ID

11119

Description

CALGB-10501 Hospital Anxiety And Depression Scale Form NCT00513747 Early or Delayed Fludarabine and Rituximab in Treating Patients With Previously Untreated Chronic Lymphocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=340EDF8E-59E2-1F88-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=340EDF8E-59E2-1F88-E044-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/18/15 6/18/15 -
Uploaded on

June 18, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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CALGB-10501 Hospital Anxiety And Depression Scale Form NCT00513747

English

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 forms  
Header
Description

Header

CALGB Form
Description

Form ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3262252
NCI Thesaurus ObjectClass
C19464
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass-2
C25442
CALGB Study No
Description

Protocol ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Description

Trial subject ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Date Form Completed
Description

Date Form Completed

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
Are data amended
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Responsible CRA
Description

ClinicalResearchAssociateResponsiblePersonName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25657
UMLS 2011AA ObjectClass
C1273518
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass-2
C25465
UMLS 2011AA ObjectClass-2
C1516627
Patient demographics
Description

Patient demographics

Patient Initials (Last, First Middle)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Hospital No.
Description

Medical Record Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Institution/Affiliate
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Participating Group
Description

Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Group Study No
Description

Study Number Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Description

Trial subject ID Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Visit number
Description

Visit number

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1549755
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
Hospital Anxiety And Depression Assessment
Description

Hospital Anxiety And Depression Assessment

I feel tense or wound up (Mark one with an X.)
Description

AnxietyPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I still enjoy the things I used to enjoy (Mark one with an X.)
Description

EmotionDissatisfactionAbsentPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C54266
UMLS 2011AA ObjectClass-2
C0013987
NCI Thesaurus ObjectClass-3
C48190
UMLS 2011AA ObjectClass-3
C0332197
NCI Thesaurus ObjectClass-4
C62184
UMLS 2011AA ObjectClass-4
C0870433
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I get a sort of frightened feeling as if something awful is about to happen (Mark one with an X.)
Description

AnxietyDistressPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ObjectClass-3
C37942
UMLS 2011AA ObjectClass-3
C0231303
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I can laugh and see the funny side of things (Mark one with an X.)
Description

EmotionPositiveMoodAlterationPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C54266
UMLS 2011AA ObjectClass-2
C0013987
NCI Thesaurus ObjectClass-3
C25246
UMLS 2011AA ObjectClass-3
C1446409
NCI Thesaurus ObjectClass-4
C62592
UMLS 2011AA ObjectClass-4
C2939186
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
Worrying thoughts go through my mind (Mark one with an X.)
Description

AnxietyThinkingPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ObjectClass-3
C54226
UMLS 2011AA ObjectClass-3
C0039869
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I feel cheerful (Mark one with an X.)
Description

EmotionPositivePersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C54266
UMLS 2011AA ObjectClass-2
C0013987
NCI Thesaurus ObjectClass-3
C25246
UMLS 2011AA ObjectClass-3
C1446409
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I can sit at ease and feel relaxed (Mark one with an X.)
Description

RelaxationPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C62188
UMLS 2011AA ObjectClass-2
C0035028
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I feel as if I am slowed down (Mark one with an X.)
Description

DepressionFatiguePersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C3036
UMLS 2011AA ObjectClass-2
C0015672
NCI Thesaurus ObjectClass-3
C2982
UMLS 2011AA ObjectClass-3
C0011570
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I get a sort of frightened feeling like butterflies in my stomach (Mark one with an X.)
Description

AnxietyNauseaPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ObjectClass-3
C3258
UMLS 2011AA ObjectClass-3
C0027497
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I have lost interest in my appearance (Mark one with an X.)
Description

DepressionAppearancePersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25377
UMLS 2011AA ObjectClass-2
C0700364
NCI Thesaurus ObjectClass-3
C2982
UMLS 2011AA ObjectClass-3
C0011570
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I feel restless as if I have to be on the move (Mark one with an X.)
Description

AnxietyMovementPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ObjectClass-3
C37994
UMLS 2011AA ObjectClass-3
C0026649
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I look forward with enjoyment to things (Mark one with an X.)
Description

EmotionConfidencePersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C54266
UMLS 2011AA ObjectClass-2
C0013987
NCI Thesaurus ObjectClass-3
C43367
UMLS 2011AA ObjectClass-3
C1704726
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I get sudden feelings of panic (Mark one with an X.)
Description

AnxietyAcuteDistressPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C26696
UMLS 2011AA ObjectClass-2
C0003467
NCI Thesaurus ObjectClass-3
C14140
UMLS 2011AA ObjectClass-3
C0205178
NCI Thesaurus ObjectClass-4
C37942
UMLS 2011AA ObjectClass-4
C0231303
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
I can enjoy a good book or radio or TV program (Mark one with an X.)
Description

EmotionActivityPersonQualityofLifeAssessmentScale

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C54266
UMLS 2011AA ObjectClass-2
C0013987
NCI Thesaurus ObjectClass-3
C43431
UMLS 2011AA ObjectClass-3
C0441655
NCI Thesaurus Property
C17047
UMLS 2011AA Property
C0518214
NCI Thesaurus Property-2
C25367
NCI Thesaurus ValueDomain
C25664
UMLS 2011AA ValueDomain
C0349674
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INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Form ID CALGB
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
Protocol ID CALGB
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Date Form Completed
Item
Date Form Completed
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
ClinicalResearchAssociateResponsiblePersonName
Item
Responsible CRA
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25465 (NCI Thesaurus ObjectClass-2)
C1516627 (UMLS 2011AA ObjectClass-2)
Item Group
Patient demographics
Patient Initials
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Medical Record Number
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Participating Group
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Visit number
Item
Visit number
float
C25337 (NCI Thesaurus ValueDomain)
C1549755 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
Item Group
Hospital Anxiety And Depression Assessment
Item
I feel tense or wound up (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.2
Code List
I feel tense or wound up (Mark one with an X.)
CL Item
Most Of The Time (Most of the time)
CL Item
A Lot Of The Time (A lot of the time)
CL Item
From Time To Time, Occasionally (From time to time, occasionally)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
I still enjoy the things I used to enjoy (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C48190 (NCI Thesaurus ObjectClass-3)
C0332197 (UMLS 2011AA ObjectClass-3)
C62184 (NCI Thesaurus ObjectClass-4)
C0870433 (UMLS 2011AA ObjectClass-4)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.3
Code List
I still enjoy the things I used to enjoy (Mark one with an X.)
CL Item
Definitely As Much (Definitely as much)
CL Item
Not Quite So Much (Not quite so much)
CL Item
Only A Little (Only a little)
CL Item
Hardly At All (Hardly at all)
Item
I get a sort of frightened feeling as if something awful is about to happen (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C37942 (NCI Thesaurus ObjectClass-3)
C0231303 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.4
Code List
I get a sort of frightened feeling as if something awful is about to happen (Mark one with an X.)
CL Item
Very Definitely And Quite Badly (Very definitely and quite badly)
CL Item
Yes, But Not Too Badly (Yes, but not too badly)
CL Item
A Little, But It Doesn't Worry Me (A little, but it doesn't worry me)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
I can laugh and see the funny side of things (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus ObjectClass-3)
C1446409 (UMLS 2011AA ObjectClass-3)
C62592 (NCI Thesaurus ObjectClass-4)
C2939186 (UMLS 2011AA ObjectClass-4)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.5
Code List
I can laugh and see the funny side of things (Mark one with an X.)
CL Item
As Much As I Always Could (As much as I always could)
CL Item
Not Quite So Much Now (Not quite so much now)
CL Item
Definitely Not So Much Now (Definitely not so much now)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
Worrying thoughts go through my mind (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C54226 (NCI Thesaurus ObjectClass-3)
C0039869 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.6
Code List
Worrying thoughts go through my mind (Mark one with an X.)
CL Item
A Great Deal Of The Time (A great deal of the time)
CL Item
A Lot Of The Time (A lot of the time)
CL Item
From Time To Time But Not Too Often (From time to time but not too often)
CL Item
Only Occasionally (Only occasionally)
Item
I feel cheerful (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus ObjectClass-3)
C1446409 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.7
Code List
I feel cheerful (Mark one with an X.)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Not Often (Not often)
CL Item
Sometimes (Sometimes)
CL Item
Most Of The Time (Most of the time)
Item
I can sit at ease and feel relaxed (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C62188 (NCI Thesaurus ObjectClass-2)
C0035028 (UMLS 2011AA ObjectClass-2)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.8
Code List
I can sit at ease and feel relaxed (Mark one with an X.)
CL Item
Definitely (Definitely)
CL Item
Usually (Usually)
CL Item
Not Often (Not often)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
I feel as if I am slowed down (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C3036 (NCI Thesaurus ObjectClass-2)
C0015672 (UMLS 2011AA ObjectClass-2)
C2982 (NCI Thesaurus ObjectClass-3)
C0011570 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.9
Code List
I feel as if I am slowed down (Mark one with an X.)
CL Item
Nearly All The Time (Nearly all the time)
CL Item
Very Often (Very often)
CL Item
Sometimes (Sometimes)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
I get a sort of frightened feeling like butterflies in my stomach (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C3258 (NCI Thesaurus ObjectClass-3)
C0027497 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.10
Code List
I get a sort of frightened feeling like butterflies in my stomach (Mark one with an X.)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
CL Item
Occasionally (Occasionally)
CL Item
Quite Often (Quite often)
CL Item
Very Often (Very often)
Item
I have lost interest in my appearance (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25377 (NCI Thesaurus ObjectClass-2)
C0700364 (UMLS 2011AA ObjectClass-2)
C2982 (NCI Thesaurus ObjectClass-3)
C0011570 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.11
Code List
I have lost interest in my appearance (Mark one with an X.)
CL Item
Definitely (Definitely)
CL Item
I Don't Take So Much Care As I Should (I don't take so much care as I should)
CL Item
I May Not Take Quite As Much Care (I may not take quite as much care)
CL Item
I Take Just As Much Care As Ever (I take just as much care as ever)
Item
I feel restless as if I have to be on the move (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C37994 (NCI Thesaurus ObjectClass-3)
C0026649 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.12
Code List
I feel restless as if I have to be on the move (Mark one with an X.)
CL Item
Very Much Indeed (Very much indeed)
CL Item
Not Very Much (Not very much)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
I look forward with enjoyment to things (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C43367 (NCI Thesaurus ObjectClass-3)
C1704726 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.13
Code List
I look forward with enjoyment to things (Mark one with an X.)
CL Item
As Much As I Ever Did (As much as I ever did)
CL Item
Rather Less Than I Used To (Rather less than I used to)
CL Item
Definitely Less Than I Used To (Definitely less than I used to)
CL Item
Hardly At All (Hardly at all)
Item
I get sudden feelings of panic (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C26696 (NCI Thesaurus ObjectClass-2)
C0003467 (UMLS 2011AA ObjectClass-2)
C14140 (NCI Thesaurus ObjectClass-3)
C0205178 (UMLS 2011AA ObjectClass-3)
C37942 (NCI Thesaurus ObjectClass-4)
C0231303 (UMLS 2011AA ObjectClass-4)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.14
Code List
I get sudden feelings of panic (Mark one with an X.)
CL Item
Very Often Indeed (Very often indeed)
CL Item
Quite Often (Quite often)
CL Item
Not Very Often (Not very often)
CL Item
Not At All (Not at all)
C91213 (NCI Thesaurus)
C91213 (NCI Thesaurus-2)
Item
I can enjoy a good book or radio or TV program (Mark one with an X.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C54266 (NCI Thesaurus ObjectClass-2)
C0013987 (UMLS 2011AA ObjectClass-2)
C43431 (NCI Thesaurus ObjectClass-3)
C0441655 (UMLS 2011AA ObjectClass-3)
C17047 (NCI Thesaurus Property)
C0518214 (UMLS 2011AA Property)
C25367 (NCI Thesaurus Property-2)
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
CL.15
Code List
I can enjoy a good book or radio or TV program (Mark one with an X.)
CL Item
Often (Often)
CL Item
Sometimes (Sometimes)
CL Item
Not Often (Not often)
CL Item
Very Seldom (Very seldom)
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