College and Stress

Answer questions as they relate to you. For most answers, check the boxes most applicable to you or fill in the blanks. The general purpose of the research is to examine possible correlations between stress related anxiety experienced by college students, and this stress’ relationship to sleep problems. You will be asked to complete the State Trait Anxiety Inventory and a Sleep Quality Inventory. Your identity will not be able to be matched up with your test results and confidentiality is assured. Participation is voluntary and you may withdraw from the study at any time without penalty. Testing will take approximately 15 minutes. Continuing this survey will act as a written and signed Informed Consent. If you have any questions you may contact the researcher, Justin Fullington, at jusfull@utm.edu, Chris Palmer, at chrapalm@utm.edu, or Angie MacKewn at amackewn@utm.edu, 731-881-7370.

Demographics

This section is a general demographics survey. Please answer all of the following questions.

UTM Student ID Number:

Professor

	MacKewn
	Jones
	Buckelew
	Key
	Merwin
	Johnson
	Other:

Course Number:

Section Number

Age

	18
	19
	20
	21
	22
	23 or older

Class

	Freshman
	Sophomore
	Junior
	Senior

Gender

	Male
	Female

Are you currently employed?

	Yes
	No

Does your current living situation require that you pay rent?

	Yes
	No

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PSQI

Instructions: The following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month. Please use a single reply rather than a range. For example, use 25 minutes rather than 20 – 30 minutes.

When have you usually gone to bed at night during the week?

When have you usually gone to bed at night during the weekend?

How long has it usually taken you to fall asleep each night during the week (in minutes)?

How long has it usually taken you to fall asleep each night during the weekend (in minutes)?

When do you usually wake up in the morning during the week?

When do you usually wake up in the morning during the weekend?

How many hours of actual sleep did you get at night during the week (per night)?

How many hours of actual sleep did you get at night during the weekend (per night)?

During the past month, how often have you had trouble sleeping because you …..(a) Cannot get to sleep within 30 minutes.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(b) Wake up in the middle of the night or early morning.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(c) Have to get up to use the bathroom.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(d) Cannot breathe comfortably.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(e) Cough or snore loudly

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(f) Feel too cold.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(g) Feel too hot.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(h) Had bad dreams.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(i) Have pain.

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble sleeping because you …..(j) Other reasons for sleep difficulties, please describe

If you listed any other reasons for sleep difficulties in Question 23, how often have you experienced these difficulties? (If you did not list any other sleep difficulties, please continue on to Question 25)

	Not during the past month
	Less than once a week
	Once/Twice a week
	Three or more times a week

During the past month, how would you rate your sleep quality overall?

	Very Good
	Fairly Good
	Fairly Bad
	Very Bad

During the past month, how often have you taken medicine (prescribed or “over the counter”) to help you sleep?

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activities?

	Not during the past month
	Less than once a week
	Once/ Twice a week
	Three or more times a week

During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done?

	No problem at all
	Slight problem
	Somewhat of a problem
	Big Problem

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STAI

A number of statements which people have used to describe themselves are given below. Read each statement and then circle the appropriate value to the right of the statement to indicate how you generally feel. There are no right or wrong answers. Do not spend too much time on any one statement but give the answer which seems to describe how you generally feel.

Almost Never

Sometimes

Often

Almost Always

I feel pleasant

I feel nervous and restless

I feel satisfied with myself

I wish I could be as happy as others seem to be

I feel like a failure

I feel rested

I am “calm, cool, and collected”

I feel that difficulties are piling up so that I cannot overcome them

I worry too much over something that really doesn’t matter

I am happy

I have disturbing thoughts

I lack self-confidence

I feel secure

I make decisions easily

I feel inadequate

I am content

Some unimportant thought runs through my mind and bothers me

I take disappointments so keenly that I can’t put them out of my mind

I am a steady person

I get in a state of tension or turmoil as I think over my recent concerns & interests

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A number of statements which people have used to describe themselves are given below. Read each statement and then circle the appropriate value to the right of the statement to indicate how you feel right now, that is, at this moment. There are no right or wrong answers. Do not spend too much time on any one statement but give the answer which seems to describe how you generally feel.

Not at all

Somewhat

Moderately so

Very much so

I feel calm

I feel secure

I am tense

I feel restrained

I feel at ease

I feel upset

I am presently worrying over possible misfortunes

I feel satisfied

I feel frightened

I feel comfortable

I feel self-confident

I feel nervous

I am jittery

I feel indecisive

I am relaxed

I feel content

I am worried

I feel confused

I feel steady

I feel pleasant

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