Question Verbatim Question Response categories and comments Number 35 Did you ever live in a foster 1=yes home? 2=no 36a Did you ever run away from 1=yes home for more than one day? 2=no 36b Did your brothers or sisters run 1=yes away from home for more than 2=no one day? 37 Was anyone in your household 1=yes depressed or mentally ill? 2=no 38 Did anyone in your household 1=yes attempt to commit suicide? 2=no 39a Did anyone in your household 1=yes go to prison? 2=no 39b Did anyone in your household 1=yes ever commit a serious crime? 2=no 40a Have you ever attempted to 1=yes commit suicide? 2=no 40b Range:1-99 If how old were you the “yes”, first time you attempted suicide? Age 40c If how old were you the Range:1-99 “yes”, last time you attempted suicide? Age 40d How many times have you Range:01-99, attempted suicide? # of times 40e Did any suicide attempt ever 1=yes result in an injury, poisoning, or 2=no overdose that had to be treated by a doctor or nurse?
Question Number Verbatim Question Response categories and comments 35 Did you ever live in a foster home? 1=yes 2=no 36a Did you ever run away from home for more than one day? 1=yes 2=no 36b Did your brothers or sisters run away from home for more than one day? 1=yes 2=no 37 Was anyone in your household depressed or mentally ill? 1=yes 2=no 38 Did anyone in your household attempt to commit suicide? 1=yes 2=no 39a Did anyone in your household go to prison? 1=yes 2=no 39b Did anyone in your household ever commit a serious crime? 1=yes 2=no 40a Have you ever attempted to commit suicide? 1=yes 2=no 40b If “yes”, how old were you the first time you attempted suicide? Age Range:1-99 40c If “yes”, how old were you the last time you attempted suicide? Age Range:1-99 40d How many times have you attempted suicide? # of times Range:01-99, 40e Did any suicide attempt ever result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse? 1=yes 2=no
Family_Health_Questionnaire_-_Female_Version_ACE_Study.docx