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Life Event Checklist LEL

Life Event Checklist LEL
Below are questions about a number of events that commonly happen in people's lives. Each question is concerned with whether an event has happened to you (and in some cases your spouse) during the LAST 12 MONTHS.
Please respond YES‚ if the event happened and NO‚ if it didn't. For several of the events‚ there are also some follow-up questions for those who answer yes.
When we ask a question about a person's spouse/partner‚ we are referring to both MARRIED SPOUSES and to unmarried partners who LIVE TOGETHER and have a MARITAL-LIKE relationship.
Some of the questions we ask below may remind you of rather painful feelings. They are‚ however‚ extremely important to people when they do happen‚ so please try to answer.
1. Have you moved during the last 12 months?
No (Skip to Q.2) Yes
If yes:
a. Would you say that you moved to a neighborhood that is better‚ worse‚ or about the same as where you were living?
Same
Better
Worse
b. Overall‚ would you say that your moving was a good or bad experience?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
2. Have you broken off an engagement to be married or ended an intimate relationship during the last 12 months?
No (Skip to Q.3) Yes
If yes:
a. How would you rate your feelings about breaking up?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
3. Did you get married during the last 12 months?
No (Skip to Q.4) Yes
If yes:
a. Did you want to get married?
No Yes
b. Overall‚ would you rate getting married as a good or bad experience?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
4. Did someone you were close to die during the last 12 months?
No (Skip to Q.5) Yes
If yes‚ who:
Spouse or intimate friend
Parent
Spouse's parent
Brother or sister child other relatives
Friend
Other
5. Were you separated or divorced during the last 12 months?
No (Skip to Q.6) Yes
If yes:
a. Did you want to get separated or divorced?
No Yes
b. Overall‚ would you rate your separation or divorce as a good or bad experience?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
6. Did you break up with a close friend during the last 12 months?
No (Skip to Q.7) Yes
If yes:
a. Did you want to break up with this friend?
No Yes
b. Overall‚ would you rate your breaking up as a good or bad experience?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
7. Have you had any important relationship‚ for example‚ with your spouse‚ a close friend‚ your boss‚ or a family member become significantly worse during the last 12 months (this should not include the relationship referred to in item 6 above)?
No (Skip to Q.8) Yes
If yes:
a. With whom? (more than one response is possible)
Boss
Spouse
Friend
Child
Parent
Other family member
8. Did you have a child or adopt a child during the last 12 months?
No (Skip to Q.9) Yes
If yes:
a. Is this a first child?
No Yes
b. Did you plan to have this child?
No Yes
c. Would you rate ha‎ving a child and adjusting to ha‎ving a child as a good or bad experience?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
9. Have you‚ a very close friend‚ or close family member had an accident that required emergency medical treatment during the last 12 months?
No (Skip to Q.10) Yes
If yes:
a. Who? (more than one response is possible)
You
Spouse/partner
Child
Parent
Spouse’s parent
Brother or sister
Friend
Other
10. Have you‚ a very close friend‚ or close family member been hospitalized for a serious (life- threatening) illness during the last 12 months?
No (Skip to Q.11) Yes
If yes:
a. Who? (more than one response is possible)
You
Spouse/partner
Child
Parent
Spouse’s parent
Brother or sister
Friend
Other
11a. (Women) Have you been pregnant during the last 12 months?
No (Skip to Q.12) Yes
If yes:
a. Was the pregnancy planned or unplanned?
Planned Unplanned
b. How would you rate being pregnant?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
11b. (Men) Has your wife‚ partner or girlfriend been pregnant during the last 12 months? [Tick no if you do not have a wife‚ partner‚ or girlfriend.]
No (Skip to Q.12) Yes
If yes:
a. Was the pregnancy planned or unplanned?
Planned Unplanned
b. How would you rate being pregnant?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
12a. (Women) Have you had an abortion during the last 12 months?
No (Skip to Q.13) Yes
12b. (Men) Has your wife‚ partner or girlfriend had an abortion during the last 12 months? [Tick no if you do not have a wife‚ partner‚ or girlfriend.]
No (Skip to Q.13) Yes
13a. (Women) Have you had a miscarriage or stillbirth during the last 12 months?
No (Skip to Q.14) Yes
13b. (Men) Has your wife‚ partner or girlfriend had a miscarriage or stillbirth during the last 12 months? [Tick no if you do not have a wife‚ partner‚ or girlfriend.]
No (Skip to Q.14) Yes
14. Have you or your spouse/partner lost or changed jobs or been involuntarily unemployed during the last 12 months?
No (Skip to Q.15) Yes
If yes:
a. Who?
You
Spouse/partner
Both
b. Why did you (or spouse) leave? (answer only for you if both lost or changed jobs)
On strike
Temporarily laid off
Fired
Found better job
Plant or business closing or reorganizing
Retired
Other
c. Could you (or spouse) have stayed in your old job if you wanted?
No Yes
d. How would you rate your feelings about leaving your job? (or your spouse leaving his/her job)?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
15. During the last 12 months‚ have you or your spouse/partner suffered a significant business or investment loss or has a business you owned failed?
No (Skip to Q.16) Yes
If yes:
a. Who?
You
Spouse/partner
Both
16. During the last 12 months‚ have you or your spouse/partner had any serious problems or disappointment at school or in an educational course (university‚ training program‚ etc.)?
(answer only for you if both had disappointments)
No (Skip to Q.17) Yes
If yes:
a. Who?
You
Spouse/partner
Both
b. What was the disappointment?
Demoted
Failed to get raise or promotion
Failed a course
Trouble with boss or coworkers
Put on academic probation
Failed to get into an educational course (college‚ training program‚ etc.)
Other
17. Have you or your spouse/partner had significant success at work or in an educational course (university‚ training program) during the last 12 months?
No (Skip to Q.18) Yes
If yes:
a. Who?
You
Spouse/partner
Both
18. Has there been a significant change in your personal finances during the last 12 months?
No (Skip to Q.19) Yes
If yes:
a. Has the change been for the better or worse?
Better         Worse
19. Has your house been broken into and/or burgled during the last 12 months?
No (Skip to Q.20) Yes
20. Have you or your spouse/partner or other member of your immediate family been assaulted or mugged during the last 12 months?
No (Skip to Q.21) Yes
If yes:
a. Who? (more than one response is possible)
You
Spouse/partner
Child
Parent
Brother or sister
Other
21. Has the behavior of any member of your family been a significant problem for you during the last 12 months?
No (Skip to Q.22) Yes
If yes:
a. Who? (more than one response is possible)
Spouse/partner
Child
Parent
Brother or sister
Other
22. Have you or your spouse/partner had to appear in court during the last 12 months as a defendant‚ a witness in a criminal case‚ or as party to a suit?
No (Skip to Q.23) Yes
If yes:
a. Who?
You
Spouse/partner
Both
b. How would you rate the court experience?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
23. Have you had a pet (animal) to whom you were attached die‚ or get lost‚ or did you have to give it away during the last 12 months?
No (Skip to Q.24) Yes
24. Other than the events we have already asked about‚ have any other important things happened to you or to a very close friend or close family member in the last 12 months that made that period significantly different from a typical year?
No (DONE w/ Questionnaire) Yes
If yes:
You can list up to three (3) events. Please do not feel obliged to include an additional event or events unless they were significant!
Event 1: To whom?
You
Spouse/partner
Child
Parent
Spouse’s parent
Brother or sister
Friend
Other
What happened?
Did you want the event to happen?
No Yes
How would you rate your feelings about this event?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
Event 2: To whom?
You
Spouse/partner
Child
Parent
Spouse’s parent
Brother or sister
Friend
Other
What happened?
Did you want the event to happen?
No Yes
How would you rate your feelings about this event?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
Event 3: To whom?
You
Spouse/partner
Child
Parent
Spouse’s parent
Brother or sister
Friend
Other
What happened?
Did you want the event to happen?
No Yes
How would you rate your feelings about this event?
Very good
Moderately good
Slightly good
Slightly bad
Moderately bad
Very bad
version: 12/13/2006 Life Events Checklist (LEL
www.psy.cmu.edu/ha‎vingscohen/Life_Events_Checklist_LEL.pdf

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