CDE Detailed Report
Subdomain Name: Mood/Anxiety
CRF: content
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C55142 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - War violence political trauma detail type | UCLAPTSDRIDSM5WrVlcPolTrDtlTyp | The type field for details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying War/Political Violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying War/Political Violence, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | War/Political Violence Trauma Details | Lived in war-torn region;Saw dead bodies;Saw wounded people;Home damaged/destroyed;Internally displaced;War refugee;Other | Lived in war-torn region;Saw dead bodies;Saw wounded people;Home damaged/destroyed;Internally displaced;War refugee;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 08:22:54.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55194 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Feel isolated frequency past month grade | UCLAPTSDRIDSM5FlIsltFqPsMGrade | Grade of frequency during the past month that the subject/participant has felt isolated, 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 isolated, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel alone even when I am around 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55100 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type | UCLAPTSDRIDSM5TraumaDetailTyp | The type of trauma experienced by the subject/participant for which details are being provided, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type of trauma experienced by the subject/participant for which details are being provided, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Trauma Type | Serious Accidental Injury;Community Violence;Domestic Violence;War/Political Violence;School Violence/Emergency;Physical Assault;Sexual Assault/Rape;Disaster;Physical abuse;Psychological Maltreatment/Emotional Abuse;Neglect;Sexual abuse;Impaired Caregiver;Kidnapping/Abduction;Terrorism;Bereavement;Separation;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;Illness/Medical Trauma | Serious Accidental Injury;Community Violence;Domestic Violence;War/Political Violence;School Violence/Emergency;Physical Assault;Sexual Assault/Rape;Disaster;Physical abuse;Psychological Maltreatment/Emotional Abuse;Neglect;Sexual abuse;Impaired Caregiver;Kidnapping/Abduction;Terrorism;Bereavement;Separation;Forced Displacement;Trafficking/Sexual Exploitation;Bullying;Attempted Suicide;Witnessed Suicide;Illness/Medical Trauma | 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 11:52:09.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55119 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Assault physical trauma detail type | UCLAPTSDRIDSM5AsltPhyTrmDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Physical Assault, 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 Physical Assault, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Physical Assault Trauma Details | Punched;Kicked;Stabbed;Shaken;Weapon Used;Reported to CPS;Reported to police;Other | Punched;Kicked;Stabbed;Shaken;Weapon Used;Reported to CPS (if a minor);Reported to police;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 14:15:09.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55153 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide witness trauma detail type | UCLAPTSDRIDSM5ScdWtnTrDtlTyp | The type field for details 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 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) | Witnessed Suicide Trauma Details | Mother;Father;Brother;Sister;Other relative;Other;Close friend;Acquaintance/schoolmate;Stranger | Mother;Father;Brother;Sister;Other relative;Other;Close friend;Acquaintance/schoolmate;Stranger | 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 09:21:06.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55079 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence community witness fear indicator | UCLAPTSDRIDSM5VcCtyWtnsFearInd | Indicator of whether the subject/participant has ever witnessed or feared violence in his or her neighborhood, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever witnessed or feared violence in his or her neighborhood, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Community Violence: Did you ever see a bad fight or shooting in your neighborhood, like between gangs? Were you afraid of getting badly hurt or killed? Have you seen someone mugged, robbed, stabbed or killed in your neighborhood? | 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 10:06:25.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55205 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Depersonalization observer frequency past month grade | UCLAPTSDRIDSM5DprObsFqPMGrade | Grade of frequency during the past month that the subject/participant has experienced depersonalization as though he or she were an outside observer, 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 experienced depersonalization as though he or she were an outside observer, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel like I am seeing myself or what I am doing from outside my body (like watching myself in a movie). | 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55132 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Rape assault sexual trauma detail perpetrator type | UCLAPTSDRIDSM5RpAsSxTrDtPrTyp | The type field for identifying details about the perpetrator related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Sexual Assault/Rape, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for identifying details about the perpetrator related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Sexual Assault/Rape, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Perpetrator | Relative;Position of trust;Acquaintance;Stranger | Relative;Position of trust (teacher, coach, minister);Acquaintance (neighbor etc);Stranger | 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 15:13:35.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55170 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Concentrate difficult frequency past month grade | UCLAPTSDRIDSM5CntDfcFqPsMGrade | Grade of frequency during the past month that the subject/participant has had difficulty concentrating, 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 difficulty concentrating, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have trouble concentrating or paying attention | 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55090 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Kidnap abduct suffer indicator | UCLAPTSDRIDSM5KnpAbdctSfrInd | Indicator of whether the subject/participant has ever been kidnapped or abducted, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever been kidnapped or abducted, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Kidnapping/Abduction: Have you ever been stolen or kidnapped (taken somewhere against your will) by someone without the permission of your parent or legal guardian? | 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 11:21:24.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55230 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom increase difficulty do well school indicator | UCLAPTSDRIDSM5SyInDfDoWlScInd | Indicator of whether the subject/participant's PTSD symptom(s) increase(s) the difficulty he or she has in doing well at school, 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) increase(s) the difficulty he or she has in doing well at school, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) make it harder for you to do well in school? | 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 13:38:45.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55241 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Impairment functional clinically significant indicator | UCLAPTSDRIDSM5FnImClnSigInd | Indicator of whether the subject/participant's symptoms of PTSD cause clinically significant functional impairment, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant's symptoms of PTSD cause clinically significant functional impairment, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Clinically Significant Functional Impairment | False;True | False;True | Alphanumeric |
check if functional impairment at home, at school, in peer relationships, in developmental progression |
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 12:16:54.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55143 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - War violence political trauma detail other text | UCLAPTSDRIDSM5WrVlcPolTrDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - War violence political 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) - War violence political trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | War/Political Violence 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 08:29:51.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 30 |
Free-Form Entry |
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| C55195 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Thought intrusive frequency past month grade | UCLAPTSDRIDSM5ThtIntFqPsMGrade | Grade of frequency during the past month that the subject/participant has had intrusive thoughts about 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 had intrusive thoughts about the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have upsetting thoughts, pictures or sounds of what happened come into my mind when I don't want them to. | 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55101 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma event role type | UCLAPTSDRIDSM5TrmaEvntRolTyp | Type specifying the degree of involvement of the subject/participant with the traumatic event type specified in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Type specifying the degree of involvement of the subject/participant with the traumatic event type specified in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Role in Event | Victim;Witness;Learned about | Victim;Witness;Learned about | 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 12:14:04.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55121 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Assault physical trauma detail other text | UCLAPTSDRIDSM5AstPhyTrmDtlOTH | The free-text field related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Assault physical 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) - Assault physical trauma detail type' specifying other text, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Physical Assault 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 14:19:55.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points | 50 |
Free-Form Entry |
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| C55154 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Suicide witness role type | UCLAPTSDRIDSM5ScdWtnsRolTyp | The type field for details about the subject/participant's degree of involvment related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Witnessed Suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The type field for details about the subject/participant's involvment related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Witnessed Suicide, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Witnessed Suicide Role in Event | Learned about;Witnessed Suicide;Witnessed body/scene | Learned about;Witnessed Suicide;Witnessed body/scene | 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 09:28:02.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55080 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Violence domestic witness indicator | UCLAPTSDRIDSM5VlncDmstWitnsInd | Indicator of whether the subject/participant has ever witnessed violence, or verbal or sexual abuse, between resident adults at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant has ever witnessed violence, or verbal or sexual abuse, between resident adults at home, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Domestic Violence: Have you ever seen adults you live with get in a bad fight with each other, where someone got punched, kicked or hit with something? Have adults you live with threatened to hurt each other? Have you ever seen an adult you live with forced to do something sexual by another adult you live with? | 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 10:16:07.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55206 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Depersonalization detached self frequency past month grade | UCLAPTSDRIDSM5DpDtSfFqPMGrade | Grade of frequency during the past month that the subject/participant has experienced depersonalization as though he or she detached from 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 experienced depersonalization as though he or she detached from him or herself, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I feel not connected to my body, like I'm not really there inside | 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55133 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Rape assault sexual trauma detail type | UCLAPTSDRIDSM5RpAstSxTrDtlTyp | The type field for identifying details related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Sexual Assault/Rape, 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 Sexual Assault/Rape, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Sexual Assault/Rape Trauma Details | Weapon Used;Drug used/suspected;Penetration occurred;Date/Acquaintance rape;Reported to police;Investigation conducted;Charges filed;Conviction;Other | Weapon Used;Drug used/suspected;Penetration occurred;Date/Acquaintance rape;Reported to police;Investigation conducted;Charges filed;Conviction;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 15:28:13.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55173 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Thought negative world frequency past month grade | UCLAPTSDRIDSM5ThNgWlFqPsMGrade | Grade of frequency during the past month that the subject/participant has had overly negative thoughts about the world, 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 overly negative thoughts about the world, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I have thoughts like, 'The world is really dangerous' | 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55091 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Terrorism present for indicator | UCLAPTSDRIDSM5TerismPsntFrInd | Indicator of whether the subject/participant was ever present for an act of terrorism, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Indicator of whether the subject/participant was ever present for an act of terrorism, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Terrorism: Were you ever there when a terrorist attack happened, like a bombing, chemical attack or where people were taken hostage? | 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 11:23:35.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C55231 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Symptom cause problem other school indicator | UCLAPTSDRIDSM5SyCsPrOtScInd | Indicator of whether the subject/participant's PTSD symptom(s) cause him or her problems at school other than increasing the difficulty of doing well, 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 him or her problems at school other than increasing the difficulty of doing well, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Do these reactions (thoughts and feelings) cause other problems at school? | 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 13:38:45.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55242 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - DSM-5 symptom code | UCLAPTSDRIDSM5DSM5SymptmCode | Code identifying the DSM-5 symptom being scored, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Code identifying the DSM-5 symptom being scored, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | DSM-5 Symptom | C1;A1;B1;D1;E1;A2;C2;B2;D2;E2;B3;B4;B5;D3;D4;D5;D6;D7;E3;E4;E5;E6 | C1;A1;B1;D1;E1;A2;C2;B2;D2;E2;B3;B4;B5;D3;D4;D5;D6;D7;E3;E4;E5;E6 | Alphanumeric | 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 14:46:04.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55144 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Displacement forced trauma detail reason | UCLAPTSDRIDSM5DsplcFrcTrDtlRsn | The cause of displacement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Forced Displacement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | The cause of displacement related to 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type' specifying Forced Displacement, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Cause of Displacement | War/Political Violence;Disaster;Other | War/Political Violence;Disaster;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 08:33:22.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C55196 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Blame self exagerrate frequency past month grade | UCLAPTSDRIDSM5BlSfExFqPsMGrade | Grade of frequency during the past month that the subject/participant has exagerratedly blamed him or herself for 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 exagerratedly blamed him or herself for the trauma/loss, as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | I think that part of what happened was my fault | 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/Anxiety | Outcomes and End Points |
Single Pre-Defined Value Selected |
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| C55102 | UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma type experience age value | UCLAPTSDRIDSM5TrmTypExpAgeVal | Values(s) of the age(s) in years of the subject/participant at which he or she was involved with the type of trauma specified in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type', as part of the UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) | Values(s) of the age(s) in years of the subject/participant at which he or she was involved with the type of trauma specified in 'UCLA PTSD Reaction Index DSM-5 (UCLA PTSD-RI DSM-5) - Trauma detail type', as part of the UCLA PTSD Reaction Index DSM-5 (UCL | Age(s) Experienced | 1;3;2;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18 | 1;3;2;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18 | Numeric Values |
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 12:19:53.0 | UCLA PTSD Reaction Index for Children/Adolescents - DSM-5 (UCLA PTSD-RI DSM-5) | Mood/Anxiety | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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