Informed Consent and Demographic Information

For classification purposes, please fill out the informed consent and demographic questions provided below. Please select the answer that best fits you. If you do not feel comfortable selecting one of the options provided, you may choose to self-describe in the "other" category. Please select one answer.

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* 1. The Effects of Childhood Trauma: Understanding Relationship Satisfaction and Dyadic Stress 
PRINCIPAL INVESTIGATOR: 
Katelyn C. Blake 
M.A. in Psychology Applicant 
Carlow University 
 814-598-3839 
CO-INVESTIGATORS:  
Dr. Jennifer Roth 
Associate Professor of Psychology 
You are being asked to participate in a study to help analyze the relationship between adverse childhood experiences (trauma) and dyadic stress in romantic relationships. This research will help determine how intimate relationships are impacted by traumatic experiences during childhood.  Individuals who are currently in a relationship are being asked to participate in this study. Your participation in this research study is completely voluntary. 
If you decide to take part in this research study, you will first be asked to complete a demographic form asking various questions regarding age, gender, etc. You will then participate in the Adverse Childhood Experiences (ACE) questionnaire, which measures abuse, neglect, and other impacts from a difficult childhood. The next assessment provided is the Dyadic Coping Inventory. This assessment is designed to understand how the individual copes with stress in relationships. The final assessment is the Relationship Satisfaction Scale. This 7-question assessment analyzes how satisfied an individual is in their current intimate relationship. This study should take about 15-20 minutes to complete. 
Individuals that participate in this research study may experience discomfort, due to being asked questions about past traumatic experiences. You are able to withdraw consent at any time during the study. If you feel unsettled after participating in this research study, you are encouraged to call the Substance Abuse and Mental Health Services Administration hotline. If you are interested in these services, please contact the hotline at 1(800)-662-4357. If you reside in Allegheny County, you may also call the Resolve Crisis Hotline at 1(888)796-8226. 
A potential benefit from taking this study is to help contribute more information regarding trauma and relationships through research. After completing this study, you will be directed to a link to enter for a chance to win a $10 Amazon gift card. The link will be the last question of the study. After following the link, you will be asked to provide your personal email address. To protect confidentiality, this information is kept separate from data collected from the survey. You will likely receive no direct benefit from taking part in this research study. 
Any information about you obtained from this research will be kept as confidential (private) as possible.  All records related to your involvement in this research study will be stored in a locked computer. The data collected from this study will be destroyed within one year of data collection. You will not be identified by name in any publications.  
This activity has been approved by the Carlow University Institutional Review Board. This Committee administers both the General Assurance of Compliance with the United States Department of Health and Human Services Policy for the protection of Human 
Subjects and the University policy covering the protection of human subjects. The Committee may be contacted through the Chairpersons by emailing the addressed provided below to discuss any questions or concerns. 
Susan O’Rourke: slorourke@carlow.edu
Ann Spence:  jaspence@carlow.edu 
 
Thank you for your valuable contribution to this research  
 
VOLUNTARY CONSENT 
Your voluntary response to this request constitutes your informed consent to your participation in this activity. You are not required to participate. If you have questions about this study, you may contact me at 814-598-3839. 
 
Katelyn C. Blake 

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* 2. What is your gender?

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* 3. What is your age classification

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* 4. What is your ethnicity?

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* 5. What is your current employment status

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* 6. Which best describes your living situation?

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* 7. What is the highest level of education you have completed?

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* 8. How many children do you have?

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* 9. What is your sexual orientation?

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* 10. How often do you feel supported in your relationship?

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* 11. How often do you communicate with your partner about things that are bothering you?

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* 12. Overall, how would you rate the level of intimacy (mutual vulnerability, openness, and sharing) in your relationship?

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* 13. Overall, how satisfied are you with the quality time you spend with your partner? 

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* 14. How satisfied are you with the way you and your partner solve conflict?

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