Self, Identification-Family, and Identification-Friend.
Fullerton, 2010). Respondents are instructed to indicate
Respondents score each item on a 5-point scale ranging
the extent to which certain statements apply to themfrom 0 = Not at all to 4 = Extremely with an additional
during a specified time period.
option for 5 = Not Applicable.
Friendship Scale (FS)The Friendship Scale (FS) is a 6-item self-report measurethat assesses perceived social isolation during the past fourweeks (Hawthorne, 2006). Respondents are instructed toplace an “X” on the line if they agree with the statement
during the specified time period.

Sensitivity to Blood, Injury, and Mutilation (SBIM)The Sensitivity to Blood, Injury, and Mutilation is a 5-item
self-report measure that assesses fear associated withgruesome or dangerous tasks or events where bodily injury
or mutilation are possible (Naifeh, Ursano, Benfer, et al.,2015). Derived from the 30-item Mutilation Questionnaire(MQ), the SBIM was originally developed as a 10-item scalethat predicted posttraumatic stress symptoms in special
operations soldiers. The scale was further refined into a5-item measure, and expanded to a 5-point Likert scale.
MoraleJob Morale
Job Morale is evaluated with a 4-item self-report measurethat assesses personal morale, motivation, energy, and driveat the present time (Britt & Dawson, 2005). Respondents
rate each item on a 5-point scale ranging from 1 = Very
Low to 5 = Very High.
Performance
Brief Resilience Scale (BRS)
The Brief Resilience Scale (BRS) is a 6-item self-reportmeasure that assesses the ability to bounce back or recoverfrom stress in one’s lifetime (Smith, Dalenm, Wiggins,
Tooley, Christopher, & Bernard, 2008). Respondents rateeach item on a 5-point scale ranging from 1 = Strongly
Disagree to 5 = Strongly Agree.
Dispositional Resilience Scale (DRS)The Dispositional Resilience Scale (DRS) is a 15-item selfreport measure that assesses three major components ofhardiness: commitment, control, and challenge (Bartone,Ursano, Wright, & Ingraham, 1989). Originally a 45-version
questionnaire, the DRS was shortened to a 15-item version
in subsequent studies. Respondents rate each item on afour-point Likert scale from 0 = Not at all True to 3 =Completely True.
Note: Use of this measure requires a license agreement.
Presenteeism
Presenteeism is a 5-item self-report measure that assesses
health-related reduced work performance (Stewart, Ricci,Chee, Hahn, & Morganstein, 2003). Respondents indicate
the amount of time during the specified time frame theylost concentration, repeated a job, worked more slowly thanusual, felt fatigued at work, and did nothing at work ondays when they were at work not feeling well. Responses
were rated on a 5-point Likert scale ranging from 1 = Noneof the Time to 5 = All of the Time.
World Health Organization Disability Assessment
Schedule (WHODAS-12)
The World Health Organization Disability Assessment
Schedule is a 12-item self-report measure that assesses theextent of disability. Questions are rated on a scale from
1 = None to 5 = Extreme/Cannot do (Weeks, Garber, &Zamorski, 2016).

Sleep
Daily Diary Study-Four Sleep Items
The Daily Diary Study’s four sleep items is a self-reportmeasure that assesses quality and quantity of sleep, andwhether sleep medication was used on the prior night.
Three of the items (sleep quality, number of hours ofactual sleep, and medication use) were adapted from thePittsburgh Sleep Quality Index (PSQI) and the last wasdeveloped for use in the Daily Diary Study at the Centerfor the Study of Traumatic Stress (Buysse, Reynolds, Monk,Berman, & Kupfer, 1989). The items are designed for use ona daily basis and response choices vary with each item.
Unit Cohesion
Unit Cohesion & Leadership
Unit Cohesion & Leadership is a 6-item self-reportmeasure that assesses unit cohesion, specifically horizontalcohesion, unit leadership, and unit functioning at thepresent time. Respondents are asked to think of theirunit at present and respond to items on a 5-point scaleranging from 1 = Strongly Disagree to 5 = Strongly Agree.
Unit cohesion is assessed with three items developed by
Podsakoff and Mackenzie (1994) and modified for military
relevance by Castro and Adler (1998). Unit leadership isassessed using the three-item General Leadership Quality
Scale developed by Vaitkus (1994).
Well-Being
General Health Questionnaire (GHQ-12)
The General Health Questionnaire is a 12-item self-reportmeasure designed to determine whether an individual is atrisk of developing a psychiatric disorder (Goldberg, 1972).
The GHQ-12 is a shortened version of the original 60-item
instrument. The questionnaire focuses on breaks in normal
functioning rather than on life-long traits to assess wellbeing; therefore, it only covers disorders associated with
distress (Goldberg & Williams, 1988). Items are rated on a
4-point scale (0 = Not at all to 3 = A lot more than usual).
A wide range of psychiatric disorders and clinicalsymptoms can be assessed in first responders and publichealth emergency workers. The Army Study to Assess
Risk and Resilience in Servicemembers (Army STARRS)
developed a broad variety of assessment instruments whichhave been used around the world for survey research. For
additional information please visit the Army STARRS andSTARRS-LS website at www.starrs-ls.org.

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Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org