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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.

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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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