This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Brief Symptoms Inventory-18 (BSI-18)
Short Name:
BSI18
Description:
The Brief Symptom Inventory 18 (BSI-18) is a short form of the Symptom Checklist-90-Revised. It is a brief self-report measure of psychological distress with 3 subscales (Depression, Anxiety, and Somatization) and a Global Severity Index. The BSI-18 is selected as a core measure because of its brevity, global assessment of common psychological issues in people with TBI, and sound psychometric characteristics. It can be used to monitor change in response to treatment. Recommended by CDISC for TBI (TAUG TBI) References: Derogatis LR, Melisaratos N., The Brief Symptom Inventory: an introductory report, Psychol Med. 1983 Aug;13(3):595-605.https://www.ncbi.nlm.nih.gov/pubmed/6622612. Copyright: Pearson, 2001, http://www.pearsonclinical.com/psychology/products/100000638/brief-symptom-inventory-18-bsi-18.html .
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-09-26
Version:
1.4
Date Created:
2014-08-22
Owner:
Number of Data Elements:
34
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Completion (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Brief Symptom Inventory - 18 (BSI18) - Faintness scale  A scale to indicate how much the participant is distressed by faintness or dizziness. BSI18FaintScale Recommended CDE
2 Brief Symptom Inventory - 18 (BSI18) - No interest scale  A scale to indicate how much a participant is distressed by feeling no interest in things. BSI18NoInterestScale Recommended CDE
3 Brief Symptom Inventory - 18 (BSI18) - Nervousness scale  A scale for participant's distress by nervousness or shakiness inside. BSINervousScale Recommended CDE
4 Brief Symptom Inventory - 18 (BSI18) - Chest pains scale  The scale for the participant's distress by pains in heart or chest. BSI18ChestPainScale Recommended CDE
5 Brief Symptom Inventory - 18 (BSI18) - Feeling lonely scale  The scale for the participant's distress in feeling lonely. BSI18FeelLonelyScale Recommended CDE
6 Brief Symptom Inventory - 18 (BSI18) - Feeling tense scale  The scale for the participant's distress in feeling tense or keyed up. BSI18FeelTenseScale Recommended CDE
7 Brief Symptom Inventory - 18 (BSI18) - Nausea scale  The scale for the participant's distress from nausea or upset stomach. BSI18NauseaScale Recommended CDE
8 Brief Symptom Inventory - 18 (BSI18) - Feeling blue scale  The scale for the participant's distress from feeling blue. BSI18FeelBlueScale Recommended CDE
9 Brief Symptom Inventory - 18 (BSI18) - Suddenly scared scale  The scale for the participant's distress from suddenly scared for no reason. BSI18ScaredScale Recommended CDE
10 Brief Symptom Inventory - 18 (BSI18) - Trouble getting breath scale  The scale for the participant's distress from trouble getting their breath. BSI18TrblBreathScale Recommended CDE
11 Brief Symptom Inventory - 18 (BSI18) - Feeling worthless scale  The scale for the participant's distress from feelings of worthlessness. BSI18FeelWorthlessScale Recommended CDE
12 Brief Symptom Inventory - 18 (BSI18) - terror or panic scale  The scale for the participant's distress from spells of terror or panic. BSI18TerrorOrPanicScale Recommended CDE
13 Brief Symptom Inventory - 18 (BSI18) - Numbness or tingling scale  The scale for the participant's distress from numbness or tingling in parts of their body. BSI18NumbScale Recommended CDE
14 Brief Symptom Inventory - 18 (BSI18) - Hopeless scale  The scale for the participant's distress from feeling hopeless about the future. BSI18FeelHopelessScale Recommended CDE
15 Brief Symptom Inventory - 18 (BSI18) - Restless scale  The scale for the participant's distress from feeling so restless they couldn't sit still. BSI18FeelRestlessScale Recommended CDE
16 Brief Symptom Inventory - 18 (BSI18) - Weak scale  The scale for the participant's distress from feeling weak in parts of their body. BSI18FeelWeakScale Recommended CDE
17 Brief Symptom Inventory - 18 (BSI18) - Thoughts of ending life scale  The scale for the participant's distress from thoughts of ending their life. BSI18ThoughtsEndingLifeScale Recommended CDE
18 Brief Symptom Inventory - 18 (BSI18) - Fearful scale  The scale for the participant's distress from feeling fearful. BSI18FeelFearfulScale Recommended CDE
19 Brief Symptom Inventory - 18 (BSI18) - Somatization raw score  Raw score for somatization symptom scale. BSI18SomScoreRaw Recommended CDE
20 Brief Symptom Inventory - 18 (BSI18) - Somatization area T score  Area T score for somatization symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. BSI18SomScoreT Recommended CDE
21 Brief Symptom Inventory - 18 (BSI18) - Depression raw score  Raw score for depression symptom scale. BSI18DeprScoreRaw Recommended CDE
22 Brief Symptom Inventory - 18 (BSI18) - Depression area T score  Area T score for depression symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. BSI18DeprScoreT Recommended CDE
23 Brief Symptom Inventory - 18 (BSI18) - Anxiety raw score  Raw score for anxiety symptom scale. BSI18AnxScoreRaw Recommended CDE
24 Brief Symptom Inventory - 18 (BSI18) - Anxiety area T score  Area T score for anxiety symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. BSI18AnxScoreT Recommended CDE
25 Brief Symptom Inventory - 18 (BSI18) - Global Severity Index raw score  Raw score for Global Severity Index symptom scale. BSI18GSIScoreRaw Recommended CDE
26 Brief Symptom Inventory - 18 (BSI18) - Global Severity Index area T score  Area T score for Global Severity Index symptom scale, as part of Brief Symptom Inventory-18 (BSI18) instrument. BSI18GSIScoreT Recommended CDE

 Change History

 Administrative Change History