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Protocol - Emotional Distress

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Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Description:

This set of questions from the PROMIS© Version 1.0 item banks measure self-reported emotional anxiety, depression, and sleep disturbance. Each question is measured on a five-point scale asking the respondent to reflect on the past 7 days.

Protocol:

Anxiety

Please respond to each item by marking one box.

In the past 7 days...

1. I felt fearful

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

2. I felt anxious

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

3. I felt worried

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

4. I found it hard to focus on anything other than my anxiety

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

5. I felt nervous

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

6. I felt uneasy

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

7. I felt tense

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

Depression

Please respond to each item by marking one box.

In the past 7 days....

8. I felt worthless

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

9. I felt that I had nothing to look forward to

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

10. I felt helpless

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

11. I felt sad

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

12. I felt like a failure

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

13. I felt depressed

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

14. I felt unhappy

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

15. I felt hopeless

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

Sleep Disturbance

Please respond to each item by marking one box.

In the past 7 days...

16. My sleep was restless

[ ] 1 Not at all

[ ] 2 A little bit

[ ] 3 Somewhat

[ ] 4 Quite a bit

[ ] 5 Very much

17. I was satisfied with my sleep

[ ] 5 Not at all

[ ] 4 A little bit

[ ] 3 Somewhat

[ ] 2 Quite a bit

[ ] 1 Very much

18. My sleep was refreshing

[ ] 5 Not at all

[ ] 4 A little bit

[ ] 3 Somewhat

[ ] 2 Quite a bit

[ ] 1 Very much

19. I had difficulty falling asleep

[ ] 1 Not at all

[ ] 2 A little bit

[ ] 3 Somewhat

[ ] 4 Quite a bit

[ ] 5 Very much

In the past 7 days…

20. I had trouble staying asleep

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

21. I had trouble sleeping

[ ] 1 Never

[ ] 2 Rarely

[ ] 3 Sometimes

[ ] 4 Often

[ ] 5 Always

22. I got enough sleep

[ ] 5 Never

[ ] 4 Rarely

[ ] 3 Sometimes

[ ] 2 Often

[ ] 1 Always

In the past 7 days…

23. My sleep quality was

[ ] 5 Very poor

[ ] 4 Poor

[ ] 3 Fair

[ ] 2 Good

[ ] 1 Very good

© 2008 PROMIS Health Organization and PROMIS Cooperative Group

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

Specific Instructions:

Additional information about PROMIS© instruments—including bank development history, available banks and short forms, domain definitions, administration, scoring, validity, and interpretation—is available on the PROMIS© website: http://www.nihpromis.org.
Research Domain Information

Release Date:

December 13, 2010

Definition

This is a measure to assess emotional distress in the past 7 days.

Purpose

This measure can be used to assess a respondent's level of emotional distress, which can have a direct impact on gastrointestinal disorders and other physical problems.

Selection Rationale

The PROMIS© protocols have been tested and have been found to be reliable and comparable to established measures of these same content areas. Additionally, they are quick and easy to administer, providing for a variety of user options.

Language

Czech, English, French, German, Hungarian, Italian, Polish, Spanish

Standards

StandardNameIDSource
Common Data Elements (CDE)Person Emotional Distress Assessment Score3163035CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Emotional distress proto62963-4LOINC

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

U.S. Department of Health and Human Services. National Institutes of Health (NIH). PROMIS© Item Bank v.1.0—Emotional Distress–Anxiety Short Form 1. PROMIS© Item Bank v. 1.0—Emotional Distress–Depression Short Form 1. PROMIS© Item Bank v. 1.0—Sleep Disturbance.

General References

None

Protocol ID:

190601

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX190601_I_Felt_FearfulPX190601010000In the past 7 days... I felt fearful4N/A
PX190601_I_Felt_AnxiousPX190601020000In the past 7 days... I felt anxious4N/A
PX190601_I_Felt_WorriedPX190601030000In the past 7 days... I felt worried4N/A
PX190601_Hard_To_FocusPX190601040000In the past 7 days... I found it hard to focus on anything other than my anxiety4N/A
PX190601_I_Felt_NervousPX190601050000In the past 7 days... I felt nervous4N/A
PX190601_I_Felt_UneasyPX190601060000In the past 7 days... I felt uneasy4N/A
PX190601_I_Felt_TensePX190601070000In the past 7 days... I felt tense4N/A
PX190601_I_Felt_WorthlessPX190601080000In the past 7 days... I felt worthless4N/A
PX190601_Nothing_To_Look_Forward_ToPX190601090000In the past 7 days... I felt that I had nothing to look forward to4N/A
PX190601_I_Felt_HelplessPX190601100000In the past 7 days... I felt helpless4N/A
PX190601_I_Felt_SadPX190601110000In the past 7 days... I felt sad4N/A
PX190601_I_Felt_Like_A_FailurePX190601120000In the past 7 days... I felt like a failure4N/A
PX190601_I_Felt_DepressedPX190601130000In the past 7 days... I felt depressed4N/A
PX190601_I_Felt_UnhappyPX190601140000In the past 7 days... I felt unhappy4N/A
PX190601_I_Felt_HopelessPX190601150000In the past 7 days... I felt hopeless4N/A
PX190601_My_Sleep_Was_RestlessPX190601160000In the past 7 days... My sleep was restless4N/A
PX190601_Satisfied_With_My_SleepPX190601170000In the past 7 days... I was satisfied with my sleep4N/A
PX190601_My_Sleep_Was_RefreshingPX190601180000In the past 7 days... My sleep was refreshing4N/A
PX190601_I_Had_Difficulty_Falling_AsleepPX190601190000In the past 7 days... I had difficulty falling asleep4N/A
PX190601_I_Had_Trouble_Staying_AsleepPX190601200000In the past 7 days... I had trouble staying asleep4N/A
PX190601_I_Had_Trouble_SleepingPX190601210000In the past 7 days... I had trouble sleeping4N/A
PX190601_I_Got_Enough_SleepPX190601220000In the past 7 days... I got enough sleep4N/A
PX190601_Sleep_QualityPX190601230000In the past 7 days... My sleep quality was4N/A