Police Trauma Questionnaire
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Informed Consent
The survey in which you are about to participate is designed to investigate the relationship between post traumatic stress disorder (PTSD) and it's effects on the lives of police officers. Rob Beckham, a graduate student in social work is conducting the survey and subsequent study.

This survey has been approved by The Institutional Review Board of New Mexico Highlands University.

The purpose of this study is to educate people working with PTSD affected officers as to those officer's needs including the right to qualified, confidential and dignified intervention. The study will hopefully reveal to the treatment and education support staff as to the causes, effects, symptoms, and treatment options of officer PTSD.

In this survey, you will not need to identify yourself.

Send any questions to:
Rev. Rob Beckham
76 CR 6480
Kirtland, NM 87417

The expected benefits are: To provide opportunity for treatment for fellow officers coping with PTSD symptoms and more understanding of the disorder.

There is a possibility that the questions on the survey will bring back unpleasant memories. If this discomfort is severe, or persists, please contact a qualified counselor who can help you to deal with these memories. Confidential web site addresses are provided below if you choose to discuss this discomfort.

Living With PTSD

E-Mail:
rbeckham1@outerbounds.net
njelsong2@sic.oc.nm.us

Please understand that your participation in this survey is completely voluntary. By completeing the survey, you are acknowledging that you have been informed of and understand the nature and purpose of this study and the possible risk of discomfort in reviewing traumatic events.

Survey Part One

Post Trauma Questionnaire
























1. Are you now or have you ever been a police officer?
2. Have you ever been diagnosed with Post Traumatic Stress Disorder or PTSD?
3. Do you believe that you do suffer from post traumatic stress disorder or PTSD?
4. What is your gender?
5. What is your age?
6. Length of time as a police officer?
7. Marital Status?
8. Do you have children?
9. Have you ever exchanged gunfire in the course of your police duties?
10. If you answered yes above:
Did you experience any of the following? (may choose more than one)
11. Has your life ever been threatened while on police duty?
12. If you answered yes to the above question:
Did you experience any of the following? (may choose more than one)
13. Has the life of anyone you love ever been threatened?
14. If you answered yes to the above question:
Did you experience any of the following? (may choose more than one)
15. Have you ever been involved in a vehicle accident while on police duty?
16. If you answered yes to the above question, Can this be attributed to traumatic stress?
17. If you answered yes to the above question:
Did you experience any of the following? (may choose more than one)
18. Have you ever witnessed the injury of another officer or partner?
19. If you answered yes to the above question:
Did you experience any of the following? (may choose more than one)
20. Have you ever lost a partner or fellow officer in a line of duty death?
21. If you answered yes to the above question:
Did you experience any of the following? (may choose more than one)
22. Have you ever lost anyone you care about to suicide?
23. If you answered yes to the above question:
Did you experience any of the following? (may choose more than one)


View current results

   Survey Part 2

Police Trauma Questionnaire Part 2






























1. In the course of your duties, were you ever involved with a citizen´s suicide?
2. If you answered yes to the question above:
Did you experience any of the following? (may choose more than one)
3. Have you ever considered suicide?
4. Have you ever attempted suicide? *Note* You are valued and your contributions to the safety of the public is appreciated. If you are considering harming yourself, please contact a qualified counselor.
5. Are you now or have you ever experienced severe relationship problems?
6. If you answered yes to the question above: Can you attribute these problems to stress?
7. As an officer do you now or did you ever experience an increase of sick days from work due to traumatic stress?
8. Are you now working as a police officer?
9. If you answered no above, can you determine that this career change was stress related?
10. If you are no longer a police officer, do you resent the fact that you are no longer in law enforcement?
11. If you are no longer a police officer, do you feel relieved?
12. Have you had recurring dreams regarding a traumatic event?
13. Have you been unable to sleep because of a fear of nightmares?
14. Have you ever experienced memories of a traumatic event that seems like it is happening again?
15. Do you now, or have you ever found yourself hesitating to answer a call while on duty in a location that reminds you of a traumatic event?
16. Do you now or have you ever found yourself hesitating to answer a call that reminds you of a traumatic event?
17. Have your unpleasant memories affected your family in any way?
18. Have you ever found yourself waking up to check if your home is secure?
19. Have you ever found yourself distracted on the job by unpleasant memories?
20. Do you lose track of time while experiecing a troubling memory?
21. Are you troubled by unreasonable anger?
22. Has unreasonable anger ever interfered with your duties as a police officer?
23. Has unreasonable anger ever contributed to relationship problems?
24. Are you troubled by nervousness or feeling jumpy?
25. Have you ever over-reacted to being approached to quickly or from behind?
26. Has unreasonable anger ever caused you problems while on duty?
27. Have you ever served in the military?
28. If yes, did you receive an injury while in the military?
29. If you served in the military, which branch of service?


View current results


Back To Living With PTSD

Survey Part Three

Police Trauma Questionnaire Part 3










1. If you served in the military service, did you ever experience combat?
2. Did you ever witness an injury while in the military?
3. If you answered yes to the question above:
Did you experience any of the following? (may choose more than one)
4. Did you ever witness a death while in the military?
5. If you answered yes to the question above:
Did you experience any of the following? (may choose more than one)
6. In your military or police duties, did you ever cause someone´s death?
7. If you answered yes to the question above:
Did you experience any of the following? (may choose more than one)
8. Have you ever been told that you should cut down on your alcohol or drug use?
9. Has your alcohol or drug useage increased following a critical incident?


View current results