This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
PTSD Checklist - Stressor Specific (PCL-S)
Short Name:
PCLS
Description:
The PCL is a 17-item self-report measure of the DSM-IV symptoms of PTSD. Respondents rate how much they were bothered by a symptom on a 5-point scale ranging from 1 (not at all) to 5 (extremely). The PCL-S (specific) asks about symptoms in relation to an identified stressful experience. The PCL-S aims to link symptom endorsements to a specified event. Similar to the PCL-C, it is optimal to assess traumatic event exposure to ensure that the index event meets PTSD Criterion A. Respondents also can be instructed to complete the PCL-S in reference to a specified event or event type (e.g., assault, disaster, or accident). References: PCL-S for DSM-IV (11/1/94) Weathers, Litz, Huska, & Keane National Center for PTSD - Behavioral Science Division Read more: https://sph.umd.edu/sites/default/files/files/PTSDChecklistScoring.pdf
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-03-22
Owner:
Number of Data Elements:
36
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 Recommended 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 Optional CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Recommended 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

Stressor Specific Event (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Event description text  The free-text field to describe the event including adverse event EvntDescrTxt Recommended CDE
2 Month when the event occurred  Value that represents one of the months of the year when the event occurred MonthEventValue Recommended UDE
3 Year when the event occurred  Value that represents the calendar year when the event occurred YearEventValue Recommended UDE

PTSD Checklist Stressor Specific (PCL-S) (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 PTSD Checklist Stressor (PCLS) - Memories indicator  Indicator how often the subject has repeated, disturbing memories thoughts, or images of a stressful experience as part of PTSD Checklist Military (PCLM). PCLSMemoriesInd Optional CDE
2 PTSD Checklist Stressor (PCLS) - Dreams indicator  Indicator whether the subject has repeated, disturbing dreams of the stressful experience as part of PTSD Checklist Stressor (PCLS). PCLSDreamsInd Optional CDE
3 PTSD Checklist Stressor (PCLS) - Happen again indicator  Indicator of how often the subject suddenly acts or feels as if the stressful experience were happening against (as if he or she was reliving it) as part of PTSD Checklist Stressor (PCLS). PCLSHappenAgainInd Optional CDE
4 PTSD Checklist Stressor (PCLS) - Very upset indicator  Indicator how often the subject feels very upset when something reminds he or she of the stressful experience as part of PTSD Checklist Stressor (PCLS). PCLSVeryUpsetInd Optional CDE
5 PTSD Checklist Stressor (PCLS) - Physical reaction indicator  Indicator how often the subject has physical reactions (e.g., heart pounding, trouble breathing, sweating) when something reminded he or she of the stressful experience as part of PTSD Checklist Stressor (PCLS). PCLSPhysicalReactionsInd Optional CDE
6 PTSD Checklist Stressor (PCLS) - Avoid having feeling indicator  Indicator how often the subject avoids thinking about or talking about the stressful experience or avoiding having feelings related to it as part of PTSD Checklist Stressor (PCLS). PCLSAvoidHavingFeelingInd Optional CDE
7 PTSD Checklist Stressor (PCLS) - Avoid situation indicator  Indicator how often the subject avoids activities or situations because they remind he or she of the stressful experience as part of PTSD Checklist Stressor (PCLS). PCLSAvoidSituationInd Optional CDE
8 PTSD Checklist Stressor (PCLS) - Remember important indicator  Indicator how often the subject has trouble remembering important parts of a stressful experience as part of PTSD Checklist Stressor (PCLS). PCLSRememberImportantInd Optional CDE
9 PTSD Checklist Stressor (PCLS) - Loss interest indicator  Indicator how often the subject has a loss of interest in activities that he or she used to enjoy as part of PTSD Checklist Stressor (PCLS). PCLSLossInterestInd Optional CDE
10 PTSD Checklist Stressor (PCLS) - Feel distant indicator  Indicator how often the subject feels distant or cut off from other people as part of PTSD Checklist Stressor (PCLS). PCLSFeelDistantInd Optional CDE
11 PTSD Checklist Stressor (PCLS) - Emotionally numb indicator  Indicator how often the subject feels emotionally numb or feels unable to have loving feelings for those he or she is close to as part of PTSD Checklist Stressor (PCLS). PCLSEmotionallyNumbInd Optional CDE
12 PTSD Checklist Stressor (PCLS) - Short future indicator  Indicator how often the subject feels as if his or her future will somehow be cut short as part of PTSD Checklist Stressor (PCLS). PCLSShortFutureInd Optional CDE
13 PTSD Checklist Stressor (PCLS) - Fall stay asleep indicator  Indicator how often the subject has trouble falling or staying asleep as part of PTSD Checklist Stressor (PCLS). PCLSFallStayAsleepInd Optional CDE
14 PTSD Checklist Stressor (PCLS) - Angry outburst indicator  Indicator how often the subject feels irritable or has angry outbursts as part of PTSD Checklist Stressor (PCLS). PCLSAngryOutburstInd Optional CDE
15 PTSD Checklist Stressor (PCLS) - Difficulty concentrating indicator  Indicator how often the subject has difficulty concentrating as part of PTSD Checklist Stressor (PCLS). PCLSDifficultyConcentratingInd Optional CDE
16 PTSD Checklist Stressor (PCLS) - Super alert indicator  Indicator how often the subject feels "super-alert" or watchful as part of PTSD Checklist Stressor (PCLS). PCLSSuperAlertInd Optional CDE
17 PTSD Checklist Stressor (PCLS) - Jumpy indicator  Indicator how often the subject feels jumpy or easily startled as part of PTSD Checklist Stressor (PCLS). PCLSJumpyInd Optional CDE
18 PTSD Checklist Stressor (PCLS) - Total score  A total score (range 17-85) can be obtained by summing the scores from each of the 17 items as part of PTSD Checklist Stressor (PCLS). PCLSTotalScore Optional CDE

 Change History

 Administrative Change History