You are invited to participate in a study of spiritual health. I
hope to learn more about the relationship between spirituality and
well-being. Any information obtained in connection with this study
that can be identified with you will remain confidential and will be
disclosed only with your permission. In any written reports or
publications, no one will be identified or identifiable and only
aggregate data will be presented. The following survey will take
between 5 and 10 minutes to complete. The information provided will
be compiled for an undergraduate research presentation. If you would
like to receive the results, please email me at spiritualhealth2004@
yahoo.com. Results will be available after April 25, 2004.
Thank you for your participation.
Your input is greatly appreciated.


1) Are you? ___ Male ___ Female

2) How old are you? ___ 18 or younger ___ 19-30 ___ 31-49

___ 65 or older

3) Are you a U.S. citizen? ___ Yes ___ No

4) People use different terms to describe their race, such
as "Black, "White," "Asian," or "Native American." Which term(s) do
you use to describe yourself?
(You may write more than one).

Race: 1.______________ 2._______________

5) Are you Catholic? ___ Yes ___ No (If No, please skip to #9)

6) How many times a month do you attend mass? ___ 0 ___ 1-2

___ 3-4 ___ 5+

7) How many times a month do you go to confession? ___ 0 ___ 1-2

___ 3-4 ___ 5+

8) How strongly do you hold your religious beliefs?


(1 = Not strongly at all) (5 = Very strongly)

1-------------2--------------3--------------4--------------5


9) Has anybody in your family been diagnosed with obsessive-
compulsive disorder?

___Yes ___ No

10) Has anybody in your family been diagnosed with schizophrenia?

___ Yes ___ No

11) The following statements refer to experiences that people
sometimes have. Please indicate how often you have these experiences
using the following key: 0 = never; 1 = almost never; 2 = sometimes;
3 = often; 4 = constantly

a. I worry that I might have dishonest thoughts.
b. I fear that I might be an evil person.
c. I fear I will act immorally.
d. I feel urges to confess sins over and over again.
e. I worry about heaven and hell.
f. I worry I must act morally at all times or I will be punished.
g. Feeling guilty interferes with my ability to enjoy things
I would like to enjoy.
h. Immoral thoughts come into my head and I can't get rid
of them.
i. I am afraid my behavior is unacceptable to God.
j. I fear I have acted inappropriately without realizing it.
k. I must try hard to avoid having certain immoral thoughts.
l. I am very worried that things I did may have been dishonest.
m. I am afraid I will disobey God's rules/laws.
n. I am afraid of having sexual thoughts.
o. I worry I will never have a good relationship with God.
p. I feel guilty about immoral thoughts I have had.
q. I worry that God is upset with me.
r. I am afraid of having immoral thoughts.
s. I am afraid my thoughts are unacceptable to God.

Thank you for completing the survey. Let me assure you that all
information obtained will remain confidential. Please send results
to spiritualhealth2004@.... Thanks!