Form Structure: NIH ToolBox Emotion Domain Fear Affect Survey CAT 18-85
This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH ToolBox Emotion Domain Fear Affect Survey CAT 18-85
Short Name:
NIHTBFearAffectCAT18to85
Description:
This self-report measure assesses fear and anxious misery for ages 18-85, using a CAT format. No versions for other ages are available; however, a fixed-length self-report form is available for ages 18-85 as a supplemental measure. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-23
Owner:
Number of Data Elements:
60
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 | 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 | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | 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 |
NIH Toolbox Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox - Test domain battery type | Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox | NIHTBTestDomainBattryTyp | Recommended | CDE |
| 2 | NIH Toolbox - Test domain battery type other | The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox | NIHTBTestDomainBatteryTypOTH | Recommended | CDE |
| 3 | NIH Toolbox - Test name type | Type of NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestNameTyp | Recommended | CDE |
| 4 | NIH Toolbox - Test name type other | The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox | NIHTBAdminTestNameTypOTH | Recommended | CDE |
| 5 | NIH Toolbox - Test administration language type | Type of language for test being administrated, as part of the NIH Toolbox | NIHTBTestAdminLanguageTyp | Recommended | CDE |
| 6 | NIH Toolbox - Test administration language type other | Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox | NIHTBTestAdminLanguageTypOTH | Recommended | CDE |
| 7 | NIH Toolbox - Form administered type | Type of NIH Toolbox form being administered, as part of the NIH Toolbox | NIHTBFormAdminTyp | Recommended | CDE |
| 8 | NIH Toolbox - Test administration flag indicator | Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagInd | Recommended | CDE |
| 9 | NIH Toolbox - Test administration flag type | Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagTyp | Recommended | CDE |
NIH Toolbox Fear Affect Survey CAT 18-85 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Emotion Domain Fear Affect 18+ - Fearful scale | Scale of participant report of truth of statement:I felt fearful, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18FearfulScl | Recommended | CDE |
| 2 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Frightened scale | Scale of participant report of truth of statement:I felt frightened, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18FrightenedScl | Recommended | CDE |
| 3 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Scared nervous scale | Scale of participant report of truth of statement:It scared me when I felt nervous, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18ScaredNervousScl | Recommended | CDE |
| 4 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Anxiety scale | Scale of participant report of truth of statement:I felt like I needed help for my anxiety, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18AnxietyScl | Recommended | CDE |
| 5 | NIH Toolbox Emotion Domain Fear Affect 18+ - Anxious scale | Scale of participant report of truth of statement:I felt anxious, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18AnxiousScl | Recommended | CDE |
| 6 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Mental health scale | Scale of participant report of truth of statement:I was concerned about my mental health, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18MntlHlthScl | Recommended | CDE |
| 7 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Upset health scale | Scale of participant report of truth of statement:I felt upset, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18UpsetScl | Recommended | CDE |
| 8 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Racing heart scale | Scale of participant report of truth of statement:I had a racing or pounding heart, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18RacingHeartScl | Recommended | CDE |
| 9 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Routine heart scale | Scale of participant report of truth of statement:I was anxious if my normal routine was disturbed, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18RoutineScl | Recommended | CDE |
| 10 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Panic scale | Scale of participant report of truth of statement:I had sudden feelings of panic, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18PanicScl | Recommended | CDE |
| 11 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Startled scale | Scale of participant report of truth of statement:I was easily startled, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18StartledScl | Recommended | CDE |
| 12 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Attention scale | Scale of participant report of truth of statement:I had trouble paying attention, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18AttentionScl | Recommended | CDE |
| 13 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Public places scale | Scale of participant report of truth of statement:I avoided public places and activities, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18PublicPlacesScl | Recommended | CDE |
| 14 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Fidgety scale | Scale of participant report of truth of statement:I felt fidgety, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18FidgetyScl | Recommended | CDE |
| 15 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Awful scale | Scale of participant report of truth of statement:I felt something awful would happen, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18AwfulScl | Recommended | CDE |
| 16 | NIH Toolbox Emotion Domain Fear Affect 18+ - Worried scale | Scale of participant report of truth of statement:I felt worried, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18WorriedScl | Recommended | CDE |
| 17 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Terrified scale | Scale of participant report of truth of statement:I felt terrified, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18TerrifiedScl | Recommended | CDE |
| 18 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Others reactions scale | Scale of participant report of truth of statement:I worried about other people's reactions to me, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18OthrsRctnsScl | Recommended | CDE |
| 19 | NIH Toolbox Emotion Domain Fear Affect 18+ - My anxiety scale | Scale of participant report of truth of statement:I found it hard to focus on anything other than my anxiety, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18MyAnxietyScl | Recommended | CDE |
| 20 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Overwhelmed scale | Scale of participant report of truth of statement: My worries overwhelmed me, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18OverwhelmScl | Recommended | CDE |
| 21 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Twitching muscles scale | Scale of participant report of truth of statement:I had twitching or trembling muscles, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18TwchngMclsScl | Recommended | CDE |
| 22 | NIH Toolbox Emotion Domain Fear Affect 18+ - Nervous scale | Scale of participant report of truth of statement:I felt nervous, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18NervousScl | Recommended | CDE |
| 23 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Indecisive scale | Scale of participant report of truth of statement:I felt indecisive, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18IndecisiveScl | Recommended | CDE |
| 24 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Worry scale | Scale of participant report of truth of statement:Many situations made me worry, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18WorryScl | Recommended | CDE |
| 25 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Difficulty sleeping scale | Scale of participant report of truth of statement:I had difficulty sleeping, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18DffSleepingScl | Recommended | CDE |
| 26 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Trouble relaxing scale | Scale of participant report of truth of statement:I had trouble relaxing, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18TrblRlxngScl | Recommended | CDE |
| 27 | NIH Toolbox Emotion Domain Fear Affect 18+ - Uneasy scale | Scale of participant report of truth of statement:I felt uneasy, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18UneasyScl | Recommended | CDE |
| 28 | NIH Toolbox Emotion Domain Fear Affect 18+ - Tense scale | Scale of participant report of truth of statement:I felt tense, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect | NIHTBFA18TenseScl | Recommended | CDE |
| 29 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Difficulty calming down scale | Scale of participant report of truth of statement:I had difficulty calming down, in the past 7 days, for ages 18+, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18DiffCalmingScl | Recommended | CDE |
NIH Toolbox Fear Affect Survey CAT 18-85 Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Raw score | Raw score, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18DiffRawScore | Recommended | CDE |
| 2 | NIH Toolbox Emotion Domain Fear Affect CAT 18+ - Theta score | Theta score, as part of the NIH Toolbox Emotion Fear Affect CAT | NIHTBFACAT18DiffThetaScore | Recommended | CDE |
| 3 | NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted scale score | Age-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures, including iPad app | NIHTBPROAgeAdjSclScore | Recommended | CDE |
| 4 | NIH Toolbox Patient Reported Outcome (PRO) Measures - Age-adjusted national percentile value | Value of age-adjusted national percentile, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures, including iPad app | NIHTBPROAgeAdjNationalPctVal | Recommended | CDE |
| 5 | NIH Toolbox Patient Reported Outcome (PRO) Measures - Fully-adjusted scale score | Fully-adjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures, including iPad app | NIHTBPROFullyAdjSclScore | Recommended | CDE |
| 6 | NIH Toolbox Patient Reported Outcome (PRO) Measures - Unadjusted scale score | Unadjusted scale score, as part of the NIH Toolbox Patient Reported Outcome (PRO) Measures, including iPad app | NIHTBPROUnadjSclScore | Recommended | CDE |
| 7 | NIH Toolbox - Standard error | Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox Web, Cat and iPad Cognition measures such as: Picture Vocabulary Test and Oral Reading Recognition Test. | NIHTBStandardError | Optional | CDE |
Keywords
