Appendix E: Measure of Negative Life Events

Life Events Checklist

Below is a list of things that sometimes happen to people. Put an ―X‖ in the space by
each of the events you have experienced during the past year (12 months). For each of the
events you check also mark whet event was good event or bad. Finally, choose how much
you feel the event has changed or has had an effect on your life by placing a circle around
the statement that best fits you (no effect - some effect - medium effect - big effect).
Remember, for each event you have experienced during the past year, (1) mark an ―X‖ in
the to show that you have experienced the event, (2) mark whether you think the event
was good or bad, a mark how much effect the event has had on your life.

(Put and ―X‖ only if it happened in past year)

Event Has it happened Type of event Effect on you

1. Moving to a new home ______ Good Bad No Some Medium Big

effect effect effect effect

2. New brother or sister ______ Good Bad No Some Medium Big

effect effect effect effect

3. Changing to new school ______ Good Bad No Some Medium Big

effect effect effect effect

4. Serious illness or injury ______ Good Bad No Some Medium Big

to a family member effect effect effect effect

5. Parents divorced Good Bad No Some Medium Big

effect effect effect effect

6. Major arguments between ______ Good Bad No Some Medium Big

you and mom or dad effect effect effect effect

7. Mother or father lost job ______ Good Bad No Some Medium Big
effect effect effect effect

8. Death of a family member ______ Good Bad No Some Medium Big

effect effect effect effect

9. Parents separated ______ Good Bad No Some Medium Big

effect effect effect effect

10. Death of a close friend ______ Good Bad No Some Medium Big

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 effect effect effect effect
(Put and ―X‖ only if it happened in past year)

Event Has it happened Type of Event Effect on you

11. Increased absence of ______ Good Bad No Some Medium Big

parent from home effect effect effect effect

12. Brother or sister leaving ______ Good Bad No Some Medium Big
home effect effect effect effect

13. Serious illness or injury ______ Good Bad No Some Medium Big
of close friend effect effect effect effect

14. Parent getting into ______ Good Bad No Some Medium Big
trouble with the law effect effect effect effect

15. Parent getting a new job ______ Good Bad No Some Medium Big
effect effect effect effect

16. New stepmother or ______ Good Bad No Some Medium Big

stepfather effect effect effect effect

17. Parent going to jail ______ Good Bad No Some Medium Big
effect effect effect effect

18. Change in parents’ ______ Good Bad No Some Medium Big

financial status effect effect effect effect
(less money at home)

19. Trouble with brother ______ Good Bad No Some Medium Big
or sister effect effect effect effect

20. Special recognition for ______ Good Bad No Some Medium Big
good grades effect effect effect effect

21. Joining a new club ______ Good Bad No Some Medium Big
effect effect effect effect

22. Losing a close friend ______ Good Bad No Some Medium Big
effect effect effect effect

23. Decrease in number of ______ Good Bad No Some Medium Big

arguments with parents effect effect effect effect

(Put and ―X‖ only if it happened in past year)

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Event Has it happened Type of event Effect on you

24. Making the honor ______ Good Bad No Some Medium Big
roll effect effect effect effect

25. New boyfriend ______ Good Bad No Some Medium Big

or Girlfriend effect effect effect effect

26. Failing a grade ______ Good Bad No Some Medium Big

effect effect effect effect

27. Increase in number ______ Good Bad No Some Medium Big

of arguments with parents effect effect effect effect

28. Getting into trouble ______ Good Bad No Some Medium Big
with police effect effect effect effect

29. Major personal illness______ Good Bad No Some Medium Big

or injury effect effect effect effect

30. Breaking up with _______ Good Bad No Some Medium Big

boyfriend/girlfriend effect effect effect effect

31. Making up with ______ Good Bad No Some Medium Big

boyfriend/girlfriend effect effect effect effect

32. Trouble with teacher ______ Good Bad No Some Medium Big
effect effect effect effect

33. Failing to make an ______ Good Bad No Some Medium Big

athletic team effect effect effect effect

34. Being suspended ______ Good Bad No Some Medium Big

from school effect effect effect effect

35. Making failing grades ______ Good Bad No Some Medium Big
on report card effect effect effect effect

36. Making an athletic ______ Good Bad No Some Medium Big

team effect effect effect effect

37. Trouble with Good Bad No Some Medium Big

classmates ______ effect effect effect effect
38. Special recognition ______ Good Bad No Some Medium Big
for athletic performance effect effect effect effect

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