Caregiver Stress Inventory

Rate the degree of intensity of your stress symptoms using the scale below. This is for your awareness only. There are no right/wrong or ideal targets to achieve. Once you are honest with yourself about the levels of various stresses you are experiencing and what the effect is on you, it becomes easier to design a routine that takes care of your needs.

This checklist is set up for you to have a before and after look at your stress responses. This helps you have a clear picture of what is helping but also can give you a sense of accomplishment based on your self-care.

Slight                                       Moderate                                                           Extreme

1            2              3              4            5              6              7             8             9            10                     

     Stress symptom                   Present level of intensity                      Level after program

1. Situational Anxiety (list):

2. Relationship Anxiety (list):

3. Generalized Anxiety
4. Hopelessness
5. Helplessness
6. Sadness (Cry easily or inability to cry)
7. Low Self-Esteem
8. Irritability
9. Anger
10. Hostility
11. Resentment
12. Fears
13. Phobias
14. Inability to Concentrate
15. Obsessive Thoughts
16. Confusion
17. Muscular Tension
18. Muscle Spasms
19. Headaches
20. Backaches
21. Stomach/Intestinal symptoms
22. Fatigue
23. Insomnia
24. Sleep too much
25. Weight
26. Work Stress