Form Structure: Neuro-Qol Item Bank v1.0 - Depression
This form structure is an organized set of data definitions for a copyrighted form
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
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 | TBI Quality of Life (TBI - QOL) and Quality of Life - Maintain task thought trouble scale | The scale representing how often the participant had trouble keeping their mind on what they were doing, as part of Neuro-QOL Depression. And as part of Traumatic Brain Injury-Quality of Life (TBI-QOL) Cognition: General Concerns � Short Form 10a | 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 |
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