Form Structure: PTSD Checklist - Military (PCL-M) for DSM-IV
This form structure is an organized set of data definitions for a copyrighted form
Title:
PTSD Checklist - Military (PCL-M) for DSM-IV
Short Name:
PCL_M_FITBIR
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-M (military) asks about symptoms in response to "stressful military experiences." It is often used with active service members and Veterans. Read more: https://sph.umd.edu/sites/default/files/files/PTSDChecklistScoring.pdf
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-12-12
Version:
1.2
Date Created:
2014-12-10
Owner:
Number of Data Elements:
26
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.
PCLM Questions (Repeat Infinitely)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | PTSD Checklist Military (PCLM) for DSM-4 - Memories scale | Scale reflecting how often the subject has repeated, disturbing memories thoughts, or images of a stressful military experience as part of PTSD Checklist Military (PCLM). | PCLMMemoriesInd | Optional | CDE |
2 | PTSD Checklist Military (PCLM) for DSM-4 - Dreams scale | Scale reflecting of how often the subject experiences repeated, disturbing dreams of a stressful military experience as part of PTSD Checklist Military (PCLM). | PCLMDreamsInd | Optional | CDE |
3 | PTSD Checklist Military (PCLM) for DSM-4 - Happening again scale | Scale reflecting how often the subject suddenly acts or feels as if a stressful military experiences was happening again (as if he or she was reliving it) as part of PTSD Checklist Military (PCLM). | PCLMHappeningAgainInd | Optional | CDE |
4 | PTSD Checklist Military (PCLM) for DSM-4 - Very upset scale | Scale reflecting how often the subject feels very upset when something reminds him or her of a stressful military experience as part of PTSD Checklist Military (PCLM). | PCLMVeryUpsetInd | Optional | CDE |
5 | PTSD Checklist Military (PCLM) for DSM-4 - Physical reaction scale | Scale reflecting of how often the subject has physical reactions (e.g. heart pounding, trouble breathing, sweating) when something reminds him or her of a stressful military experience as part of PTSD Checklist Military (PCLM). | PCLMPhysicalReactionInd | Optional | CDE |
6 | PTSD Checklist Military (PCLM) for DSM-4 - Thinking about scale | Scale reflecting how often the subject avoids thinking about or talking about a stressful military experience or avoiding having feelings related to it as part of PTSD Checklist Military (PCLM). | PCLMThinkingAboutInd | Optional | CDE |
7 | PTSD Checklist Military (PCLM) for DSM-4 - Avoid situation scale | Scale reflecting how often the subject avoids activities or situations because they remind him or her of a stressful military experience as part of PTSD Checklist Military (PCLM). | PCLMAvoidSituationInd | Optional | CDE |
8 | PTSD Checklist Military (PCLM) for DSM-4 - Remember important part scale | Scale reflecting whether the subject has trouble remembering important parts of a stressful military experience as part of PTSD Checklist Military (PCLM). | PCLMRememberImportantPartInd | Optional | CDE |
9 | PTSD Checklist Military (PCLM) for DSM-4 - Loss of interest scale | Scale reflecting of how often the subject loses interest in activities that he or she used to enjoy as part of PTSD Checklist Military (PCLM). | PCLMLossInterestInd | Optional | CDE |
10 | PTSD Checklist Military (PCLM) for DSM-4 - Feel distant scale | Scale reflecting how often the subject feels distant or cut off from other people as part of PTSD Checklist Military (PCLM). | PCLMFeelDistantInd | Optional | CDE |
11 | PTSD Checklist Military (PCLM) for DSM-4 - Emotionally numb scale | Scale reflecting 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 Military (PCLM). | PCLMEmotionallyNumbInd | Optional | CDE |
12 | PTSD Checklist Military (PCLM) for DSM-4 - Short future scale | Scale reflecting how often the subject feels as if his or her future will somehow be cut short as part of PTSD Checklist Military (PCLM). | PCLMShortFutureInd | Optional | CDE |
13 | PTSD Checklist Military (PCLM) for DSM-4 - Trouble falling or staying asleep scale | Scale reflecting how often the subject has trouble falling or staying asleep as part of PTSD Checklist Military (PCLM). | PCLMFallStayAsleepInd | Optional | CDE |
14 | PTSD Checklist Military (PCLM) for DSM-4 - Angry outburst scale | Scale reflecting how often the subject feels irritable or has angry outbursts as part of PTSD Checklist Military (PCLM). | PCLMAngryOutburstInd | Optional | CDE |
15 | PTSD Checklist Military (PCLM) for DSM-4 - Difficulty concentrating scale | Scale reflecting how often the subject has difficulty concentrating as part of PTSD Checklist Military (PCLM). | PCLMDifficultyConcentratingInd | Optional | CDE |
16 | PTSD Checklist Military (PCLM) for DSM-4 - Watchful scale | Scale reflecting how often the subject is "super-alert" or watchful or on guard as part of PTSD Checklist Military (PCLM). | PCLMWatchfulInd | Optional | CDE |
17 | PTSD Checklist Military (PCLM) for DSM-4 - Jumpy scale | Scale reflecting of how often the subject feels jumpy or is easily startled as part of PTSD Checklist Military (PCLM). | PCLMJumpyInd | Optional | CDE |
18 | PTSD Checklist Military (PCLM) for DSM-4 - 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 Military (PCLM). | PCLMTotalScore | Optional | CDE |
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