Form Structure: PROMIS Bank v1.0 - Emotional Distress - Depression
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
PROMIS Bank v1.0 - Emotional Distress - Depression
Short Name:
PROMISDepression
Description:
PROMIS - Emotional Distress - Depression. This form should be used for any version of the PROMIS forms that are derived from this bank of questions, including (but not limited to) the Emotional Distress - Depression v1.0 Item Bank Computer Adaptive Test (CAT) and Short Form (SF) 8a
Disease:
General (For all diseases)
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-02-11
Version:
1.1
Date Created:
2015-01-12
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.
In the past 7 days (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | 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 | Optional | CDE |
| 2 | 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 | Optional | CDE |
| 3 | 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 | Optional | CDE |
| 4 | 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 | Optional | CDE |
| 5 | 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 | Optional | CDE |
| 6 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel not as good as other people past week scale | The scale which represents how often the participant felt that he/she was not as good as other people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISNotAsGoodAsOthPplScale | Optional | CDE |
| 7 | 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 | Optional | CDE |
| 8 | 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 | Optional | CDE |
| 9 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel blamed for things past week scale | The scale which represents how often the participant felt that he/she was to blame for things in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISIBlameMeForThingsScale | Optional | CDE |
| 10 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel like failure past week scale | The scale which represents how often the participant felt like a failure in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltLikeAFailureScale | Optional | CDE |
| 11 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble feeling close people past week scale | The scale which represents how often the participant had trouble feeling close to people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTroubleFeelingCloseScale | Optional | CDE |
| 12 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel disappointed in self past week scale | The scale which represents how often the participant felt disappointed in himself in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISDisappointedInSelfScale | Optional | CDE |
| 13 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel not needed past week scale | The scale which represents how often the participant felt that he/she was not needed in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltNotNeededScale | Optional | CDE |
| 14 | 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 | Optional | CDE |
| 15 | 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 | Optional | CDE |
| 16 | Patient-Reported Outcome Measurement Information System (PROMIS) - trouble make decision past week scale | The scale which represents how often the participant had trouble making decisions in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTroubleMakeDecisionScale | Optional | 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 | Optional | 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 | Optional | CDE |
| 19 | 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 | Optional | CDE |
| 20 | 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 | Optional | CDE |
| 21 | 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 | Optional | CDE |
| 22 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel ignored by people past week scale | The scale which represents how often the participant felt ignored by people in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltIgnoredByPeopleScale | Optional | CDE |
| 23 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel upset no reason past week scale | The scale which represents how often the participant felt upset for no reason in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFltUpsetForNoReasonScale | Optional | CDE |
| 24 | 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 | Optional | CDE |
| 25 | 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 | Optional | CDE |
| 26 | 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 | Optional | CDE |
| 27 | Patient-Reported Outcome Measurement Information System (PROMIS) - feel guilty past week scale | The scale which represents how often the participant felt guilty in the past 7 days, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFeltGuiltyScale | Optional | CDE |
| 28 | 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 | Optional | CDE |
Scoring (Appears Exactly 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Patient-Reported Outcome Measure Information System (PROMIS) - form administered type | The specific PROMIS form type administered, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISFormType | Required | CDE |
| 2 | Patient-Reported Outcome Measure Information System (PROMIS) - raw score | The participant's raw score on the PROMIS form, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISRawScore | Optional | CDE |
| 3 | Patient-Reported Outcome Measure Information System (PROMIS) - items completed count | The count of items on the PROMIS form completed by the participant, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISItemCompletedCount | Optional | CDE |
| 4 | Patient-Reported Outcome Measure Information System (PROMIS) - T-score value | The T-score value, a standardized score with a mean of 50 and standard deviation of 10 representing the rescaled raw score, as part of the Patient-Reported Outcome Measurement Information System. | PROMISTScore | Recommended | CDE |
| 5 | Patient-Reported Outcome Measure Information System (PROMIS) - Standard error | Standard error, as part of the Patient-Reported Outcome Measurement Information System (PROMIS) | PROMISStandardError | Recommended | CDE |
| 6 | Patient-Reported Outcome Measure Information System (PROMIS) - theta value | The value of theta reported from the CAT PROMIS results, as part of the Patient-Reported Outcome Measurement Information System (PROMIS). | PROMISTheta | Optional | CDE |
Keywords
