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Suicidal Ideation Behavior Reportable Event Form

218 Shared Subjects

N/A
Clinical Assessments
Suicide
04/24/2015
sibre01

View Change History
01
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project id, subject_id, subjectid, subjid
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY adate, date_created, visit_date
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
site String 101 Recommended Site Study Site site_uid
Query visit String 60 Recommended Visit name visit_name
session_id String 20 Recommended session ID/screening ID screeningid
version_form String 121 Recommended Form used/assessment name form_name
Query report_type Integer Recommended Report type: 0;1 0=Initial; 1=Followup
Query sibfunum Integer Recommended SIBRE Follow-up Number
Query aeid Integer Recommended Adverse event identifier sae_id
aeterm String 250 Recommended Verbatim Term sibtrm
sibonst Date Recommended Onset date of SIB:
dtsmprpt Date Recommended Date Symptoms Reported to site
Query sibstday Integer Recommended SIB Day in Study
Query sibevnt Integer Recommended SIB Event 1::10;99 1=Wish to be dead; 2=Non specific active suicidal thoughts; 3=Active suicidal ideation with some intent to act without specific plan; 3=Active suicidal ideation with any methods (not plan) without intent to act; 4=Active suicidal ideation with some intent to act, without specific plan; 5=Active suicidal ideation with specific plan and intent; 6=Acual attempt; 7=Interrupted attempt; 8=Aborted attempt; 9=Preparatory acts or behavior; 10=Completed suicide; 99=Other
sibdscrp String 500 Recommended SIB Description
Query sibemrg Integer Recommended SIB event emergent or worsened from baseline 1;2 1=Yes; 2=No
emrgdscr String 250 Recommended SIB - Treatment emergent explanation
Query sibresrc Integer Recommended SIB info source 1::4;99 1=Scale; 2=Patient interview; 3=Self report; 4=Outside clinician; 99=Other
sibsrcsp String 250 Recommended SIB source other specify
siboutcm String 250 Recommended Outcome (referral, hospitalization, etc)
Query actptnt Integer Recommended Action Taken with Respect to Patient 1;2;99 1=None; 2=Patient discontinued from study; 99=Other
actsp String 250 Recommended Action taken with respect to patient other specify
requestsae String 250 Recommended Request for additional information
comments_misc String 4,000 Recommended Miscellaneous comments on study, interview, methodology relevant to this form data addlinfo
reason_for_rejection String 250 Recommended Please, specify reason for rejection or disapproval:
parent_id String 20 Recommended Parent ID
Query study_id Integer Recommended Study ID number 46=Acute Phase; 47=Stabilization Phase
Query suicatt_age Integer Recommended Age at lifetime suicide attempt age
Query medthreat Integer Recommended Medical threat of worst suicide attempt 0::7; -9 0=No information; 1=No danger; 2=Minimal danger; 3=Mild danger; 4=Moderate danger; 5=Severe danger; 6=Extreme danger; 7=Death; -9 =Missing/NA medthreat1
Query currentepi Integer Recommended Suicide attempt: current episode? 0;1; -9 0=No; 1=Yes; -9=unknown
Query lvnmacat Integer Recommended Suicidal Behavior. Since Last Visit number of actual attempts -900 = Missing; -300 = N/A suic1
Query sbeh1 Integer Recommended Self-injurious/suicidal behavior Number
Query intent1 Integer Recommended Self-injurious/suicidal behavior Intent 0::6 0 = No information; 1 = Obviously no intent; 2 = Only minimal intent; 3 = Definite but still ambivalent; 4 = Serious; 5 = Very serious; 6 = Extreme (e.g., careful planning and every expectation of death)
Query comm Integer Recommended Prior to the most severe self-injurious/suicidal behavior, did he/she have direct communication with other regarding the behavior 0;1; 999 0 = No; 1 = Yes; 999 = Not Applicable/Missing
Query sibre_int Integer Recommended Intoxicated during self-injurious/suicidal behavior 0;1 0 = No; 1 = Yes int
Query sibre_med Integer Recommended On medication during self-injurious/suicidal behavior 0;1 0 = No; 1 = Yes med
Query sibre_tx Integer Recommended In treatment during self-injurious/suicidal behavior 0 = No; 1 = Yes tx
Query pcoshosp Integer Recommended patient hospitalized 0;1;-7 0=No; 1=Yes; -7=Refused hosp
Query levent Integer Recommended Any siginificant life event(s) in six months prior to self-injurious/suicidal behavior 0;1 0 = No; 1 = Yes
spevent String 50 Recommended If any significant life event(s) in six months prior to the self-injurious/suicidal behavior, specify
Query cord Integer Recommended Confused or disorganized during self-injurious/suicidal behavior 0;1 0 = No; 1 = Yes
Query dorh Integer Recommended Delusional or hallucinating during self-injurious/suicidal behavior 0;1 0 = No; 1 = Yes
Query other_impairment Integer Recommended Other impairment during self-injurious/suicidal behavior 0;1 0 = No; 1 = Yes other
Query suiciage Integer Recommended How old was the subject during the most severe suicide attempt? (specify age in years) gage
deathdate1 Date Recommended Date of death MM/DD/YYYY ddate
Query age_at_death_months Integer Recommended Age at death in months dage
lthldt String 25 Recommended Most lethal attempt date gdate
primary_cause_death String 200 Recommended Primary cause of death cause
Query methodsuicide Integer Recommended Method of suicide 1::17 1 = Firearm,2 = Hanging,3 = Jumping,4 = Drowning,5 = Stabbing,6 = Carbon Monoxide,7 = Overdose,8 = Cutting,9 = Car Accident,10 = Other; 11 = Ingestion of toxic substance; 12 = Burning;13=Drugs w/ Sedative Effects - BDZ/HYP; 14=Drugs w/ Sedative - Unknown; 15=Drugs w/out Sedative Effects/Ingested Suicide; 16=2h = Drugs w/out Sedative Effects/Ingested Suicide; 17=Shooting method1
dsmvers String 10 Recommended version/name of assessment form
Query bsit0 Float Recommended Weeks from Time 0/baseline to assessment week1
Query monthsbl Float Recommended Actual number of months from Baseline
csdeath String 255 Recommended Cause of death spother
suicsp String 50 Recommended If death of suicide, specify
death017 String 500 Recommended Immediate cause of death (Final disease or condition resulting in death) catofmed
Query bsimo Float Recommended Months from Time 0 to assessment monfol
Query month1 Integer Recommended Months since Time 0 to suicidal/self-injurious act
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

  • Use the search bar to filter the elements displayed. This will not filter on the Size of Required columns
  • Download a copy of this definition in CSV format
  • Download a blank CSV submission template prepopulated with the correct structure header rows ready to fill with subject records and upload

Please email the The NDA Help Desk with any questions.