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

 General Details

Title:
PROMIS Bank v1.0 - Emotional Distress - Depression
Short Name:
PROMISDepression
Description:
PROMIS - Emotional Distress - Depression. This form should be used for any version of the PROMIS forms that are derived from this bank of questions, including (but not limited to) the Emotional Distress - Depression v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8a
Disease:
General (For all diseases) , Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-11
Version:
1.1
Date Created:
2015-01-12
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.

In the past 7 days (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 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 Optional CDE
2 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 Optional CDE
3 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 Optional CDE
4 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 Optional CDE
5 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 Optional CDE
6 Patient-Reported Outcome Measurement Information System (PROMIS) - feel not as good as other people past week scale  The scale which represents how often the participant felt that he/she was not as good as other people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISNotAsGoodAsOthPplScale Optional CDE
7 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 Optional CDE
8 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 Optional CDE
9 Patient-Reported Outcome Measurement Information System (PROMIS) - feel blamed for things past week scale  The scale which represents how often the participant felt that he/she was to blame for things in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISIBlameMeForThingsScale Optional CDE
10 Patient-Reported Outcome Measurement Information System (PROMIS) - feel like failure past week scale  The scale which represents how often the participant felt like a failure in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltLikeAFailureScale Optional CDE
11 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble feeling close people past week scale  The scale which represents how often the participant had trouble feeling close to people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTroubleFeelingCloseScale Optional CDE
12 Patient-Reported Outcome Measurement Information System (PROMIS) - feel disappointed in self past week scale  The scale which represents how often the participant felt disappointed in himself in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISDisappointedInSelfScale Optional CDE
13 Patient-Reported Outcome Measurement Information System (PROMIS) - feel not needed past week scale  The scale which represents how often the participant felt that he/she was not needed in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltNotNeededScale Optional CDE
14 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 Optional CDE
15 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 Optional CDE
16 Patient-Reported Outcome Measurement Information System (PROMIS) - trouble make decision past week scale  The scale which represents how often the participant had trouble making decisions in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTroubleMakeDecisionScale Optional 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 Optional 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 Optional CDE
19 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 Optional CDE
20 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 Optional CDE
21 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 Optional CDE
22 Patient-Reported Outcome Measurement Information System (PROMIS) - feel ignored by people past week scale  The scale which represents how often the participant felt ignored by people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltIgnoredByPeopleScale Optional CDE
23 Patient-Reported Outcome Measurement Information System (PROMIS) - feel upset no reason past week scale  The scale which represents how often the participant felt upset for no reason in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFltUpsetForNoReasonScale Optional CDE
24 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 Optional CDE
25 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 Optional CDE
26 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 Optional CDE
27 Patient-Reported Outcome Measurement Information System (PROMIS) - feel guilty past week scale  The scale which represents how often the participant felt guilty in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFeltGuiltyScale Optional CDE
28 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 Optional CDE

Scoring (Appears Exactly 1 Time)

# Title Short Description Variable Name Required? Type
1 Patient-Reported Outcome Measure Information System (PROMIS) - form administered type  The specific PROMIS form type administered, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISFormType Required CDE
2 Patient-Reported Outcome Measure Information System (PROMIS) - raw score  The participant's raw score on the PROMIS form, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISRawScore Optional CDE
3 Patient-Reported Outcome Measure Information System (PROMIS) - items completed count  The count of items on the PROMIS form completed by the participant, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISItemCompletedCount Optional CDE
4 Patient-Reported Outcome Measure Information System (PROMIS) - T-score value  The T-score value, a standardized score with a mean of 50 and standard deviation of 10 representing the rescaled raw score, as part of the Patient-Reported Outcome Measurement Information System. PROMISTScore Recommended CDE
5 Patient-Reported Outcome Measure Information System (PROMIS) - Standard error  Standard error, as part of the Patient-Reported Outcome Measurement Information System (PROMIS) PROMISStandardError Recommended CDE
6 Patient-Reported Outcome Measure Information System (PROMIS) - theta value  The value of theta reported from the CAT PROMIS results, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). PROMISTheta Optional CDE

 Change History

 Administrative Change History