Self-Rated Cross Screening Survey Step 1 of 2 50% Informed Content The Southern Arkansas University Athletic Department has partnered with the University Counseling Center and implemented a self-rated screening tool to support mental health and promote well-being among student athletes. The purpose of the survey is to screen for psychological distress at least once annually using a validated screening tool and offer mental health support to student athletes, in accordance with the NCAA Mental Health Best Practices. The content submitted in the Self-Rated Cross Screening Survey is confidential and will only be accessed by the Counseling Center staff. The only information to be released by the counseling center to the athletic department is whether you, the athlete, have or have not completed the yearly screening.Consent(Required) I have read and consent to the above informed consent statement and understand that a counselor will reach out to offer counseling services if a possible need is identified. I further understand that participation in counseling is optional and cannot be mandated by the counseling center.Name(Required) First Last Age(Required)Please enter a number from 17 to 99.Gender Male Female Prefer not to say During the past two weeks, how much (or how often) have you been bothered by the following problems?(Required)Not at allSlight, less than a day or twoMild, several daysModerate, more than half the daysSevere, nearly every dayLittle interest or pleasure in doing things?Feeling down, depressed, or hopeless?Feeling more irritated, grouchy, or angry than usual?Sleeping less than usual, but still have a lot of energy?Starting lots more projects than usual or doing more risky things than usual?Feeling nervous, anxious, frightened, worried, or an edge?Feeling panic or being frightened?Avoiding situations that make you anxious?Unexplained aches and pains (e.g., head, back, joints, abdomen, legs)?Feeling that your illnesses are not being taken seriously enough?Thoughts of actually hurting yourself?Hearing things other people couldn’t hear, such as voices even when no one was around?Feeling that someone could hear your thoughts, or that you could hear what another person was thinking?Problems with sleep that affected your sleep quality over all?Problems with memory (e.g., learning new information) or with location (e.g., finding your way home)?Unpleasant thoughts, urges, or images that repeatedly enter your mind?Feeling driven to perform certain behaviors or mental acts over and over again?Feeling detached or distant from yourself, your body, your physical surroundings, or your memories?Not knowing who you really are or what you want out of life?Not feeling close to other people or enjoying your relationships with them?Drinking at least 4 drinks of any kind of alcohol in a single day?Smoking any cigarettes, a cigar, or pipe, or using snuff or chewing tobacco?Using any of the following medicines ON YOUR OWN, that is, without a doctor’s prescription, in greater amounts or longer than prescribed [e.g., painkillers (like Vicodin), stimulants (like Ritalin or Adderall), sedatives or tranquilizers (like sleeping pills or Valium), or drugs like marijuana, cocaine or crack, club drugs (like ecstasy), hallucinogens (like LSD), heroin, inhalants or solvents (like glue), or methamphetamine (like speed)]? Δ
