CDE Detailed Report
Subdomain Name: Mood%2FAnxiety
CRF: UCLA PTSD Reaction Index for Children
Displaying 101 - 127 of 127
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C55114 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence domestic trauma detail type | UCLAPTSDRIDSM5VcDomTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Domestic Violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Domestic Violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Domestic Violence Trauma Details | Witnessed bad fight;Witnessed sexual assault;Threatened harm;Weapon Used;Serious Injury;Report Filed | Witnessed bad fight;Witnessed sexual assault;Threatened harm;Weapon Used;Serious Injury;Report Filed | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:01:19.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55150 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully trauma detail other text | UCLAPTSDRIDSM5BullyTrDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bully trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Bullying Trauma Details Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:03:18.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55202 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect negative fear frequency past month grade | UCLAPTSDRIDSM5AfNgFrFqPMGrade | Grade of frequency during the past month that the subject/participant has felt fearful, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has felt fearful, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel afraid or scared | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55227 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause other problem home indicator | UCLAPTSDRIDSM5SmCsOthPbHmInd | Indicator of whether the subject/participant's PTSD symptom(s) cause problems other than getting into trouble or difficulty getting along at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's PTSD symptom(s) cause problems other than getting into trouble or difficulty getting along at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) cause some other problem at home? | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:20:54.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55129 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional trauma detail other text | UCLAPTSDRIDSM5AbsPsyEmTrDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional trauma detail type' specifying Psychological Maltreatment/Emotional Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional trauma detail type' specifying Psychological Maltreatment/Emotional Abuse, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM- | Psychological Maltreatment/Emotional Abuse Trauma Details Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:00:04.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55163 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Flashback frequency past month grade | UCLAPTSDRIDSM5FlshbFqPsMoGrade | Grade of frequency during the past month that the subject/participant has had flashbacks of the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has had flashbacks of the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel like I am back at the time when the bad thing happened, like it's happening all over again. | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55087 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Abuse psychological emotional suffer indicator | UCLAPTSDRIDSM5AbsPsyEmoSfrInd | Indicator of whether the subject/participant has ever suffered psychological maltreatment or emotional abuse at home or by his or her family, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever suffered psychological maltreatment or emotional abuse at home or by his or her family, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Psychological Maltreatment/Emotional Abuse: Did anyone in your family ever keep telling you that you are no good, keep yelling at you or keep threatening to or send you away? Were you often punished at home in ways that felt very unfair? | False;True | False;True | Alphanumeric |
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I'm going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:00:54.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55098 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt indicator | UCLAPTSDRIDSM5SuicdAtmptInd | Indicator of whether the subject/participant has ever attempted suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever attempted suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Attempted Suicide: Have you ever tried to kill yourself? | False;True | False;True | Alphanumeric |
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I'm going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:43:30.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55238 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause developmental progress other problem indicator | UCLAPTSDRIDSM5SyCsDvPgOtPrInd | Indicator of whether the subject/participant's PTSD symptom(s) cause(s) problems of developmental progression other than difficulty in doing important things that his or her peers are doing, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's PTSD symptoms cause problems of developmental progression other than difficulty in doing important things that his or her peers are doing, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Other | No;Yes | No;Yes | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment.s |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 14:25:18.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55140 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail death cause other text | UCLAPTSDRIDSM5BvmtTrDtDthCsOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail death reason' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Bereavement trauma detail death reason' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Death Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:56:31.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points | 50 |
Free-Form Entry |
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| C55189 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Irritable aggressive frequency past month grade | UCLAPTSDRIDSM5IrAgFqPsMoGrade | Grade of frequency during the past month that the subject/participant has been irritable or aggressive, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has been irritable or aggressive, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I get upset easily or get into arguments or physical fights | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55117 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - School violence emergency trauma detail type | UCLAPTSDRIDSM5SchVcEmTrDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying School Violence/Emergency, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying School Violence/Emergency, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | School Violence/Emergency Trauma Details | Shooting;Stabbing;Fire;Suicide;Bomb threat;Assault;Other | Shooting;Stabbing;Fire;Suicide;Bomb threat;Assault;Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:07:44.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55151 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt trauma detail method type | UCLAPTSDRIDSM5ScdAtTrDtlMthTyp | The type field for details of method related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Attempted Suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for details of method related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Attempted Suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Method | Drug;Hanging;Drowning;Firearm;Other | Drug;Hanging;Drowning;Firearm;Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:14:21.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55077 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Injury accidental serious indicator | UCLAPTSDRIDSM5InjryAccdlSrsind | Indicator of whether the subject/participant has ever been in or seen an accident in which someone could have been hurt or killed, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever been in or seen an accident in which someone could have been hurt or killed, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Serious Accidental Injury: Have you ever been in a bad accident (like a serious car, bus, train or bicycle accident or a bad fall) where you or someone else was or could have been badly hurt or killed? Have you ever seen a bad accident where someone was badly hurt or killed? | False;True | False;True | Alphanumeric |
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I'm going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 09:43:11.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55203 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Behavior risky frequency past month grade | UCLAPTSDRIDSM5BhvRskFqPMGrade | Grade of frequency during the past month that the subject/participant has engaged in risky behavior, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has engaged in risky behavior, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I do risky or unsafe things that could really hurt me or someone else. | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55228 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause problem home describe text | UCLAPTSDRIDSM5SymCsPrbHmDscTxt | The free-text field for describing problems at home caused by the subject/participant's PTSD symptoms, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field for describing problems at home caused by the subject/participant's PTSD symptoms, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Describe | Alphanumeric |
Clinician: Check whether the reactions (thoughts and feelings) above appear to cause clinically significant distress or functional impairment. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:30:05.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points | 255 |
Free-Form Entry |
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| C55130 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Caregiver impaired trauma detail impairment type | UCLAPTSDRIDSM5CrgvImTrDtIptTyp | The type field for identifying details of the impairement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Impaired Caregiver, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details of the impairement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Impaired Caregiver, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Impairment Due to | Medical illness;Mental health problem;Alcohol use/abuse/addiction;Drug use/abuse/addiction | Medical illness;Mental health problem;Alcohol use/abuse/addiction;Drug use/abuse/addiction | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:02:04.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55164 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect negative disgust frequency past month grade | UCLAPTSDRIDSM5AfNgDgFqPsMGrade | Grade of frequency during the past month that the subject/participant has felt disgust about the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has felt disgust about the trauma or loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel like what happened was sickening or gross | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55088 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Caregiver impaired indicator | UCLAPTSDRIDSM5CrgvrImprdInd | Indicator of whether the subject/participant has ever been dependent upon someone who was unable to care for him or her, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever been dependent upon someone who was unable to care for him or her, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Impaired Caregiver: Was there ever a time when someone who was supposed to take care of you couldn't , like they were too sick, they were so sad they stayed in bed or they had a drinking or drug problem? | False;True | False;True | Alphanumeric |
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I'm going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:04:24.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55099 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide witness indicator | UCLAPTSDRIDSM5SuicdWtnsInd | Indicator of whether the subject/participant has ever seen someone after that person attempted or committed suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever seen someone after that person attempted or committed suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Witnessed Suicide: Have you ever seen someone after he/she attempted or committed suicide? | False;True | False;True | Alphanumeric |
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I'm going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 11:45:21.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55239 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Impairment functional development progression symptom cause indicator | UCLAPTSDRIDSM5ImpFncDvPgSCsInd | Indicator of whether the subject/participant's PTSD symptoms cause functional impairment in his or her developmental progression, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's PTSD symptoms cause functional impairment in his or her developmental progression, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Developmental Progression | False;True | False;True | Alphanumeric |
check if youth endorses #1 [UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom increase difficulty do important thing peer indicator] below |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 13:33:01.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55141 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Separation trauma detail cause type | UCLAPTSDRIDSM5SepTrmDtlCsTyp | The type field for identifying causal details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Separation, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying causal details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Separation, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Separation | Parents divorced;Parents separated;Parent deported;Parent hospitalized;Parent/sibling incarcerated;Child placed in foster care;As refugee, separated from relatives/close friends in country of origin;Other | Parents divorced;Parents separated;Parent deported;Parent hospitalized;Parent/sibling incarcerated;Child placed in foster care;As refugee, separated from relatives/close friends in country of origin;Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 15:58:50.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55191 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Negative assumption self frequency past month grade | UCLAPTSDRIDSM5NgAsSfFqPsMGrade | Grade of frequency during the past month that the subject/participant has made overly negative assumptions about him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has made overly negative assumptions about him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have thoughts like 'I will never be able to trust other people.' | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55118 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - School emergency violence trauma detail other text | UCLAPTSDRIDSM5SchEmVcTrDtlOTH | The free-text field related to | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - School emergency violence trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | School Violence Emergency Trauma Details Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 14:12:17.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points | 50 |
Free-Form Entry |
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| C55152 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt trauma detail method other text | UCLAPTSDRIDSM5ScdAtTrDtlMthOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt trauma detail method type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide attempt trauma detail method type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Method Other | Alphanumeric |
TRAUMA/LOSS DETAILS: For each experience endorsed on the Trauma/Loss History Screening Questions form, place a check mark to indicate whether the specified trauma details were present, whether the child/adolescent was a victim, witness or learned about* the trauma, and the age(s) over which the trauma occurred. (Both of these forms may be updated over the course of treatment as additional information about trauma history is revealed or as additional traumas occur.) *Learned about only refers to indirect exposure in learning aversive details of violent personal assault, homicide, suicide, serious accident, or serious injury to a close relative or friend. It does not include learning about death due to natural causes. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:19:11.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55078 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Illness medical trauma indicator | UCLAPTSDRIDSM5IllnsMdclTrmaInd | Indicator of whether the subject/participant has ever been or seen someone so sick that the subject/participant feared the sick person might die, or has ever had a fearful or painful medical treatment, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever been or seen someone so sick that the subject/participant feared the sick person might die, or has ever had a fearful or painful medical treatment, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA P | Illness/Medical Trauma: Have you ever been so sick that you and your parents (or people taking care of you) were scared that you might die? Did you have a medical treatment that was very scary or painful? Did you ever see someone you really care about get so sick that you were scared they might die? | False;True | False;True | Alphanumeric |
TRAUMA/LOSS HISTORY SCREENING QUESTIONS: Use the questions in the screening form provided below to ask about history of different types of trauma and loss. Place a check mark in the box on the left for each type of trauma /loss experience that has occurred. In interviewing the child/adolescent, you may ask: Sometimes people have scary or violent things that happen to them where someone could have been or was badly hurt or killed. I'm going to ask you some questions about whether any of these kinds of things have happened to you so that you can tell me if they did. [For those children/adolescents able to complete the form on their own, you may instruct them to place a check mark in the box on the left of the screening form to indicate that the trauma/loss has happened to them.] In either case, follow up on those items endorsed using the TRAUMA/LOSS DETAILS form provided in the next section. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-20 09:48:30.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55204 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Affect negative vengeful frequency past month grade | UCLAPTSDRIDSM5AfNgVgFqPMGrade | Grade of frequency during the past month that the subject/participant has felt vengeful regarding the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Grade of frequency during the past month that the subject/participant has felt vengeful regarding the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I want to get back at someone for what happened | 0;1;2;3;4 | None;Little;Some;Much;Most | Numeric Values |
Here is a list of problems people can have after bad things happen. Please think about the bad thing that happened to you that bothers you the most now. For each problem CIRCLE ONE of the numbers (0, 1, 2, 3 or 4) that tells how many days the problem happened to you in the past month, even if the bad thing happened a long time ago. Use the Frequency Rating Sheet to help you decide how many days the problem happened in the past month. |
Steinberg A, Brymer M, Decker K, Pynoos, R. The University of California at Los<br />Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psych Rep.<br />2004;6:96-100. | Pediatric | Exploratory | 1.00 | 2017-04-21 09:53:38.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood%2FAnxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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