ELECTRONIC SUPPLEMENTARY MATERIAL 3
APPENDIX 1.
Sexual Dysfunction Screening Questionnaire.
Royal Berkshire and Battle NHS Trust
INTENSIVE CARE FOLLOW-UP CLINIC
This questionnaire has been designed to give us useful information. Some questions are of a personal nature, but we should be very grateful if you could answer them as honestly as possible. We do not wish to cause offence.
Private and confidential
1)Are you in a regular relationship?YesNo
2)If yes, how long have you been in your relationship?______
3)How would you describe your sex life in the year previous to admission?
1 = Poor 2 = Not very good 3 = Quite good 4 = Good 5 = Very good
4)How would you describe your sex life now?
1 = Poor 2 = Not very good 3 = Quite good 4 = Good 5 = Very good
5)a. Self-stimulation (masturbation) is a common and normal activity in adults.
Was this a normal activity for you before intensive care?
YesNo
- If yes, have you been able to do so since?YesNo
(Any comments?)
6)If your sex life has altered since your admission, what is the change?
7)If your sex life has altered since your admission, what do you think has caused the change? Please tick one or more:
Physical changes due to the illness
(Please explain)
Everything works OK, but I no longer have the desire
My partner is now worried about having sex
I am frightened that sex may cause me to be ill
Nothing works anymore, but I do have the desire
I have a better sex life than before
8)Are you satisfied with your present sex life?YesNo
9)Is your partner satisfied with your present sex life?YesNo
10)Has your general relationship with your partner changed since your illness?
YesNo
11)If so, in what way?
12)Please write any comments on how the Intensive Care Unit experience has affected your sexuality, sexual relationships and sexual performance.
13)Has any other health professional asked you about changes in your sex life since your illness; or warned you that you might experience problems?
YesNo
If so, who?
Thank you very much for your help in completing this questionnaire.
If the questions have raised any issues that you would like to explore further please mention them to the doctor in the clinic or the nurse who collects the questionnaire, as we may well be able to offer you help.
APPENDIX 2.
Trauma Screening Questionnaire (TSQ)
Your own reactions now to the traumatic event
Please consider the following reactions which sometimes occur after a traumatic event. This questionnaire is concerned with your personal reactions to the experience of being admitted and treated on the Intensive Care Unit (ICU).
Please indicate (Yes/No) whether or not you have experienced any of the following at least twice in the past week.
1. Upsetting thoughts or memories about the event that have come into your
mind against your will YesNo
2. Upsetting dreams about the event YesNo
3. Acting or feeling as though the event were happening again YesNo
4. Feeling upset by reminders of the event YesNo
5. Bodily reactions (such as fast heartbeat, stomach churning, sweatiness,
dizziness) when reminded of the event YesNo
6. Difficulty falling or staying asleep YesNo
7. Irritability or outbursts of anger YesNo
8. Difficulty concentrating YesNo
9. Heightened awareness of potential dangers to yourself and others YesNo
10. Being jumpy or being startled at something unexpected YesNo