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1/29/2014 DataExplorer - IAN Stats

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Researcher Code Book

Depression History Questionnaire - 1.0.4 (exported at 1/28/2013 6:44:11 AM)

Questionnaire Completion History

Total completed=4783, AssignedCount=11005, ActiveCount=0, PercentCompleted=43.5%

Section 1: History of Depressive Illness

When joining IAN, mothers and fathers of children with autism spectrum disorders answer brief medical history questionnaires. The rate of depression reportedby parents answering these questionnaires has been much higher than expected. This in-depth Depression History Questionnaire is meant to help researchersbetter understand the nature and timing of depression in parents of children on the autism spectrum.

It is important for all parents in IAN to complete this questionnaire, reguardless of whether or not they have a history of depressive illness/symptoms.

Section 1, Question 1 - field name: hx_sad (ItemRefID=2787)

Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty, or depressed?

Coded Value Response

0 No

1 Yes

Section 1, Question 2 - field name: hx_discouraged (ItemRefID=2788)

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Have you ever had a period lasting several days or longer when most of the day you were very discouraged about how things weregoing in your life?


0 No

1 Yes

Section 1, Question 3 - field name: hx_lost_interest (ItemRefID=2789)

Have you ever had a period lasting several days or longer when you lost interest in most things you usually enjoy like work,hobbies, and personal relationships?


0 No

1 Yes

Rule Type Severity Expression TargetItemID Message

SkipRule hx_sad != "1" and hx_discouraged != "1" and hx_lost_interest != "1" 2792

Section 1, Question 4 - field name: age_first_felt_dp (ItemRefID=2790)

When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) youlost interest in most things you usually enjoy...How old were you?

Please enter your age in YEARS to the nearest b irthday.


Value User Entered Coded Value


ValidationRule Warningage_first_felt_dp

> patient.age2541

You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an

incorrect birthdate when you registered, please contact [email protected]



Section 1, Question 5 - field name: hx_see_pro_dp (ItemRefID=2791)

Did you ever see a medical or mental health professional because a) you felt sad, empty or depressed, b) you felt discouragedabout your life, or c) you lost interest in most things you usually enjoy?


0 No

1 Yes

Section 1, Question 6 - field name: dx_dp_pro (ItemRefID=2792)

Have you ever been diagnosed by a medical or mental health professional with a depressive illness (or a mood disorder with adepressive component)?


0 No

1 Yes


SkipRule dx_dp_pro = "0" or dx_dp_pro = null 2797

Section 1, Question 7 - field name: age_first_dx_dp (ItemRefID=2793)

When you were first diagnosed by a medical or mental health professional with a depressive illness...How old were you?







ValidationRule Warningage_first_dx_dp

> patient.age2544

You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, you

may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an


Section 1, Question 8 - field name: type_pro_dp (ItemRefID=2794)

What type of professional first diagnosed you with a depressive illness?


1 Physician other than a psychiatrist (family doctor, internist, etc.)

2 Psychiatrist

3 Psychologist

4 Other Therapist or Counselor

5 Other

Section 1, Question 9 - field name: type_dx_dp_fem (ItemRefID=2795)

(Females only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.

Note: If you are male, you have reached this question in error. Please contact [email protected]


1 Major Depressive Disorder

2 Dysthymic Disorder

3 Postpartum Depression

4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause

5 Seasonal Affective Disorder (SAD)

6 Bipolar Disorder (also known as manic depression)

7 Cyclothymic Disorder



8 Not sure, but it was some type of depression

9 Other


DisableRule patient.gender != "F" 2795

Section 1, Question 10 - field name: type_dx_dp_male (ItemRefID=2796)

(Males only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.

Note: If you are female, you have reached this question in error. Please contact [email protected]








9 Other


DisableRule patient.gender = "F" 2796

SkipRule dx_dp_pro = "1" 2801

Section 1, Question 11 - field name: hx_self_dx_dp (ItemRefID=2797)

Have you ever diagnosed yourself with a depressive illness, perhaps through an internet self-assessment tool, an informationalbrochure at the doctor's office, or symptoms listed in a medication advertisement?


0 No

1 Yes




SkipRule hx_self_dx_dp = "0" or hx_self_dx_dp = null 2801

Section 1, Question 12 - field name: self_dx_type_dp_fem (ItemRefID=2798)

(Females only) Which of the following diagnoses did you give yourself?











9 Other



Section 1, Question 13 - field name: self_dx_type_male (ItemRefID=2799)

(Males only) Which of the following diagnoses did you give yourself?











9 Other



Section 1, Question 14 - field name: reason_no_pro_dx (ItemRefID=2800)

There are many reasons that a person coping with a depressive illness may not see a medical or mental health professional about theircondition. Please tell us why you did not see a medical or mental health professional about your depressive illness. Check all that apply.

(This question refers to reasons for not seeking professional assistance at the time of your self-diagnosis irrespective of any earlier contact with mental health professionals).


1 No insurance for mental health issues

2 Not enough money (whether insured or not)

3 No time

4 No energy

5 Other family member in greater need

6 Fear about impact of diagnosis on future health or life insurance eligibility

7 Worry about what other will think of you

8 Inability to find a medical or mental health professional you trust

9 I did see a professional but they did not diagnose depression

10 Other

Section 1, Question 15 - field name: hx_dp_tx (ItemRefID=2801)

Treatment for depressive symptoms may include medication and/or therapy. Whether or not you have been diagnosed by a medical ormental health professional, have you ever been treated for depressive symptoms?


0 No

1 Yes




SkipRule hx_dp_tx != "1" 2805

Section 1, Question 16 - field name: type_tx_dp (ItemRefID=2802)

Have you used any of the following treatments or techniques to deal with a depressive illness? Check all that apply.


1 Medication

2 Alternative Medicine (herbs, homeopathic remedies, acupuncture, vitamins, etc)

3 Individual Therapy or Counseling (for example, talk therapy or cognitive behavioral therapy)

4 Group Therapy

5 Marital or Family Therapy

6 Support Group, in person

7 Support Group, online

8 Spiritual practice (such as prayer or meditation)

9 Speaking with a pastor, rabbi, etc.

10 Life-style changes (such as diet or exercise)

11 Self-help books

12 Other

Section 1, Question 17 - field name: current_tx_dp (ItemRefID=2803)

Are you currently being treated for depressive symptoms?


0 No

1 Yes



Section 1, Question 18 - field name: hx_hosp_dp (ItemRefID=2804)

Have you ever been hospitalized due to a depressive illness?


0 No

1 Yes

Section 1, Question 19 - field name: hx_thought_hurt_self_dp (ItemRefID=2805)

Have you ever thought about hurting yourself?


0 No

1 Yes

Section 1, Question 20 - field name: hx_attempted_hurtself_dp (ItemRefID=2806)

Have you ever attempted to hurt yourself?


0 No

1 Yes


SkipRule dx_dp_pro != "1" and hx_self_dx_dp != "1" and hx_dp_tx != "1" 2825



Section 1, Question 21 - field name: hx_pattern_dp (ItemRefID=2807)

Over your lifetime, what pattern has your depressive illness tended to have? Check all that apply.


1 I go through long periods of a fairly constant level of depression.

2 There are times when I have energetic "up" periods, and there are times when I have depressed "down" periods.

3 I have had one or more distinct episodes of depression lasting at least 2 weeks.

Section 1, Question 22 - field name: hx_number_dp (ItemRefID=2808)

How many periods of depressive illness do you estimate you have had?


1 1

2 2

3 3

4 4 or more

Section 1, Question 23 - field name: coping_asd_freq_dp (ItemRefID=2809)

In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the frequency of yourdepressive illness?


1 All my periods of depressive illness were associated with coping with my child's ASD.

2 Some of my periods of depressive illness were associated with coping with my child's ASD.

3 None of my periods of depressive illness were associated with coping with my child's ASD.



Section 1, Question 24 - field name: coping_asd_severity_dp (ItemRefID=2810)

In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the severity of yourdepressive illness?


1 Coping with my child's ASD has made my depressive illness much more severe.

2 Coping with my child's ASD has made my depressive illness somewhat more severe.

3 Coping with my child's ASD has had no effect on the severity of my depressive illness.

Section 1, Question 25 - field name: hx_before_children_dp (ItemRefID=2811)

Did you experience a depressive illness before having any children?


0 No

1 Yes


SkipRule hx_before_children_dp = "1" 2813

Section 1, Question 26 - field name: before_asdchild_dp (ItemRefID=2812)

Did you experience a depressive illness before having your child who was later diagnosed with an Autism Spectrum Disorder(ASD)?


0 No

1 Yes



Section 1, Question 27 - field name: first_concern_dp (ItemRefID=2813)

Did you experience a depressive illness as you first became concerned about your child who was later diagnosed with an AutismSpectrum Disorder (ASD)?


0 No

1 Yes

Section 1, Question 28 - field name: twelve_month_dp (ItemRefID=2814)

Did you experience a depressive illness in the twelve months after your child was diagnosed with an ASD?


0 No

1 Yes

Section 1, Question 29 - field name: hx_other_times_dp (ItemRefID=2815)

Did you experience a depressive illness at any of the following times? Check all that apply.


1 At a transition point, such as when your child left elementary school to enter middle school, or left middle school to enter high school.

2 When you came to believe that your child might never "grow out of" having autism.

3 When you were unable to obtain services you felt were crucial for your child's progress.

4 When your child reached a crisis point of some kind either at home or school.



Section 2: Information about Specific Episodes of Depressive Illness

Section 2, Question 1 - field name: length_first_dp (ItemRefID=2816)

Think of the very first time in your life you experienced a depressive illness. How long did this episode last?


1 Less than 1 month

2 1-3 months

3 4-7 months

4 8-12 months

5 More than 1 year

Section 2, Question 2 - field name: prior_life_event_dp (ItemRefID=2817)

Was there something going on in your life shortly before this first experience of depressive illness that you believe contributed to it?Check all that apply.


1 Major job or school related stress

2 Job loss

3 Divorce or end of close relationship

4 Marital or relationship difficulties

5 Abusive relationship

6 Death of a loved one

7 Violent crime (rape, mugging, carjacking, etc.)

8 Illness or injury involving a loved one

9 Illness or injury involving yourself

10 Financial crisis

11 Pregnancy (yours or your partner's)

12 Events related to your child with an Autism Spectrum Disorder

13 Other



Section 2, Question 3 - field name: functioning_first_period_dp (ItemRefID=2818)

Which of the following best describes your functioning during this first period of depressive illness?


1 I was so ill that I needed to spend time in an inpatient clinic or hospital.

2 I was barely able to function, but was not hospitalized.

3 I was somewhat able to function.

4 I functioned fairly well.

Section 2, Question 4 - field name: first_symptoms_dp (ItemRefID=2819)

What type of symptoms did you experience during this first depressive illness? Check all that apply.


1 Feeling sad or empty

2 Loss of interest or pleasure in daily activities

3 Weight loss or gain

4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)

5 Frequent crying

6 Fatigue or low energy

7 Feeling worthless or guilty

8 Inability to concentrate, think, or make decisions

9 Low sex drive

10 Feeling isolated from others

11 Digestive problems

12 Restlessness

13 Loss of interest in interaction with others

14 Loss of appetite or eating too much

15 Slowed speech and physical movement

16 Drop in school or work performance

17 Drug or alcohol abuse



18 Thoughts about death or suicide

Section 2, Question 5 - field name: first_worst_dp (ItemRefID=2820)

Was this first experience of depressive illness also the worst experience of depressive illness that you have had?


0 No

1 Yes


SkipRule first_worst_dp != "0" 2825

Section 2, Question 6 - field name: age_worst_dp (ItemRefID=2821)

Think of your worst experience of depressive illness.Â How old were you when this occurred?







ValidationRule Warningage_worst_dp> patient.age

2573You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an


Section 2, Question 7 - field name: prior_life_event_worst_dp (ItemRefID=2822)

Was there something going on in your life shortly before this worst experience of depressive illness that you believe contributed to it?Check all that apply.



2 Job loss








10 Financial crisis



13 Other

Section 2, Question 8 - field name: functioning_worst_dp (ItemRefID=2823)

Which of the following best describes your functioning during this worst period of depressive illness?








Section 2, Question 9 - field name: type_symptoms_worst_dp (ItemRefID=2824)

What type of symptoms did you experience during this worst depressive illness? Check all that apply.






5 Frequent crying




9 Low sex drive



12 Restlessness









Section 3: History of Manic Illness

Section 3, Question 1 - field name: hx_manic_period (ItemRefID=2825)

Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds gotoo fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as drivingtoo fast or spending too much money. Have you ever had a period like this lasting several days or longer?


0 No

1 Yes


SkipRule hx_manic_period = "0" or hx_manic_period = null 2827

Section 3, Question 2 - field name: age_first_felt_manic (ItemRefID=2826)

When you first experienced a period of elevated mood, decreased need for sleep, racing thoughts, and intense bursts of activity...Howold were you?







ValidationRule Warningage_first_felt_manic> patient.age

2578You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]

Section 3, Question 3 - field name: dx_manic_pro (ItemRefID=2827)

Have you ever been diagnosed by a medical or mental health professional with manic depression, bipolar disorder, or cyclothymia?


0 No

1 Yes


SkipRule dx_manic_pro = "0" or dx_manic_pro = null 2832

Section 3, Question 4 - field name: age_first_dx_manic (ItemRefID=2828)

When you were first diagnosed by a medical or mental health professional with manic depression, bipolar disorder, orcyclothymia...How old were you?





ValidationRule Warningage_first_dx_manic> patient.age

2580You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]



Section 3, Question 5 - field name: type_pro_manic (ItemRefID=2829)

What type of professional first diagnosed you with manic depression, bipolar disorder, or cyclothymia?



2 Psychiatrist

3 Psychologist


5 Other

Section 3, Question 6 - field name: type_dx_pro_manic (ItemRefID=2830)

Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.




3 Other

Section 3, Question 7 - field name: hx_hosp_manic (ItemRefID=2831)

Have you ever been hospitalized due to manic depression, bipolar disorder, or cyclothymia?


0 No

1 Yes



Section 4: Family History

Section 4, Question 1 - field name: hx_family_dp (ItemRefID=2832)

Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a depressive illness, such asMajor Depressive Disorder, Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal AffectiveDisorder (SAD)?


0 No

1 Yes


SkipRule hx_family_dp != "1" 2834

Section 4, Question 2 - field name: hx_bio_rel_dp (ItemRefID=2833)

Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all thatapply.


1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter

7 Maternal grandmother (mother's mother)

8 Maternal grandfather (mother's father)

9 Maternal aunt (mother's sister)

10 Maternal uncle (mother's brother)

11 First cousin on your mother's side

12 Paternal grandmother (father's mother)

13 Paternal grandfather (father's father)

14 Paternal aunt (father's sister)

15 Paternal uncle (father's brother)

16 First cousin on your father's side

17 Other



Section 4, Question 3 - field name: hx_family_manic (ItemRefID=2834)

Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a manic illness, such as BipolarDisorder (also known as Manic Depression)?


0 No

1 Yes


SkipRule hx_family_manic != "1" 2836

Section 4, Question 4 - field name: hx_bio_rel_manic (ItemRefID=2835)

Which of your biological relatives have been diagnosed with or treated for a manic illness, such as Biplar Disorder (also known as ManicDepression)? Check all that apply.


1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter













17 Other

Section 4, Question 5 - field name: hx_family_suicide (ItemRefID=2836)

Has anyone in your immediate or extended biological family ever attempted or committed suicide?


0 No

1 Yes


SkipRule hx_family_suicide != "1" 2838

Section 4, Question 6 - field name: hx_bio_rel_suicide (ItemRefID=2837)

Which of your biological relatives have attempted or committeed suicide? Check all that apply.




1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other

Section 5: ASD and Life Impact

At some point in the future, IAN will launch extensive social and financial impact questionnaires. In the meantime, we are using this section of the DepressionHistory Questionnaire to begin to understand family stess and its impact. In the next section, we will ask briefly about various aspects of raising a child with anASD.

Section 5, Question 1 - field name: impact_childASD_beh (ItemRefID=2838)

To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?

Difficult behaviors of child with an ASD


1 Not at all

2 A little

3 A moderate amount



4 A great deal

5 Not applicable

Section 5, Question 2 - field name: impact_exhaustion (ItemRefID=2839)


Exhaustion due to a child's unusual sleep patterns (refusal to sleep, waking in the middle of the night, extensive bedtimerituals, etc.)


1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable

Section 5, Question 3 - field name: impact_support_difficulty (ItemRefID=2840)


Difficulty getting therapies, educational programs, or support you believe your child needs


1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable



Section 5, Question 4 - field name: impact_disappointment_tx (ItemRefID=2841)


Disappointment when a treatment program did not yield the results you had hoped for


1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable

Section 5, Question 5 - field name: impact_problem_reversal (ItemRefID=2842)


Distress when your child experienced a major problem or reversal in progress at school or in some other area of life


1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable



Section 5, Question 6 - field name: impact_worry_future (ItemRefID=2843)


Worry about your child's future


1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable

Section 5, Question 7 - field name: impact_relationship_partner (ItemRefID=2844)

What impact, if any, has raising a child with an ASD had on the following:

Relationship with spouse or life partner


1 Very positive impact

2 Somewhat positive impact

3 No impact

4 Somewhat negative impact

5 Very negative impact



Section 5, Question 8 - field name: impact_extended_fam (ItemRefID=2845)


Relationship with extended family




3 No impact



Section 5, Question 9 - field name: impact_friendship_social (ItemRefID=2846)


Friendships and social network




3 No impact





Section 5, Question 10 - field name: impact_career_education (ItemRefID=2847)


Your own career or continuing education




3 No impact



Section 5, Question 11 - field name: impact_financial (ItemRefID=2848)


Your financial situation




3 No impact





Questionnaire Scoring

This questionnaire has no scoring defined

Additional Response CodesCoded Value Description

-444 Value is not present. (Skipped without filling in an answer)

-555 No proper value is applicable.

-666 Skipped due to form logic

-777 Patient delayed the answer

-888 Not known

-999 Patient was asked but refused to answer








0 No

1 Yes




0 No

1 Yes




0 No

1 Yes




When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) you



lost interest in most things you usually enjoy...How old were you?






> patient.age2541






0 No

1 Yes




0 No

1 Yes










> patient.age2544







2 Psychiatrist

3 Psychologist


5 Other















9 Other













9 Other







0 No

1 Yes















9 Other















9 Other









3 No time

4 No energy






10 Other




0 No

1 Yes






1 Medication



4 Group Therapy







11 Self-help books

12 Other




0 No

1 Yes




0 No

1 Yes






0 No

1 Yes




0 No

1 Yes


SkipRule dx_dp_pro != "1" and hx_self_dx_dp != "1" and hx_dp_tx != "1" 2763










1 1

2 2

3 3

4 4 or more
















0 No

1 Yes








0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












1 Less than 1 month

2 1-3 months

3 4-7 months

4 8-12 months

5 More than 1 year





2 Job loss








10 Financial crisis



13 Other

















5 Frequent crying




9 Low sex drive



12 Restlessness










0 No

1 Yes


SkipRule first_worst_dp = "1" 2763














2 Job loss








10 Financial crisis



13 Other

















5 Frequent crying




9 Low sex drive



12 Restlessness











0 No

1 Yes









ValidationRule Warningage_first_felt_manic

> patient.age2578

You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,

you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]


Have you ever been diagnosed by a medical or mental health professional with manic depression, bipolar disorder, or cyclothymia?


0 No

1 Yes






When you were first diagnosed by a medical or mental health professional with manic depression, bipolar disorder, orcyclothymia...How old were you?





ValidationRule Warningage_first_dx_manic

> patient.age2580

You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered

an incorrect birthdate when you registered, please contact [email protected]


What type of professional first diagnosed you with manic depression, bipolar disorder, or cyclothymia?



2 Psychiatrist

3 Psychologist


5 Other






3 Other


Have you ever been hospitalized due to manic depression, bipolar disorder, or cyclothymia?


0 No

1 Yes





0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter













17 Other




0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter













17 Other







1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little



3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable







3 No impact









3 No impact











3 No impact









3 No impact









3 No impact










0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












> patient.age2541


may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]




0 No

1 Yes




0 No

1 Yes









ValidationRule Warning age_first_dx_dp> patient.age

2544







2 Psychiatrist

3 Psychologist


5 Other















9 Other













9 Other







0 No

1 Yes















9 Other















9 Other









3 No time

4 No energy






10 Other




0 No

1 Yes






1 Medication



4 Group Therapy







11 Self-help books

12 Other




0 No

1 Yes






0 No

1 Yes




0 No

1 Yes




0 No

1 Yes


SkipRule dx_dp_pro != "1" or hx_self_dx_dp != "1" 2701










1 1

2 2

3 3

4 4 or more
















0 No

1 Yes








0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












1 Less than 1 month

2 1-3 months

3 4-7 months

4 8-12 months

5 More than 1 year





2 Job loss








10 Financial crisis



13 Other

















5 Frequent crying




9 Low sex drive



12 Restlessness










0 No

1 Yes










2573







2 Job loss








10 Financial crisis





13 Other















5 Frequent crying




9 Low sex drive



12 Restlessness











0 No

1 Yes










2578You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered



Have you ever been diagnosed by a medical or mental health professional with a manic illness?




0 No

1 Yes




When you were first diagnosed by a medical or mental health professional with a manic illness...How old were you?









What type of professional first diagnosed you with a manic illness?



2 Psychiatrist

3 Psychologist


5 Other






3 Other


Have you ever been hospitalized due to a manic illness?


0 No

1 Yes





0 No

1 Yes






1 Mother

2 Father



3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son



6 Daughter











17 Other







1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable







1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable







3 No impact









3 No impact











3 No impact









3 No impact









3 No impact










0 No

1 Yes




0 No

1 Yes






0 No

1 Yes










> patient.age2541

You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]




0 No

1 Yes




0 No

1 Yes









ValidationRule Warningage_first_dx_dp> patient.age







2 Psychiatrist

3 Psychologist


5 Other















9 Other













9 Other







0 No

1 Yes















9 Other















9 Other









3 No time

4 No energy






10 Other




0 No

1 Yes






1 Medication



4 Group Therapy







11 Self-help books

12 Other






0 No

1 Yes




0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












1 1

2 2

3 3

4 4 or more


















0 No

1 Yes






0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












1 Less than 1 month

2 1-3 months

3 4-7 months

4 8-12 months

5 More than 1 year





2 Job loss








10 Financial crisis



13 Other

















5 Frequent crying




9 Low sex drive



12 Restlessness










0 No

1 Yes










2573







2 Job loss










10 Financial crisis



13 Other















5 Frequent crying




9 Low sex drive



12 Restlessness











0 No

1 Yes









ValidationRule Warningage_first_felt_manic

> patient.age2578

You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered







0 No

1 Yes









ValidationRule Warning age_first_dx_manic> patient.age

2580







2 Psychiatrist

3 Psychologist


5 Other






3 Other




0 No

1 Yes





0 No

1 Yes




Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all that



apply.


1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes








1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other







1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable







1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable







3 No impact









3 No impact











3 No impact









3 No impact









3 No impact










0 No

1 Yes




0 No

1 Yes






0 No

1 Yes










> patient.age2541





0 No

1 Yes




0 No

1 Yes










> patient.age2544








2 Psychiatrist

3 Psychologist


5 Other


SkipRule patient.gender != "F" 2547













9 Other



SkipRule patient.gender != "M" 2552











9 Other






0 No

1 Yes


SkipRule hx_self_dx_dp = "1" 2550
















9 Other


SkipRule patient.gender = "F" 2552

SkipRule hx_see_pro_dp = "1" 2552











9 Other


SkipRule hx_see_pro_dp = "1" 2552






3 No time

4 No energy





9 Other




0 No

1 Yes






1 Medication



4 Group Therapy









11 Self-help books

12 Other




0 No

1 Yes




0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












1 1

2 2

3 3

4 4 or more


















0 No

1 Yes






0 No

1 Yes




0 No

1 Yes




0 No

1 Yes












1 Less than 1 month

2 1-3 months

3 4-7 months

4 8-12 months

5 More than 1 year





2 Job loss










10 Financial crisis



13 Other















5 Frequent crying




9 Low sex drive



12 Restlessness










0 No

1 Yes










2573You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]







2 Job loss








10 Financial crisis



13 Other















5 Frequent crying




9 Low sex drive



12 Restlessness











0 No

1 Yes












2578






0 No

1 Yes
















2 Psychiatrist

3 Psychologist


5 Other






3 Other




0 No

1 Yes





0 No

1 Yes








1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes






1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other




0 No

1 Yes








1 Mother

2 Father

3 Brother

4 Sister

5 Son

6 Daughter











17 Other







1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little



3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable





1 Not at all

2 A little

3 A moderate amount

4 A great deal

5 Not applicable







3 No impact











3 No impact









3 No impact









3 No impact









3 No impact



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