PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| DIAGNOSTIC CRITERIA FOR POSTTRAUMATIC STRESS DISORDER | ptsd_diag | N | checkbox | 1, A.(1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity or self or others. | 2, A.(2) The person's response involved intense fear, helplessness or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. | 3, B.(1) Recurrent and intrusive distressing recollections of the event, including images thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. | 4, B.(2) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content | 5, B.(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur | 6, B.(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event | 7, B.(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event | 8, C.(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma | 9, C.(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma | 10, C.(3) Inability to recall an important aspect of the trauma | 11, C.(4) Markedly diminished interest or participation in significant activities | 12, C.(5) Feeling of detachment or estrangement from others | 13, C.(6) Restricted range of affect (e.g., unable to have loving feelings) | 14, C.(7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) | 15, D.(1) Difficulty falling or staying asleep | 16, D.(2) Irritability or outbursts of anger | 17, D.(3) Difficulty concentrating | 18, D.(4) Hypervigilance | 19, D.(5) Exaggerated startle response | 20, E. Duration of the disturbance (symptoms in criteria B, C, and D) is more than one month. | 21, The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | - | - | |
| 1. Have you ever experienced, witnesses or otherwise been involved in any events that could have brought serious harm or even death to you or someone else? | ptsd_1 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 1a. If yes: Specify | ptsd_1a | Y | notes | - | - | - | |
| 2. Did this event cause you to have intense feelings of fear, helplessness or horror? | ptsd_2 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 2a. If yes: Specify | ptsd_2a | Y | notes | - | - | - | |
| 3. Have you ever been bothered by unwanted thoughts or dreams or images that kept coming back to you, about traumatic event that you experienced or witnessed? | ptsd_3 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 4. Have you ever felt as if you were reliving some traumatic event that you experienced or witnessed? | ptsd_4 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 5. Have you ever been intensely distressed or extremely anxious when you were reminded in some way about a traumatic event that you experienced or witnessed? | ptsd_5 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 6. Have you tried in general to avoid thinking or talking about the event? | ptsd_6 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 7. Have you ever tried in general to avoid activities, places or people that remind you of the event? | ptsd_7 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 8. Are you unable to recall important parts of the event? | ptsd_8 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 9. Since the event, do you tend to feel detached from other people? | ptsd_9 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 10. Since this event, have you been unable to experience a full range of feelings? | ptsd_10 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 11. Since this event, have you found yourself unable to see a future for yourself? | ptsd_11 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 12. difficulty falling asleep or staying asleep (apart from depression or mania) | ptsd_12 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 13. irritability or angry outbursts (apart from depression or mania) | ptsd_13 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 14. difficulty concentrating (apart from depression or mania) | ptsd_14 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 15. being too much on alert | ptsd_15 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 16. being too easily startled | ptsd_16 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 17. Have you been very upset about having these symptoms? | ptsd_17 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 18. Have these symptoms interfered with your ability to work, to be with others or to function in other areas of life | ptsd_18 | N | radio | 1, Yes | 0, No | 9, Unknown | - | - | |
| 19. How long did these symptoms (in the above section ) last? | ptsd_19 | N | text | - | Months | - | |
| 20. When did the traumatic event occur (if several, ask about the event most closely associated with symptoms)? | ptsd_20 | Y | text | - | - | - | |
| 21. When did you start to experience these symptoms (in the above section)? | ptsd_21 | Y | text | - | - | - | |
| 21a. <h6 style="background-color:#DA70D6">INTERVIEWER</h6>: Compute age on onset | ptsd_21a | N | calc | round(datediff([dg_dateofbirth], [ptsd_21], 'y','mdy'),0) | - | - | |
| Notes | post_traumatic_stress_disordercsv_notes | Y | notes | - | - | - |