Form Structure: PTSD Checklist - Stressor Specific (PCL-S)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
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
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 |
Keywords