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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

Lien

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

Mots-clés

  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 18/06/2015 18/06/2015 -
Téléchargé le

18 juin 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy

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    CALGB-10501 Hospital Anxiety And Depression Scale Form NCT00513747

    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

    Header
    Description

    Header

    CALGB Form
    Description

    Form ID CALGB

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    boolean

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

    ClinicalResearchAssociateResponsiblePersonName

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Similar models

    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

    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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)
    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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