My gender is:


 
How old are you?

 
Who lives in your home with you?


 
Which type of pet do you have?


 
I have been diagnosed with the following disorder(s):


 
I regularly experience the following symptoms (check all that apply):


 
How many years have you been ill?

 
How disabled are you by your chronic illness?

 
Which best describes your driving situation?


 
I am hurt when I am not invited to social events.


 
I do not sleep well.


 
I often feel hopeless.


 
I do not receive support from my family or friends.


 
Sometimes I wish I were dead.


 
I am frequently lonely.


 
I am grateful for my chronic illness.


 
My illness prevents me from attending social events.


 
I am not looking forward to anything.


 
I do not cope well with my illness.


 
I often feel helpless.


 
I have neuropathic pain.


 
I am looking for ways to kill myself.


 
I frequently suffer from headaches and abdominal pain.


 
I have frequent nightmares.


 
I often feel healthy.


 
I engage in self-injury.


 
My mood is dictated by my physical pain.


 
My fatigue impacts my relationship with others.


 
I do not have a reason for living.


 
I am a burden to others.


 
I do not feel a sense of belonging in my family.


 
My friends and family do not believe I am truly ill.


 
I have a plan to kill myself.


 
My healthcare provider does not validate my illness.


 
I feel frustrated due to my chronic illness.


 
I need help to bathe or brush my teeth or hair.


 
I frequently have as much energy as I need.


 
I feel guilty if I cancel plans due to my illness.


 
I have talked or written about death/dying/suicide.


 
I need help to make a meal, do laundry, or vacuum.


 
I feel lonely, even when I am around people.


 
I think that others would be better off if I were dead.


 
I have increased physical symptoms after participating in activities.


 
I am physically able to do the things that I want to do.


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Which best describes you?


 
Have you ever thought about or attempted to kill yourself?


 
How often have you thought about killing yourself in the past year?


 
Have you ever told someone that you were going to commit suicide, or that you might do it?


 
How likely is it that you will attempt suicide someday?


 
These days, the people in my life would be better off if I were gone.

 
These days, I think I give back to society.

 
These days, the people in my life would be happier without me.

 
These days, I think I have failed the people in my life.

 
These days, I think people in my life would miss me if I went away.

 
These days, I think I am a burden on society.

 
These days, I think I am an asset to the people in my life.

 
These days, I think my ideas, skills, or energy make a difference.

 
These days, I think my death would be a relief to the people in my life.

 
These days, I think I contribute to the well-being of the people in my life.

 
These days, I feel like a burden on the people in my life.

 
These days, I think the people in my life wish they could be rid of me.

 
These days, I think I contribute to my community.

 
These days, I think I make things worse for the people in my life.

 
These days, I think I matter to the people in my life.

 
These days, other people care about me.

 
These days, I feel like I belong.

 
These days, I rarely interact with people who care about me.

 
These days, I am fortunate to have many caring and supportive friends.

 
These days, I feel disconnected from other people.

 
These days, I often feel like an outsider in social gatherings.

 
These days, I feel that there are people I can turn to in times of need.

 
These days, I feel unwelcome in most social situations.

 
These days, I am close to other people.

 
These days, I have at least one satisfying interaction every day.

 
How often do you feel unhappy doing so many things alone?


 
How often do you feel you have no one to talk to?


 
How often do you feel you cannot tolerate being so alone?


 
How often do you feel as if no one understands you?


 
How often do you find yourself waiting for people to call or write?


 
How often do you feel completely alone?


 
How often do you feel unable to reach out and communicate with those around you?


 
How often do you feel starved for company?


 
How often do you feel it is difficult for you to make friends?


 
How often do you feel shut out and excluded by others?


Thank you so much for participating in our research study!  Your efforts will help us to better understand suicidal thoughts and behavior in people with chronic invisible illnesses.  

If any of these questions triggered a sense of hopelessness or increased suicidal ideation, please call the National Suicide Prevention Lifeline at 1-800-273–TALK (8255) to speak with a counsellor 24/7. Another option is to text HOPELINE at 741741 with the word "start" to text with a live, trained specialist.  

Results from this survey will be published in the scientific press to raise awareness in both the medical and scientific community.  Links to the abstracts and articles from this work will be disseminated through the Standing Up to POTS Facebook page.    

Thank you!
End survey
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