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

 General Details

Title:
Neuro-Qol Item Bank v1.0 - Depression
Short Name:
NeuroQolDepression
Description:
This form contains the entire contents of the Neuro-QOL Item Bank v1.0 questions for Depression. This form can be used in it's entirety, or partly for the short form.
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-11-03
Version:
1.0
Date Created:
2015-09-11
Owner:
Number of Data Elements:
42
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 Administration (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

In the past 7 days (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Patient-Reported Outcome Measurement Information System (PROMIS) - feel depressed past week scale  The scale which represents how often the participant felt depressed in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltDepressedScale Recommended CDE
2 Patient-Reported Outcome Measurement Information System (PROMIS) - feel hopeless past week scale  The scale which represents how often the participant felt hopeless in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltHopelessScale Recommended CDE
3 Patient-Reported Outcome Measurement Information System (PROMIS) - feel nothing can cheer self up past week scale  The scale which represents how often the participant felt that nothing could cheer him/her up in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISNothingCheersMeUpScale Recommended CDE
4 Patient-Reported Outcome Measurement Information System (PROMIS) - feel life empty past week scale  The scale which represents how often the participant felt that life was empty in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltLifeWasEmptyScale Recommended CDE
5 Patient-Reported Outcome Measurement Information System (PROMIS) - feel worthless past week scale  The scale which represents how often the participant felt worthless in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltWorthlessScale Recommended CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - feel unhappy past week scale  The scale which represents how often the participant felt unhappy in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltUnhappyScale Recommended CDE
7 Patient-Reported Outcome Measurement Information System (PROMIS) - feel no reason live past week scale  The scale which represents how often the participant felt he/she had no reason for living in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFltNoReasnForLivingScale Recommended CDE
8 Patient-Reported Outcome Measurement Information System (PROMIS) - feel nothing interesting past week scale  The scale which represents how often the participant felt that nothing was interesting in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISNothngWsInterestingScale Recommended CDE
9 Patient-Reported Outcome Measurement Information System (PROMIS) - feel helpless past week scale  The scale which represents how often the participant felt helpless in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltHelplessScale Recommended CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - want to give up on everything past week scale  The scale which represents how often the participant wanted to give up on everything in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWantGivUpOnEvrythngScale Recommended CDE
11 Patient-Reported Outcome Measurement Information System (PROMIS) - feel nothing to look forward to past week scale  The scale which represents how often the participant felt that he/she had nothing to look forward to in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISNothingLookForwardScale Recommended CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - withdraw other people past week scale  The scale which represents how often the participant withdrew from other people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISWithdrewFromOthPplScale Recommended CDE
13 Quality of Life - Everything extra effort complete past week scale  The scale representing how often the participant felt that everything they did was an effort in the past 7 days, as part of Neuro-QOL Depression. QoLEverythExtrEffrtCompltScl Recommended CDE
14 Quality of Life - Mistake self critical past week scale  The scale representing how often the participant was critical of himself/herself for their mistakes in the past 7 days, as part of Neuro-QOL Depression. QoLMistakeSelfCriticalScl Recommended CDE
15 Patient-Reported Outcome Measurement Information System (PROMIS) - feel sad past week scale  The scale which represents how often the participant felt sad in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltSadScale Recommended CDE
16 Patient-Reported Outcome Measurement Information System (PROMIS) - feel lonely past week scale  The scale which represents how often the participant felt lonely in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltLonelyScale Recommended CDE
17 Patient-Reported Outcome Measurement Information System (PROMIS) - feel discourage about future past week scale  The scale which represents how often the participant felt discouraged about the future in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISDiscouragdAbtFutureScale Recommended CDE
18 Patient-Reported Outcome Measurement Information System (PROMIS) - find things in life overwhelming past week scale  The scale which represents how often the participant found that things in life were overwhelming in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISLifeThingsOverwhelmScale Recommended CDE
19 Quality of Life - Feel unloved past week scale  The scale representing how often the participant felt unloved in the past 7 days, as part of Neuro-QOL Depression. QoLFeltUnlovedScl Recommended CDE
20 Patient-Reported Outcome Measurement Information System (PROMIS) - feel pessimistic past week scale  The scale which represents how often the participant felt pessimistic in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltPessimisticScale Recommended CDE
21 Quality of Life - Maintain task thought trouble past week scale  The scale representing how often the participant had trouble keeping their mind on what they were doing in the past 7 days, as part of Neuro-QOL Depression. QoLMntainTaskThoughtTroublScl Recommended CDE
22 Patient-Reported Outcome Measurement Information System (PROMIS) - feel emotional exhaust past week scale  The scale which represents how often the participant felt emotionally exhausted in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltEmotExhaustedScale Recommended CDE
23 Quality of Life - Need help with depression scale  The scale representing how often the participant felt they needed help with depression in the past 7 days, as part of the Neuro-QOL Depression. QoLNeedHelpDepressionScl Recommended CDE
24 Quality of Life - Enjoyment trouble past week scale  The scale representing how often the participant had trouble enjoying things that they used to enjoy in the past 7 days, as part of Neuro-QOL Depression Adult Bank. QoLEnjoymentTroubleScl Recommended CDE

Scoring (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Quality of Life in Neurological Disorders (Neuro-Qol) - Form administered status  The specific Neuro-Qol form administered status, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLFormStatus Recommended CDE
2 Quality of Life in Neurological Disorders (Neuro-Qol) - Items completed count  The count of items on the Neuro-Qol form completed by the participant, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLItemCompletedCount Recommended CDE
3 Quality of Life in Neurological Disorders (Neuro-Qol) - Standard error  Standard error, as part of the Quality of Life in Neurological Disorders (Neuro-Qol) QoLStandardError Recommended CDE
4 Quality of Life in Neurological Disorders (Neuro-Qol) - Theta value  Theta metric value reported from the CAT Neuro-Qol results, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLThetaVal Recommended CDE
5 Quality of Life in Neurological Disorders (Neuro-Qol) - T-score value  The value of the T-score, a standardized score with a mean of 50 and a standard deviation (SD) of 10 representing the rescaled raw score, as part of the Quality of Life in Neurological Disorders (Neuro-Qol).(PROMIS). QoLTScore Recommended CDE
6 Quality of Life in Neurological Disorders (Neuro-Qol) - Raw score  The participant's raw score on the Neuro-Qol form, as part of the Quality of Life in Neurological Disorders (Neuro-Qol). QoLRawScore Recommended CDE

 Change History

 Administrative Change History