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Protocol - Emotional Distress

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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

Protocol Name from Source:

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

Availability:

Publicly available

Personnel and Training Required
None
Equipment Needs
None
Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

Adults aged 18 years and older

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.
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 Score 3163035 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Emotional distress proto 62963-4 LOINC
Derived Variables

None

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_Hard_To_Focus PX190601040000 In the past 7 days... I found it hard to focus on anything other than my anxiety 4 N/A
PX190601_I_Felt_Anxious PX190601020000 In the past 7 days... I felt anxious 4 N/A
PX190601_I_Felt_Depressed PX190601130000 In the past 7 days... I felt depressed 4 N/A
PX190601_I_Felt_Fearful PX190601010000 In the past 7 days... I felt fearful 4 N/A
PX190601_I_Felt_Helpless PX190601100000 In the past 7 days... I felt helpless 4 N/A
PX190601_I_Felt_Hopeless PX190601150000 In the past 7 days... I felt hopeless 4 N/A
PX190601_I_Felt_Like_A_Failure PX190601120000 In the past 7 days... I felt like a failure 4 N/A
PX190601_I_Felt_Nervous PX190601050000 In the past 7 days... I felt nervous 4 N/A
PX190601_I_Felt_Sad PX190601110000 In the past 7 days... I felt sad 4 N/A
PX190601_I_Felt_Tense PX190601070000 In the past 7 days... I felt tense 4 N/A
PX190601_I_Felt_Uneasy PX190601060000 In the past 7 days... I felt uneasy 4 N/A
PX190601_I_Felt_Unhappy PX190601140000 In the past 7 days... I felt unhappy 4 N/A
PX190601_I_Felt_Worried PX190601030000 In the past 7 days... I felt worried 4 N/A
PX190601_I_Felt_Worthless PX190601080000 In the past 7 days... I felt worthless 4 N/A
PX190601_I_Got_Enough_Sleep PX190601220000 In the past 7 days... I got enough sleep 4 N/A
PX190601_I_Had_Difficulty_Falling_Asleep PX190601190000 In the past 7 days... I had difficulty falling asleep 4 N/A
PX190601_I_Had_Trouble_Sleeping PX190601210000 In the past 7 days... I had trouble sleeping 4 N/A
PX190601_I_Had_Trouble_Staying_Asleep PX190601200000 In the past 7 days... I had trouble staying asleep 4 N/A
PX190601_My_Sleep_Was_Refreshing PX190601180000 In the past 7 days... My sleep was refreshing 4 N/A
PX190601_My_Sleep_Was_Restless PX190601160000 In the past 7 days... My sleep was restless 4 N/A
PX190601_Nothing_To_Look_Forward_To PX190601090000 In the past 7 days... I felt that I had nothing to look forward to 4 N/A
PX190601_Satisfied_With_My_Sleep PX190601170000 In the past 7 days... I was satisfied with my sleep 4 N/A
PX190601_Sleep_Quality PX190601230000 In the past 7 days... My sleep quality was 4 N/A
Research Domain Information
Measure Name:

Emotional Distress

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.

Keywords

Emotional distress, anxiety, depression, sleep disturbance, Gastrointestinal, PROMIS