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

 General Details

Title:
NIH ToolBox Emotion Domain Fear Affect Survey CAT 18-85
Short Name:
NIHTBFearAffectCAT18to85
Description:
This self-report measure assesses fear and anxious misery for ages 18-85, using a CAT format. No versions for other ages are available; however, a fixed-length self-report form is available for ages 18-85 as a supplemental measure. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
Traumatic Brain Injury , General (For all diseases)
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-23
Owner:
Number of Data Elements:
60
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 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

NIH Toolbox Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox - Test domain battery type  Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox NIHTBTestDomainBatteryTyp Recommended CDE
2 NIH Toolbox - Test domain battery type other  The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox NIHTBTestDomainBatteryTypOTH Recommended CDE
3 NIH Toolbox - Test name type  Type of NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestNameTyp Recommended CDE
4 NIH Toolbox - Test name type other  The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox NIHTBAdminTestNameTypOTH Recommended CDE
5 NIH Toolbox - Test administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
6 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH Recommended CDE
7 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE
8 NIH Toolbox - Test administration flag indicator  Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagInd Recommended CDE
9 NIH Toolbox - Test administration flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE

NIH Toolbox Fear Affect Survey CAT 18-85 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Fear Affect 18+ - Fearful scale  Scale of participant report of truth of statement:I felt fearful, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18FearfulScl Recommended CDE
2 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Frightened scale  Scale of participant report of truth of statement:I felt frightened, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18FrightenedScl Recommended CDE
3 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Scared nervous scale  Scale of participant report of truth of statement:It scared me when I felt nervous, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18ScaredNervousScl Recommended CDE
4 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Anxiety scale  Scale of participant report of truth of statement:I felt like I needed help for my anxiety, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18AnxietyScl Recommended CDE
5 NIH Toolbox Emotion Domain Fear Affect 18+ - Anxious scale  Scale of participant report of truth of statement:I felt anxious, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18AnxiousScl Recommended CDE
6 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Mental health scale  Scale of participant report of truth of statement:I was concerned about my mental health, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18MntlHlthScl Recommended CDE
7 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Upset health scale  Scale of participant report of truth of statement:I felt upset, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18UpsetScl Recommended CDE
8 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Racing heart scale  Scale of participant report of truth of statement:I had a racing or pounding heart, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18RacingHeartScl Recommended CDE
9 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Routine heart scale  Scale of participant report of truth of statement:I was anxious if my normal routine was disturbed, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18RoutineScl Recommended CDE
10 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Panic scale  Scale of participant report of truth of statement:I had sudden feelings of panic, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18PanicScl Recommended CDE
11 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Startled scale  Scale of participant report of truth of statement:I was easily startled, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18StartledScl Recommended CDE
12 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Attention scale  Scale of participant report of truth of statement:I had trouble paying attention, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18AttentionScl Recommended CDE
13 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Public places scale  Scale of participant report of truth of statement:I avoided public places and activities, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18PublicPlacesScl Recommended CDE
14 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Fidgety scale  Scale of participant report of truth of statement:I felt fidgety, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18FidgetyScl Recommended CDE
15 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Awful scale  Scale of participant report of truth of statement:I felt something awful would happen, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18AwfulScl Recommended CDE
16 NIH Toolbox Emotion Domain Fear Affect 18+ - Worried scale  Scale of participant report of truth of statement:I felt worried, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18WorriedScl Recommended CDE
17 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Terrified scale  Scale of participant report of truth of statement:I felt terrified, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18TerrifiedScl Recommended CDE
18 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Others reactions scale  Scale of participant report of truth of statement:I worried about other people's reactions to me, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18OthrsRctnsScl Recommended CDE
19 NIH Toolbox Emotion Domain Fear Affect 18+ - My anxiety scale  Scale of participant report of truth of statement:I found it hard to focus on anything other than my anxiety, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18MyAnxietyScl Recommended CDE
20 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Overwhelmed scale  Scale of participant report of truth of statement: My worries overwhelmed me, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18OverwhelmScl Recommended CDE
21 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Twitching muscles scale  Scale of participant report of truth of statement:I had twitching or trembling muscles, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18TwchngMclsScl Recommended CDE
22 NIH Toolbox Emotion Domain Fear Affect 18+ - Nervous scale  Scale of participant report of truth of statement:I felt nervous, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18NervousScl Recommended CDE
23 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Indecisive scale  Scale of participant report of truth of statement:I felt indecisive, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18IndecisiveScl Recommended CDE
24 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Worry scale  Scale of participant report of truth of statement:Many situations made me worry, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18WorryScl Recommended CDE
25 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Difficulty sleeping scale  Scale of participant report of truth of statement:I had difficulty sleeping, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18DffSleepingScl Recommended CDE
26 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Trouble relaxing scale  Scale of participant report of truth of statement:I had trouble relaxing, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18TrblRlxngScl Recommended CDE
27 NIH Toolbox Emotion Domain Fear Affect 18+ - Uneasy scale  Scale of participant report of truth of statement:I felt uneasy, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18UneasyScl Recommended CDE
28 NIH Toolbox Emotion Domain Fear Affect 18+ - Tense scale  Scale of participant report of truth of statement:I felt tense, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect NIHTBFA18TenseScl Recommended CDE
29 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Difficulty calming down scale  Scale of participant report of truth of statement:I had difficulty calming down, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18DiffCalmingScl Recommended CDE

NIH Toolbox Fear Affect Survey CAT 18-85 Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Raw score  Raw score, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18DiffRawScore Recommended CDE
2 NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Theta score  Theta score, as part of the NIH Toolbox Emotion Fear Affect CAT NIHTBFACAT18DiffThetaScore Recommended CDE
3 NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROAgeAdjSclScore Recommended CDE
4 NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted national percentile value  Value of age-adjusted national percentile, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROAgeAdjNationalPctVal Recommended CDE
5 NIH Toolbox Patient Reported Outcome (PRO) Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROFullyAdjSclScore Recommended CDE
6 NIH Toolbox Patient Reported Outcome (PRO) Measures - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures NIHTBPROUnadjSclScore Recommended CDE
7 NIH Toolbox - Standard error  Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox NIHTBStandardError Optional CDE

 Change History

 Administrative Change History