|
|
baseline_a_002 |
String |
100
|
Recommended |
Interview Start Time: |
|
|
|
| Query
|
baseline_b_001 |
Integer |
|
Recommended |
What is the highest grade you completed in school? |
0::5; -888; -999
|
0=Less than high school graduate; 1=High schoolgraduate; 2=Vocational/tech training graduate; 3=Some college; 4=College graduate; 5=Anypost-graduate work(masters-doctorate); -888=Not Applicable; -999=Missing;
|
sod013_wk3 |
| Query
|
hispanic |
Integer |
|
Recommended |
Is subject of Hispanic, Latino, or Spanish origin? |
0; 1; 999
|
0 = No; 1 = Yes; 999= missing
|
baseline_b_002 |
|
|
ethnic_group |
String |
255
|
Recommended |
Ethnic group |
|
|
baseline_b_004, sod012_wk3 |
| Query
|
enrollmentdate |
Integer |
|
Recommended |
EnrollmentDate |
|
|
|
| Query
|
interview_end |
Integer |
|
Recommended |
Date/time of end of interview |
|
|
|
| Query
|
interview_end_dt |
Integer |
|
Recommended |
Date of end of interview |
|
|
|
| Query
|
interview_end_tm |
Integer |
|
Recommended |
Time of end of interview |
|
|
|
| Query
|
interview_start |
Integer |
|
Recommended |
Date/time of start of interview |
|
|
|
| Query
|
interview_start_dt |
Integer |
|
Recommended |
Date of start of interview |
|
|
|
| Query
|
interview_start_tm |
Integer |
|
Recommended |
Time of start of interview |
|
|
|
| Query
|
sod001_wk3 |
Integer |
|
Recommended |
Relationship with Patient |
1::8; -888;-999
|
1=Spouse/partner; 2=Daughter/Son; 3=Father/Mother; 4=Sibling; 5=Other Family member (grandparent, aunt, uncle, etc); 6=Roomate; 7=Friend; 8=Other; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_b_005 |
Integer |
|
Recommended |
Do you consider yourself to be |
1::5; -888; -999
|
1=Heterosexual or straight; 2=Gay or Lesbian; 3=Bisexual; 4=Refused; 5=Other; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_b_006 |
Integer |
|
Recommended |
Do you have a primary care provider, like a family doctor, internist, or nurse practitioner? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_b_007_1 |
Integer |
|
Recommended |
What is your employment status? Employed full-time |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___1, sod015_wk3 |
| Query
|
baseline_b_007_2 |
Integer |
|
Recommended |
What is your employment status? Employed part-time |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___2, sod016_wk3 |
| Query
|
baseline_b_007_3 |
Integer |
|
Recommended |
What is your employment status? No paid employment |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___3, sod017_wk3 |
| Query
|
baseline_b_007_4 |
Integer |
|
Recommended |
What is your employment status? Student |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___4, sod018_wk3 |
| Query
|
baseline_b_007_5 |
Integer |
|
Recommended |
What is your employment status? Retired |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___5, sod019_wk3 |
| Query
|
baseline_b_007_6 |
Integer |
|
Recommended |
What is your employment status? Physically / Mentally disabled |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___6, sod020_wk3 |
| Query
|
baseline_b_007_7 |
Integer |
|
Recommended |
What is your employment status? Other (specify) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_b_007___7, sod021_wk3 |
|
|
baseline_b_008 |
String |
500
|
Recommended |
If Other, please specify |
|
|
sod022_wk3 |
| Query
|
baseline_b_009 |
Integer |
|
Recommended |
What is your current marital status? |
1::5; -888; -999
|
1=Never married; 2=Married; 3=Widowed; 4=Divorced; 5=Other (specify); -888=Not Applicable; -999=Missing;
|
sod023_wk3 |
|
|
baseline_b_010 |
String |
100
|
Recommended |
If Other, please specify |
|
|
sod024_wk3 |
| Query
|
baseline_b_011 |
Integer |
|
Recommended |
Do you live alone? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_b_012 |
Integer |
|
Recommended |
Has someone close to you died within the past 3 months? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_001 |
Integer |
|
Recommended |
Now I would like to talk with you about your suicidal thoughts and actions over the past week, including today. At any time during the past week, including today, did you wish you were dead or wish yo |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_002 |
Integer |
|
Recommended |
At any time during the past week, including today, have you actually had any thoughts of killing yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_003 |
Integer |
|
Recommended |
At any time during the past week, including today, have you thought about HOW you might do this? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_004 |
Integer |
|
Recommended |
What way did you think of most often to kill yourself? |
1::6; -888;-999
|
1=Medication; 2=Hanging; 3=Jumping; 4=A gun; 5=Cutting; 6=Other; -888=Not Applicable; -999=Missing;
|
|
|
|
baseline_c_004_a |
String |
500
|
Recommended |
If Other, please describe |
|
|
|
| Query
|
baseline_c_005 |
Integer |
|
Recommended |
At any time during the past week, including today, have you had any intention of acting on these thoughts of killing yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_006 |
Integer |
|
Recommended |
At any time during the past week, including today, have you started to work out, or actually worked out, the details of how to kill yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_007 |
Integer |
|
Recommended |
At any time during the past week, including today, did you intend to carry out this plan? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_008 |
Integer |
|
Recommended |
Over the past week, including today, how often did these thoughts of killing yourself or of wanting to go to sleep and never wake up occur? |
1::4; -888; -999
|
1=Once a week; 2=2-5 times in a week; 3=Daily or almost daily; 4=Many times each day; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_009 |
Integer |
|
Recommended |
Over the past week, including today, how long did the thoughts last? |
1::5; -888; -999
|
1=Fleeting-few seconds or minutes; 2=Less than1hour; 3=1-4 hours; 4=4-8 hours; 5=More than 8 hours; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_010 |
Integer |
|
Recommended |
Over the past week, including today, did you try to stop thinking about killing yourself or going to sleep and not waking up? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_011 |
Integer |
|
Recommended |
How easily could you control or stop these thoughts? (INTERVIEWER NOTE: placard available for patient reference) |
1::5; -888; -999
|
1=Easily able to control thoughts; 2=Can control thoughts with little difficulty; 3=Can control thoughts with some difficulty; 4=Can control thoughts with a lot of difficulty; 5=Unable to control thoughts; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_012 |
Integer |
|
Recommended |
Did you think about things like family, religion, or fear of pain or death that might affect your wish to be dead or to go to sleep and not wake up? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_013 |
Integer |
|
Recommended |
Choose one of the following statements that best describes whether anyone or anything did or did not stop you from attempting to kill yourself. (INTERVIEWER NOTE: placard available for patient refer |
1::5; -888; -999
|
1=Something definitely stopped you from attempting suicide; 2=Something probably stopped you; 3=Uncertain whether something stopped you; 4=Something most likely did not stop you; 5=Something definitely did not stop you; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_014 |
Integer |
|
Recommended |
When you thought about killing yourself or going to sleep and not waking up, did you have a reason in mind like ending your pain or getting attention or revenge? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_015 |
Integer |
|
Recommended |
What sort of reasons did you have for thinking about wanting to die? Was it to end the pain or stop the way you were feeling, in other words you couldnt go on living with this pain or how you were fee |
1::5; -888; -999
|
1=It was completely to get attention, revenge or are action from others; 2=It was mostly to get attention, revenge or are action from others; 3=It was equally to get attention, revenge or are action from others and to end or stop the pain; 4=It was mostly to end or stop the pain; 5=It was completely to end or stop the pain; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_c_016 |
Integer |
|
Recommended |
Was this past week, including today, the most suicidal youve ever been in your life? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_complete |
Integer |
|
Recommended |
Complete? |
|
0=Incomplete; 1=Unverified; 2=Complete; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_d_001 |
Integer |
|
Recommended |
Now I am going to ask you about your suicidal thoughts over your entire lifetime. When you were feeling most suicidal, did you wish you were dead or wish you could go to sleep and not wake up? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_d_002 |
Integer |
|
Recommended |
When you were feeling most suicidal, did you actually have any thoughts of killing yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_d_003 |
Integer |
|
Recommended |
When you were feeling most suicidal, did you think about how you might do this? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_d_004 |
Integer |
|
Recommended |
What way did you think of to kill yourself most often? |
1::6; -888;-999
|
1=Medication; 2=Hanging; 3=Jumping; 4=A gun; 5=Cutting; 6=Other; -888=Not Applicable; -999=Missing;
|
|
|
|
baseline_d_004_a |
String |
500
|
Recommended |
If Other, please describe |
|
|
|
| Query
|
baseline_d_005 |
Integer |
|
Recommended |
When you were feeling most suicidal, did you have any intention of acting on these thoughts of killing yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_d_006 |
Integer |
|
Recommended |
When you were feeling most suicidal, did you start to work out, or actually work out, the details of how to kill yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_d_007 |
Integer |
|
Recommended |
At the time, did you intend to carry out this plan? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_001 |
Integer |
|
Recommended |
At any time in your life, including today, have you made a suicide attempt? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_002 |
Integer |
|
Recommended |
How many suicide attempts have you made in your lifetime, including today? |
|
|
|
| Query
|
baseline_e_003 |
Integer |
|
Recommended |
How many of these attempts occurred in the past week, including today? |
|
|
|
| Query
|
baseline_e_004 |
Integer |
|
Recommended |
Is your current visit due to a suicide attempt? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_005 |
Integer |
|
Recommended |
Now think about your most serious attempt. During your most serious attempt, were you trying to end your life? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_006 |
Integer |
|
Recommended |
Did you want to die, even a little, during your most serious attempt? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_007 |
Integer |
|
Recommended |
Did you think it was possible that you could have died from what you did during your most serious attempt? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_008 |
Integer |
|
Recommended |
So then did you do it purely for other reasons without ANY intention of killing yourself, like to relieve stress, feel better, get sympathy, or get something else to happen to you? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_009_1 |
Integer |
|
Recommended |
During your most serious attempt, how did you try to kill yourself? Medication |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_009___1 |
| Query
|
baseline_e_009_2 |
Integer |
|
Recommended |
During your most serious attempt, how did you try to kill yourself? Hanging |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_009___2 |
| Query
|
baseline_e_009_3 |
Integer |
|
Recommended |
During your most serious attempt, how did you try to kill yourself? Jumping |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_009___3 |
| Query
|
baseline_e_009_4 |
Integer |
|
Recommended |
During your most serious attempt, how did you try to kill yourself? A gun |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_009___4 |
| Query
|
baseline_e_009_5 |
Integer |
|
Recommended |
During your most serious attempt, how did you try to kill yourself? Cutting |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_009___5 |
| Query
|
baseline_e_009_6 |
Integer |
|
Recommended |
During your most serious attempt, how did you try to kill yourself? Other |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_009___6 |
|
|
baseline_e_009_a |
String |
500
|
Recommended |
If Other, please describe |
|
|
baseline_e_009___a |
| Query
|
baseline_e_010 |
Integer |
|
Recommended |
As a result of your most serious attempt, were you injured more seriously than surface scratches or mild nausea? |
0;1; -888; -999
|
0=No, only minor injury; 1=Yes, more than minor injury; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_011_1 |
Integer |
|
Recommended |
As a result of your most serious attempt, did you receive any of the following? Treatment by a doctor in an outpatient setting, lik |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_011___1 |
| Query
|
baseline_e_011_2 |
Integer |
|
Recommended |
As a result of your most serious attempt, did you receive any of the following? Treatment in an emergency room |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_011___2 |
| Query
|
baseline_e_011_3 |
Integer |
|
Recommended |
As a result of your most serious attempt, did you receive any of the following? Admission to a MEDICAL hospital (stayed overnight) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_011___3 |
| Query
|
baseline_e_011_4 |
Integer |
|
Recommended |
As a result of your most serious attempt, did you receive any of the following? Admission to a PSYCHIATRIC or SUBSTANCE ABUSE hospi |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_011___4 |
| Query
|
baseline_e_011_5 |
Integer |
|
Recommended |
As a result of your most serious attempt, did you receive any of the following? Other medical attention |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_011___5 |
|
|
baseline_e_011_a |
String |
100
|
Recommended |
If Other, please specify |
|
|
baseline_e_011___a |
| Query
|
baseline_e_012 |
Integer |
|
Recommended |
Did your injury cause you to be extremely drowsy, or result in broken bones, or severe bleeding? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_013 |
Integer |
|
Recommended |
As a result of your most serious attempt, were you unconscious from an overdose, or did you suffer extensive blood loss that required a transfusion, or severe damage to your head or a vital organ? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_014 |
Integer |
|
Recommended |
Were you injured so severely that you needed treatment in an intensive care unit? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_015 |
Integer |
|
Recommended |
Did you suffer permanent physical damage from which you will never completely recover, such as paralysis or disfigurement? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_016 |
Integer |
|
Recommended |
Although you werent injured, how serious could your injuries have been? Would you say: |
1::3; -888; -999
|
1=What I did was not likely to cause injury; 2=What I did was likely to cause physical injury but not death; 3=What I did was likely to cause death with or without medica lhelp, for example trying to shoot yourself in the head but the gun failed to fire; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_017 |
Integer |
|
Recommended |
Did the most serious suicide attempt weve been discussing happen during the past week, including today? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_018 |
Integer |
|
Recommended |
During you most recent attempt, were you trying to end your life? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_019 |
Integer |
|
Recommended |
Did you want to die, even a little, during your most recent attempt? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_020 |
Integer |
|
Recommended |
Did you think it was possible that you could have died from what you did during your most recent attempt? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_021 |
Integer |
|
Recommended |
So then did you do it purely for other reasons without ANY intention of killing yourself, like to relieve stress, feel better, get sympathy, or get something else to happen to you? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_022_1 |
Integer |
|
Recommended |
During your most recent attempt, how did you try to kill yourself? Medication |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_022___1 |
| Query
|
baseline_e_022_2 |
Integer |
|
Recommended |
During your most recent attempt, how did you try to kill yourself? Hanging |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_022___2 |
| Query
|
baseline_e_022_3 |
Integer |
|
Recommended |
During your most recent attempt, how did you try to kill yourself? Jumping |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_022___3 |
| Query
|
baseline_e_022_4 |
Integer |
|
Recommended |
During your most recent attempt, how did you try to kill yourself? A gun |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_022___4 |
| Query
|
baseline_e_022_5 |
Integer |
|
Recommended |
During your most recent attempt, how did you try to kill yourself? Cutting |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_022___5 |
| Query
|
baseline_e_022_6 |
Integer |
|
Recommended |
During your most recent attempt, how did you try to kill yourself? Other |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_022___6 |
|
|
baseline_e_022_a |
String |
100
|
Recommended |
If Other, please describe |
|
|
baseline_e_022___a |
| Query
|
baseline_e_023 |
Integer |
|
Recommended |
As a result of your most recent attempt, were you injured more seriously than surface scratches or mild nausea? |
0;1; -888; -999
|
0=No, only minor injury; 1=Yes, more than minor injury; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_024_1 |
Integer |
|
Recommended |
As a result of your most recent attempt, did you receive any of the following: Treatment by a doctor in an outpatient setting, like |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_024___1 |
| Query
|
baseline_e_024_2 |
Integer |
|
Recommended |
As a result of your most recent attempt, did you receive any of the following: Treatment in an emergency room |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_024___2 |
| Query
|
baseline_e_024_3 |
Integer |
|
Recommended |
As a result of your most recent attempt, did you receive any of the following: Admission to a MEDICAL hospital (stayed overnight) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_024___3 |
| Query
|
baseline_e_024_4 |
Integer |
|
Recommended |
As a result of your most recent attempt, did you receive any of the following: Admission to a PSYCHIATRIC or SUBSTANCE ABUSE hospit |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_024___4 |
| Query
|
baseline_e_024_5 |
Integer |
|
Recommended |
As a result of your most recent attempt, did you receive any of the following: Other medical attention (specify) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_e_024___5 |
|
|
baseline_e_024a |
String |
100
|
Recommended |
If other, please describe |
|
|
|
| Query
|
baseline_e_025 |
Integer |
|
Recommended |
Did your injury cause you to be extremely drowsy, or result in broken bones, or severe bleeding? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_026 |
Integer |
|
Recommended |
As a result of your most recent attempt, were you unconscious from an overdose, or did you suffer extensive blood loss that required a transfusion, or severe damage to your head or a vital organ? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_027 |
Integer |
|
Recommended |
Were you injured so severely that you needed treatment in an intensive care unit? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_028 |
Integer |
|
Recommended |
Did you suffer permanent physical damage from which you will never completely recover, such as paralysis or disfigurement? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_029 |
Integer |
|
Recommended |
Although you werent injured, how serious could your injuries have been? Would you say: |
1::3; -888; -999
|
1=What I did was not likely to cause injury; 2=What I did was likely to cause physical injury but not death; 3=What I did was likely to cause death with or without medica lhelp, for example trying to shoot yourself in the head but the gun failed to fire; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_030 |
Integer |
|
Recommended |
In your lifetime, including today, has there ever been a time when you started to do something to end your life but someone or something stopped you before you actually did anything? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_031 |
Integer |
|
Recommended |
How many times were you stopped by someone or something in your lifetime, including today? |
|
|
|
| Query
|
baseline_e_032 |
Integer |
|
Recommended |
How many of these interrupted attempts occurred in the past week, including today? |
|
|
|
| Query
|
baseline_e_033 |
Integer |
|
Recommended |
In your lifetime, including today, has there ever been a time when you started to do something to try to end your life but you stopped yourself before you actually did anything? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_034 |
Integer |
|
Recommended |
How many times did you stop yourself from ending your life? |
|
|
|
| Query
|
baseline_e_035 |
Integer |
|
Recommended |
How many of these stopped attempts occurred in the past week, including today? |
|
|
|
| Query
|
baseline_e_036 |
Integer |
|
Recommended |
In your lifetime, including today, have you ever taken any steps towards making a suicide attempt or preparing to kill yourself, such as collecting pills, getting a gun, giving valuables away or writi |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_e_037 |
Integer |
|
Recommended |
About how many times have you done this? |
|
|
|
| Query
|
baseline_e_038 |
Integer |
|
Recommended |
How many of these occurred in the past week, including today? |
|
|
|
| Query
|
baseline_f_001 |
Integer |
|
Recommended |
Have you ever intentionally cut, scratched, burned, or beaten yourself, without wanting to kill yourself? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_f_002 |
Integer |
|
Recommended |
Have you engaged in this behavior in the past week? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_f_003 |
Integer |
|
Recommended |
How many times have you done this in the past week? |
|
|
|
| Query
|
baseline_f_004_1 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Cut Self |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___1 |
| Query
|
baseline_f_004_2 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Scratched Self |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___2 |
| Query
|
baseline_f_004_3 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Beat Self/Bang |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___3 |
| Query
|
baseline_f_004_4 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Burned Self |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___4 |
| Query
|
baseline_f_004_5 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Carved Designs |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___5 |
| Query
|
baseline_f_004_6 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Placed/Stuck I |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___6 |
| Query
|
baseline_f_004_7 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Picked Scabs/S |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___7 |
| Query
|
baseline_f_004_8 |
Integer |
|
Recommended |
In your lifetime, which of the following things have you done to intentionally hurt yourself? Other |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_f_004___8 |
|
|
baseline_f_004_a |
String |
100
|
Recommended |
If Other, please specify |
|
|
baseline_f_004___a |
| Query
|
baseline_f_005 |
Integer |
|
Recommended |
Including all of your self-harm behaviors, how many times have you intentionally injured yourself, without the desire to die, in your lifetime. |
|
|
|
| Query
|
baseline_g_001 |
Integer |
|
Recommended |
Are any firearms currently kept in or around your home? |
0::4; -888; -999
|
0=No; 1=Yes; 3=DontKnow; 4=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_g_002 |
Integer |
|
Recommended |
Do any of these firearms belong to you personally? |
0::4; -888; -999
|
0=No; 1=Yes; 3=DontKnow; 4=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_g_003 |
Integer |
|
Recommended |
Are any of the firearms kept loaded and unlocked? |
0::4; -888; -999
|
0=No; 1=Yes; 3=DontKnow; 4=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_g_004 |
Integer |
|
Recommended |
Do you have access to any of the firearms, or are they stored in such a way that you cant use them? |
1::4; -888; -999
|
1=Easy access; 2=Can access with difficulty; 3=No access; 4=Unknown/refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_i_001 |
Integer |
|
Recommended |
Over the past 12 months, have you used drugs other than those required for medical reasons? |
0;1; -888; -999;9999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing; 9999=no data
|
|
| Query
|
baseline_i_002_1 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Marijuana (pot, weed, hash) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___1 |
| Query
|
baseline_i_002_10 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Inhalants (gasoline, glue, paint, paint thinner, nitrous, whippets) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___10 |
| Query
|
baseline_i_002_11 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Other drug not listed above |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___11 |
| Query
|
baseline_i_002_2 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Painkillers (Oxycontin, Percocet, Darvocet, Vicodin, Lortab) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___2 |
| Query
|
baseline_i_002_3 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Cocaine (powder, crack) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___3 |
| Query
|
baseline_i_002_4 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Tranquilizers or sedatives (downers, benzos, Xanax, Ativan, Valium, Klonopin or barbituates, Halc |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___4 |
| Query
|
baseline_i_002_5 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Hallucinogens (LSD, PCP, Acid, Mushrooms, salvia, Angel Dust, wet) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___5 |
| Query
|
baseline_i_002_6 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Stimulants (amphetamines, speed, uppers, meth, crank) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___6 |
| Query
|
baseline_i_002_7 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Ecstasy |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___7 |
| Query
|
baseline_i_002_8 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Heroin |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___8 |
| Query
|
baseline_i_002_9 |
Integer |
|
Recommended |
Which of these drugs, if any, have you used (not for medical purposes)? Cold or cough medicines |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_i_002___9 |
|
|
baseline_i_002_a |
String |
100
|
Recommended |
If Other, please specify |
|
|
baseline_i_002___a |
| Query
|
baseline_j_001 |
Integer |
|
Recommended |
How often do you have a drink containing alcohol? |
0::9; -888; -999
|
0=Never; 1=Less than monthly; 2=Monthly; 3=Weekly; 4=2-3 times a week; 5=4-6 times a week; 6=daily; 7=Monthly or less; 8=2-4 times a month; 9=4 or more times a week -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_j_002 |
Integer |
|
Recommended |
How many drinks containing alcohol do you have on a typical day when you are drinking? |
|
|
|
| Query
|
baseline_j_003 |
Integer |
|
Recommended |
How often do you have four (six for male) or more drinks on one occasion? |
0::7; -888; -999
|
0=Never; 1=Less than monthly; 2=Monthly; 3=Weekly; 4=2-3 times a week; 5=4-6 times a week; 6=daily; -888=Not Applicable; -999=Missing;7 = daily or almost daily
|
|
| Query
|
baseline_k_001 |
Integer |
|
Recommended |
What is your current smoking status? |
1::3; -888; -999
|
1=Smoked in last 30 days; 2=Former smoker; 3=Never smoked; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_002 |
Integer |
|
Recommended |
Heart disease or heart attack |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_003 |
Integer |
|
Recommended |
Cancer |
0;1;-888;-999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_004 |
Integer |
|
Recommended |
HIV |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_005 |
Integer |
|
Recommended |
Has she/he ever been to a doctor for any of these things…Diabetes /Diabetes |
0;1; -888; -999;-7
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing/NK; -7=Refused //Now I'd like to ask you about your child's use of health services during the past year and throughout his/her whole life.
|
|
| Query
|
baseline_k_006 |
Integer |
|
Recommended |
Stroke |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_007 |
Integer |
|
Recommended |
Chronic pain, like headaches, joint pain, neck pain, or back pain that you experience frequently |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_008 |
Integer |
|
Recommended |
Depression? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_009 |
Integer |
|
Recommended |
Bipolar disorder, sometimes known as manic-depression? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_010 |
Integer |
|
Recommended |
An alcohol use disorder, like alcohol abuse or dependence? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_011 |
Integer |
|
Recommended |
Any drug use disorder, like drug abuse or dependence? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_012 |
Integer |
|
Recommended |
An anxiety disorder? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_013 |
Integer |
|
Recommended |
Attention Deficit Disorder (ADD / ADHD) |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_014 |
Integer |
|
Recommended |
An eating disorder, like anorexia or bulimia? |
0::3; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;2=Current; 3=Both Current and Lifetime
|
|
| Query
|
baseline_k_015 |
Integer |
|
Recommended |
Schizophrenia or schizoaffective disorder? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_016 |
Integer |
|
Recommended |
Any other psychiatric disorder? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
|
|
baseline_k_016_a |
String |
100
|
Recommended |
Specify: |
|
|
baseline_k_016___a |
| Query
|
baseline_k_017 |
Integer |
|
Recommended |
Are you currently taking ANY medication(s) for an emotional or psychological problem? |
0::2; -888; -999
|
0=No; 1=Yes; 2=Unsure; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_018 |
Integer |
|
Recommended |
Have you ever been hospitalized for a psychological or emotional problem? |
1::4; -888; -999
|
1=Never; 2=Once; 3=Twice; 4=Three or more times; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_019 |
Integer |
|
Recommended |
In the past 30 days (including today), have you been hit, kicked, punched, or otherwise hurt by someone? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_k_020 |
Integer |
|
Recommended |
If yes, who hurt you? |
1::6; -888; -999
|
1=Boyfriend or husband; 2=Other family member; 3=Girlfriend or wife; 4=Someone not related to me; 5=Don�t know; 6=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_l_001 |
Integer |
|
Recommended |
The following question is about activities you might do during a typical day. Does your health now limit you in moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playi |
1::3; -888; -999
|
1=Yes, limited a lot; 2=Yes, limited a little; 3=No, not limited at all; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_l_002 |
Integer |
|
Recommended |
During the past 4 weeks, were you limited in the kind of work or other regular daily activities you do as a result of your physical health? |
1::5; -888; -999
|
1=All of the time; 2=Most of the time; 3=Some of the time; 4=A little of the time; 5=None of the time; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_l_003 |
Integer |
|
Recommended |
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? |
1::5; -888; -999
|
1=Not at all; 2=A little bit; 3=Moderately; 4=Quite a bit; 5=Extremely; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_l_004 |
Integer |
|
Recommended |
How much of the time during the past 4 weeks did you have a lot of energy? |
1::5; -888; -999
|
1=All of the time; 2=Most of the time; 3=Some of the time; 4=A little of the time; 5=None of the time; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_l_005 |
Integer |
|
Recommended |
How much of the time during the past 4 weeks, have you felt downhearted and depressed? |
1::5; -888; -999
|
1=All of the time; 2=Most of the time; 3=Some of the time; 4=A little of the time; 5=None of the time; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_l_006 |
Integer |
|
Recommended |
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? |
1::5; -888; -999
|
1=All of the time; 2=Most of the time; 3=Some of the time; 4=A little of the time; 5=None of the time; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_m_001 |
Integer |
|
Recommended |
During the past 6 months, did you visit a healthcare provider as an outpatient? Please remember that we count visits to a counselor or therapist as an outpatient visit. |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
|
|
baseline_m_002 |
String |
100
|
Recommended |
About how many times have you visited an outpatient provider for psychiatric or mental health related issues in the last 6 months |
|
|
|
|
|
baseline_m_003 |
String |
100
|
Recommended |
About how many times did you visit an outpatient provider for medical problems tht were not due to psychiatric or mental health-related problems |
|
|
|
| Query
|
baseline_m_006 |
Integer |
|
Recommended |
Now Ill ask about emergency room visits. During the past 6 months, did you go to the emergency room as a patient? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_m_007 |
Integer |
|
Recommended |
How many emergency room visits were for psychiatric or mental health problems, including suicidal thoughts or actions? |
|
|
|
| Query
|
baseline_m_008 |
Integer |
|
Recommended |
In the past six months, how many emergency room visits were for medical problems not related to a psychiatric or mental health problem? |
|
|
|
| Query
|
baseline_m_009 |
Integer |
|
Recommended |
Now Ill ask about hospital admissions. Did you stay overnight in a hospital during the past 6 months for any reason? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_m_010 |
Integer |
|
Recommended |
Did you stay overnight in the hospital because of psychiatric or other mental health problems, including suicidal thoughts or actions? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
|
|
baseline_m_011 |
String |
100
|
Recommended |
How many days were you in the hospital for psychiatric or mental health problems? |
|
|
|
| Query
|
baseline_m_012 |
Integer |
|
Recommended |
Did you stay overnight in the hospital for any medical reasons not related to psychiatric or mental health problems in the past six months? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
|
|
baseline_m_013 |
String |
100
|
Recommended |
How many days were you in the hospital for medical reasons? |
|
|
|
| Query
|
baseline_n_001 |
Integer |
|
Recommended |
Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? |
0::4; -888; -999
|
0=No; 1=Yes; 3=DontKnow; 4=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_n_002 |
Integer |
|
Recommended |
What year was your first active duty service? |
|
|
|
| Query
|
baseline_n_003 |
Integer |
|
Recommended |
What year was your last year of your active duty service? |
|
|
|
| Query
|
baseline_n_004 |
Integer |
|
Recommended |
Have you ever served in a combat or war zone? |
0::4; -888; -999
|
0=No; 1=Yes; 3=DontKnow; 4=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_n_005 |
Integer |
|
Recommended |
So far as you know, are you covered by any military health care plan such as TriCare or receive services from the Department of Veterans Affairs (VA)? |
0::4; -888; -999
|
0=No; 1=Yes; 3=Don�t Know; 4=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_p_001 |
Integer |
|
Recommended |
Did patient become distressed in response to the assessment? (i.e., was not distressed in the beginning of the assessment but became distressed during the interview) |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_p_002 |
Integer |
|
Recommended |
Did the patient withdraw from the study before completing the assessment? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_p_003 |
Integer |
|
Recommended |
Was the person enrolled but found to be later ineligible? (e.g. non-working phone number, no suicidal ideation attempt in past week). |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_q_001 |
Integer |
|
Recommended |
Did this subject withdraw from the study after being fully enrolled at a site? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_q_002 |
Integer |
|
Recommended |
Date of withdrawal |
|
|
|
| Query
|
baseline_q_004 |
Integer |
|
Recommended |
Outcome of attempt to recruit subject back into the study. |
1::4; -888; -999
|
1=Subject returned to study; 2=Subject declined to return to study; 3=Message left for subject, awaiting response; 4=No reliable contact information available; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_r_001 |
Integer |
|
Recommended |
Did this subject experience distress during a follow-up phone assessment? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
baseline_r_002_1 |
Integer |
|
Recommended |
Please indicate which phone assessment the distress occurred |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
baseline_r_002, baseline_r_002___2, baseline_r_002___3, baseline_r_002___4, baseline_r_002___5 |
| Query
|
j2_x |
Integer |
|
Recommended |
How many drinks containing alcohol do you have on a typical day when you are drinking? |
0::9; -888; -999
|
0=0-1; 1=2; 2=3; 3=4; 4=5-6; 5=7-9; 6=10; 7=1 or 2; 8 = 3 or 4; 9 = 10 or more; -888=Not Applicable; -999=Missing
|
|
| Query
|
alc_pos |
Integer |
|
Recommended |
Above threshold set by National Institute on Alcohol Abuse and Alcoholism (NIAAA)? |
0;1;-888;-999
|
0=No, below NIAAA threshold; 1=Yes, above NIAAA threshold; -888=Not Applicable; -999=Missing;
|
|
| Query
|
alc_rapid |
Integer |
|
Recommended |
Frequency of alcohol consumption |
|
|
|
|
|
age |
String |
20
|
Recommended |
Age (years: months: days) |
|
|
|
| Query
|
suicide_composite1_6wk |
Integer |
|
Recommended |
Met criteria for expanded suicide composite at |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
suicide_composite1, suicide_composite1_6 |
| Query
|
suicide_interrupted_6_6wk |
Integer |
|
Recommended |
Interrupted Suicide reported through |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
suicide_interrupted, suicide_interrupted_6 |
| Query
|
suicide_interrupted_6wk |
Integer |
|
Recommended |
Interrupted Suicide reported at |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
suicide_interrupted_total |
Integer |
|
Recommended |
Total interrupted suicide attempts per subject over follow-up |
|
|
|
| Query
|
suicide_prep_6_6wk |
Integer |
|
Recommended |
Preparatory acts reported through |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
suicide_prep, suicide_prep_6 |
| Query
|
suicide_prep_6wk |
Integer |
|
Recommended |
Preparatory acts reported at |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
suicide_prep_total |
Integer |
|
Recommended |
Total suicide preparatory behaviors per subject over follow-up |
|
|
|
| Query
|
suicide_aborted_6wk |
Integer |
|
Recommended |
Aborted Suicide reported at |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
suicide_aborted, suicide_aborted_6 |
| Query
|
sa_any_allwk |
Integer |
|
Recommended |
Suicide attempt reported during any of the study weeks |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
suicide_behavior_high_baseline |
Integer |
|
Recommended |
Highest level of suicidal behavior individual ever had at time of baseline |
|
0=Nosuicidalbehavior; 1=Preparatoryacts; 2=Abortedattempt; 3=Interruptedatempt; 4=Attemptbutnophysicaldamageorveryminor; 5=Minorphysicaldamage; 6=Moderatephysicaldamage; 7=Moderatelyseverephysicaldamage; 8=Severephysicaldamage; -888=Not Applicable; -999=Missing;
|
|
| Query
|
scomp2_any_6wk |
Integer |
|
Recommended |
Suicide reported through - clearly or probably intentional |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
scomp2_any |
| Query
|
scomp2_any_allwk |
Integer |
|
Recommended |
Suicide reported during any of the study weeks - clearly or probably intentional |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
scomp2_total |
Integer |
|
Recommended |
Total suicide attempt by assessment period - clearly or probably intentional |
|
|
|
| Query
|
scomp2_total2 |
Integer |
|
Recommended |
Suicide totals reported including unknowns - clearly or probably intentional |
|
|
|
| Query
|
scomp2_total_6wk |
Integer |
|
Recommended |
Suicide totals reported at - clearly or probably intentional |
|
|
scomp3_total_6 |
| Query
|
scomp2_total_unkwk |
Integer |
|
Recommended |
Suicide totals reported with unknown dates - clearly or probably intentional |
|
|
scomp2_total_6 |
| Query
|
scomp3_any_6wk |
Integer |
|
Recommended |
Suicide reported through - clearly or probably or unsure intentional |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
scomp2_any_6, scomp3_any |
| Query
|
scomp3_any_allwk |
Integer |
|
Recommended |
Suicide reported during any of the study weeks - clearly or probably or unsure intentional |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
scomp3_total |
Integer |
|
Recommended |
Total suicide attempt by assessment period - clearly or probably or unsure intentional |
|
|
|
| Query
|
scomp3_total2 |
Integer |
|
Recommended |
Suicide totals reported including unknowns - clearly or probably or unsure intentional |
|
|
|
| Query
|
scomp3_total_6wk |
Integer |
|
Recommended |
Suicide totals reported at - clearly or probably or unsure intentional |
|
|
|
| Query
|
scomp3_total_unkwk |
Integer |
|
Recommended |
Suicide totals reported with unknown dates - clearly or probably or unsure intentional |
|
|
|
| Query
|
scomp_any_6wk |
Integer |
|
Recommended |
Suicide reported through - clearly intentional |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
sa_any, scomp_any, scomp_any_6, scomp_total_6 |
| Query
|
scomp_any_allwk |
Integer |
|
Recommended |
Suicide reported during any of the study weeks - clearly intentional |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
scomp_prob_total2 |
Integer |
|
Recommended |
Suicide totals reported including unknowns - probable suicide |
|
|
|
| Query
|
scomp_prob_total_6wk |
Integer |
|
Recommended |
Suicide totals reported at - probable suicide |
|
|
scomp_prob_total, scomp_prob_total_6 |
| Query
|
scomp_prob_total_unkwk |
Integer |
|
Recommended |
Suicide totals reported with unknown dates - probable suicide |
|
|
|
| Query
|
scomp_total |
Integer |
|
Recommended |
Total suicide completed by assessment period - clearly intentional |
|
|
|
| Query
|
scomp_total2 |
Integer |
|
Recommended |
Suicide totals reported including unknowns - clearly intentional |
|
|
|
| Query
|
scomp_total_6wk |
Integer |
|
Recommended |
Suicide totals reported at - clearly intentional |
|
|
|
| Query
|
scomp_total_unkwk |
Integer |
|
Recommended |
Suicide totals reported with unknown dates - clearly intentional |
|
|
|
| Query
|
scomp_unsure_total2 |
Integer |
|
Recommended |
Suicide totals reported including unknowns - unsure if suicide |
|
|
|
| Query
|
scomp_unsure_total_6wk |
Integer |
|
Recommended |
Suicide totals reported at - unsure if suicide |
|
|
scomp_unsure_total, scomp_unsure_total_6 |
| Query
|
scomp_unsure_total_unkwk |
Integer |
|
Recommended |
Suicide totals reported with unknown dates - unsure if suicide |
|
|
|
| Query
|
suicide_aborted_total |
Integer |
|
Recommended |
Total aborted suicide attempts per subject over follow-up |
|
|
|
| Query
|
sa_total2 |
Integer |
|
Recommended |
Additive suicide attempt totals over follow-up period |
|
|
|
| Query
|
sa_total |
Integer |
|
Recommended |
Total suicide attempt by assessment period |
|
|
|
| Query
|
sa_total_unkwk |
Integer |
|
Recommended |
Total suicide attempt with unknown dates |
|
|
|
| Query
|
suicide_composite2_6wk |
Integer |
|
Recommended |
Met criteria for traditional suicide composite at |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
suicide_composite2, suicide_composite2_6 |
| Query
|
callphase_1 |
Integer |
|
Recommended |
Week of assessment |
0::6; -888; -999
|
0=No phase; 1=6 weeks; 2=12 weeks; 3=24 weeks; 4=36 weeks; 5=52 weeks; 6=end; -888=Not Applicable; -999=Missing;
|
|
| Query
|
ltf_3 |
Integer |
|
Recommended |
Subject missed 6, 12, and 24 wk assessments |
0;1; -888; -999
|
0=False; 1=True; -888=Not Applicable; -999=Missing;
|
|
| Query
|
termination |
Integer |
|
Recommended |
Why is this interview being ended? |
5; 24; 30; 31; 34; 37; 47; 56; -888; -999
|
5=Refusal; 24=Need to transfer this respondent to Boystown; 30=System Error; 31=Soft refusal (Hungup by respondent); 34=Bad linequality; 37=Language; 47=Hangup(don't know by whom); 56=Accidently Opened; -888=Not Applicable; -999=Missing;
|
|
| Query
|
termination34 |
Integer |
|
Recommended |
To interviewer:Can you confirm this number belongs to the respondent? |
34; 45; -888; -999
|
34=Can confirm; 45=Can not confirm; -888=Not Applicable; -999=Missing;
|
|
| Query
|
termination37 |
Integer |
|
Recommended |
To interviewer:Can you confirm the respondents name even though there is a language barrier? |
37; 48; -888; -999
|
37=Yes; 48=No/Unsure; -888=Not Applicable; -999=Missing;
|
|
| Query
|
timezoneid |
Integer |
|
Recommended |
Background Variable: TimeZoneId |
|
|
|
| Query
|
unr1 |
Integer |
|
Recommended |
Please select if this respondent is UNREACHABLE. |
0;1; -888; -999
|
0=No-not unreachable; 1=Yes, unreachable; -888=Not Applicable; -999=Missing;
|
|
| Query
|
wk6b1 |
Integer |
|
Recommended |
Ok, after you enrolled in the study on enroll until now,did you ever wish you were dead or wish you could go to sleep and not wake up? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b1 |
| Query
|
wk6b2 |
Integer |
|
Recommended |
In the past weeks since enroll, did you actually have any thoughts of killing yourself? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b2 |
| Query
|
wk6b3 |
Integer |
|
Recommended |
In the past weeks,did you ever think about how you might do this? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b3 |
| Query
|
wk6b4 |
Integer |
|
Recommended |
What way did you most often think of to kill yourself? |
1::7; -888;-999
|
1=Medication; 2=Hanging; 3=Jumping; 4=A gun; 5=Cutting; 6=DK; 7=Other (describe); -888=Not Applicable; -999=Missing;
|
b4 |
| Query
|
wk6b4a |
Integer |
|
Recommended |
Would you say you most often think to kill yourself by using medication? |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
b4a |
| Query
|
wk6b4b |
Integer |
|
Recommended |
Would you say you most often think to kill yourself by hanging yourself? |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
b4b |
| Query
|
wk6b4c |
Integer |
|
Recommended |
Would you say you most often think to kill yourself by jumping? |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
b4c |
| Query
|
wk6b4d |
Integer |
|
Recommended |
Would you say you most often think to kill yourself by using a gun? |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
b4d |
| Query
|
wk6b4e |
Integer |
|
Recommended |
Would you say you most often think to kill yourself by cutting yourself? |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
b4e |
|
|
wk6b4f |
String |
100
|
Recommended |
Is there another way you most oftent hink to kill yourself that I have not mentioned? |
|
|
b4f |
|
|
wk6b4_7_other |
String |
500
|
Recommended |
What way did you most often think of to kill yourself? - Other |
|
|
b4_7_other |
| Query
|
wk6b5 |
Integer |
|
Recommended |
In the past weeks,did you ever have any intention of acting on these thoughts of killing yourself? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b5 |
| Query
|
wk6b6 |
Integer |
|
Recommended |
In the past weeks,did you ever start to work out, or actually work out, the details of how to kill yourself? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b6 |
| Query
|
wk6b7 |
Integer |
|
Recommended |
Did you ever intend to carry out this plan? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b7 |
| Query
|
wk6b8 |
Integer |
|
Recommended |
Today, have you had thoughts of killing yourself? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
b8 |
| Query
|
wk6c1 |
Integer |
|
Recommended |
after you enrolled in the study on enroll until now, have you made a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c1 |
| Query
|
wk6c10 |
Integer |
|
Recommended |
As a result of the attempt, were you injured more seriously than surface scratches or mild nausea? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c10 |
| Query
|
wk6c10s |
Integer |
|
Recommended |
As a result of the attempt, were you injured more seriously than surface scratches or mild nausea? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c10s |
| Query
|
wk6c11a |
Integer |
|
Recommended |
Treatment by a health care provider in a doctors office or clinic. |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c11a, c11as |
| Query
|
wk6c11b |
Integer |
|
Recommended |
Treatment in an emergency room |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c11b, c11bs |
| Query
|
wk6c11c |
Integer |
|
Recommended |
Admission to a psychiatricor substance abuse hospital where you stayed overnight |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c11c, c11cs |
| Query
|
wk6c11d |
Integer |
|
Recommended |
Admission to a medical hospital where you stayed overnight |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c11d, c11ds |
| Query
|
wk6c11e |
Integer |
|
Recommended |
Treatment from some other medical or mental health professional |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c11e, c11es |
| Query
|
wk6c11f |
Integer |
|
Recommended |
Just to be sure I understand, did you receiveANY treatment from ANY health professional for the attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c11f, c11fs |
| Query
|
wk6c12 |
Integer |
|
Recommended |
As a result of the attempt, did you receive an injury that caused you to be extremely drowsy or result in broken bones or severe bleeding? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c12, c12s |
| Query
|
wk6c13 |
Integer |
|
Recommended |
As a result of the attempt, were you unconscious from an overdoseOR did you suffer extensive blood loss that required a transfusion ORsevere damage to your head OR a vital organ? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c13, c13s |
| Query
|
wk6c14 |
Integer |
|
Recommended |
As a result of the attempt, were you injured so severely that you needed treatment in an intensive care unit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c14, c14s |
| Query
|
wk6c15 |
Integer |
|
Recommended |
As a result of the attempt, did you suffer permanent physical damage from which you may never completely recover, such as paralysisOR disfigurement? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c15, c15s |
| Query
|
wk6c16 |
Integer |
|
Recommended |
Although you weren't injured as a result of the attempt, how serious could your injuries have been? Would you say what you did was: Not likely to cause injury. Likely to cause physical inju |
1::3; -888;-999
|
1=Not likely to cause injury; 2=Likely to cause physical injury but not death; 3=Likely to cause death even without medical help; -888=Not Applicable; -999=Missing;
|
c16, c16s |
| Query
|
wk6c2 |
Integer |
|
Recommended |
How many suicide attempts have you made in the past weeks since enroll? |
0::10; 12; -888; -999
|
0=0; 1=1; 2=2; 3=3; 4=4; 5=5; 6=6; 7=7; 8=8; 9=9; 10=10 or more(please specify number); 12=Refused; -888=Not Applicable; -999=Missing;
|
c2 |
| Query
|
wk6c24 |
Integer |
|
Recommended |
In the past weeks,has there ever been a time when you started to do something to end your life but someone or something stopped you BEFORE you actually did anything? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c24 |
| Query
|
wk6c25 |
Integer |
|
Recommended |
How many times were you stopped by someone or something in the past weeks? |
|
|
c25 |
| Query
|
wk6c26 |
Integer |
|
Recommended |
In the past weeks, has there ever been a time when you started to do something to end your life but you stopped yourself before you actually did anything? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c26 |
| Query
|
wk6c27 |
Integer |
|
Recommended |
How many times did you stop yourself from ending your life? |
|
|
c27 |
| Query
|
wk6c28 |
Integer |
|
Recommended |
In the past weeks, have you ever taken any steps towards making a suicide attempt or preparing to kill yourself, such as collecting pills, getting a gun, giving valuables away, or writing a |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c28 |
| Query
|
wk6c29 |
Integer |
|
Recommended |
About how many times have you done this? |
|
|
c29 |
|
|
wk6c2_10_other |
String |
100
|
Recommended |
How many suicide attempts have you made in the past weeks since enroll? - Other |
|
|
c2_10_other |
|
|
wk6c4c1 |
String |
100
|
Recommended |
[For the situation that respondent had multiple suicide attempts in the same day] Please enter which attempt was the most serious. |
|
|
c4c1 |
| Query
|
wk6c5 |
Integer |
|
Recommended |
Were you trying to end your life during the attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c5, c5s |
| Query
|
wk6c6 |
Integer |
|
Recommended |
Did you want to die, even a little, during the attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c6, c6s |
| Query
|
wk6c7 |
Integer |
|
Recommended |
Did you think it was possible that you could have died from what you did during the (WK6C4C)attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c7, c7s |
| Query
|
wk6c8 |
Integer |
|
Recommended |
Would you say that the attempt was for other reasons without any intention of killing yourself, such as to relieve stress, get sympathy, or feel better? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c8, c8s |
| Query
|
wk6c9a |
Integer |
|
Recommended |
How about Medication? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c9a, c9as |
| Query
|
wk6c9b |
Integer |
|
Recommended |
How about Hanging? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c9b, c9bs |
| Query
|
wk6c9c |
Integer |
|
Recommended |
How about Jumping? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c9c, c9cs |
| Query
|
wk6c9d |
Integer |
|
Recommended |
How about A gun? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c9d, c9ds |
| Query
|
wk6c9e |
Integer |
|
Recommended |
How about Cutting? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
c9e, c9es |
| Query
|
wk6c9f |
Integer |
|
Recommended |
and for this attempt, did you try something that I have not mentioned? |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
c9f, c9fs |
|
|
wk6c9fs_1_other |
String |
100
|
Recommended |
and for this attempt, did you try something that I have not mentioned? - Other |
|
|
c9f_1_other, c9fs_1_other |
| Query
|
wk6c9_1 |
Integer |
|
Recommended |
Dont know (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_1, c9s_1 |
| Query
|
wk6c9_2 |
Integer |
|
Recommended |
Medication (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_2, c9s_2 |
| Query
|
wk6c9_3 |
Integer |
|
Recommended |
Hanging (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_3, c9s_3 |
| Query
|
wk6c9_4 |
Integer |
|
Recommended |
Jumping (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_4, c9s_4 |
| Query
|
wk6c9_5 |
Integer |
|
Recommended |
A gun (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_5, c9s_5 |
| Query
|
wk6c9_6 |
Integer |
|
Recommended |
Cutting (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_6, c9s_6 |
| Query
|
wk6c9_7 |
Integer |
|
Recommended |
Other (describe:) (During the attempt, how did you try to kill yourself?) |
0;1; -888; -999
|
0=-; 1=+; -888=Not Applicable; -999=Missing;
|
c9_7, c9s_7 |
|
|
wk6c9_7_other |
String |
100
|
Recommended |
During the attempt, how did you try to kill yourself? - Other |
|
|
c9_7_other, c9s_7_other |
| Query
|
wk6d1 |
Integer |
|
Recommended |
After you enrolled in the study on enroll until now, have you ever intentionally cut, scratched, burned, or beaten yourself WITHOUTwanting to kill yourself? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d1 |
| Query
|
wk6d3a |
Integer |
|
Recommended |
How many times have you intentionally hurt yourself in the past weeks since enroll? |
0::12; -888; -999
|
0=0; 1=1; 2=2; 3=3; 4=4; 5=5; 6=6; 7=7; 8=8; 9=9; 10=10; 11= 10 or more(please specify number); 12=Refused; -888=Not Applicable; -999=Missing;
|
d3a |
|
|
wk6d3a_12_other |
String |
100
|
Recommended |
How many times have you intentionally hurt yourself in the past weeks since enroll? - Other |
|
|
d3a_12_other |
| Query
|
wk6d4h |
Integer |
|
Recommended |
Have you intentionally done something else to hurt yourself that I have not mentioned? |
1::3; -888; -999
|
1=Yes (Please specify); 2=No; 3=Refused; -888=Not Applicable; -999=Missing;
|
d4h |
|
|
wk6d4h_1_other |
String |
500
|
Recommended |
Have you intentionally done something else to hurt yourself that I have not mentioned? - Other |
|
|
d4h_1_other |
| Query
|
wk6d4_1 |
Integer |
|
Recommended |
Have you intentionally cut yourself? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respond Yes or No to the item.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_1 |
| Query
|
wk6d4_2 |
Integer |
|
Recommended |
Have you intentionally scratched yourself? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respond Yes or No to the item.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_2 |
| Query
|
wk6d4_3 |
Integer |
|
Recommended |
Have you intentionally Beat yourself or banged your head? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respond Yes or No to the it |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_3 |
| Query
|
wk6d4_4 |
Integer |
|
Recommended |
Have you intentionally Carved designs or words into your skin? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respond Yes or No to t |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_4 |
| Query
|
wk6d4_5 |
Integer |
|
Recommended |
Have you intentionally placed or stuck items under your skin to hurt yourself? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respon |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_5 |
| Query
|
wk6d4_6 |
Integer |
|
Recommended |
Have you intentionally picked scabs or skin to hurt yourself? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respond Yes or No to th |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_6 |
| Query
|
wk6d4_7 |
Integer |
|
Recommended |
Have you intentionally burned yourself? (Which of the following things have you done to intentionally hurt yourself? Im going to read you a list, and you respond Yes or No to the item.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
d4_7 |
| Query
|
wk6death |
Integer |
|
Recommended |
I am very sorry to hear about your loss. I work with a project that was participating in. The project followed subject's health over time. I know this might be hard for you, but is it okay if I ask you a couple of questions |
1;2; -888;-999
|
1=Yes; 2=No; -888=Not Applicable; -999=Missing;
|
death |
| Query
|
wk6deathcircum |
Integer |
|
Recommended |
Can you tell me more about the circumstances surrounding subjects death? |
|
1=Yes=definitelysuicide.; 2=Probablesuicide.; 3=No=clearlynotsuicide.; 4=Notenoughinformationgiventodetermine.; -888=Not Applicable; -999=Missing;
|
deathcircum |
| Query
|
wk6e1a |
Integer |
|
Recommended |
In the past weeks since enroll, have you spoken with any counselors over the phone? This includes mental health counselors, psychologists, psychiatrists, or calling a crisis hotline |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
e1a |
| Query
|
wk6e2 |
Integer |
|
Recommended |
In the past weeks, did you visit any kind of medical or mental health provider in an office, clinic, or health center? This includes any doctor, nurse practitioner, mental health counselor, |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
e2 |
| Query
|
wk6e3 |
Integer |
|
Recommended |
About how many times have you visited a provider in a clinic, health center, or doctors office for psychiatric or mental health related issues in the past weeks? |
|
|
e3 |
| Query
|
wk6e4 |
Integer |
|
Recommended |
About how many times have you visited a provider in a clinic, health center, or doctors office for medical problems that were NOT DUE TO psychiatric or mental health related problems in the past GetW |
|
|
e4 |
| Query
|
wk6e5 |
Integer |
|
Recommended |
Ok, now I would like to learn more about any visits you may have made to a hospital as an admitted patient. In the past weeks,how many times did you visit a hospital for any reason? This i |
0::10; 12; -888; -999
|
0=0; 1=1; 2=2; 3=3; 4=4; 5=5; 6=6; 7=7; 8=8; 9=9; 10=10 or more(please specify number); 12=Refused; -888=Not Applicable; -999=Missing;
|
e5 |
|
|
wk6e5_10_other |
String |
100
|
Recommended |
Ok, now I would like to learn more about any visits you may have made to a hospital as an admitted patient. In the past weeks,how many times did you visit a hospital for any reason? This i |
|
|
e5_10_other |
| Query
|
wk6f1 |
Integer |
|
Recommended |
Now I am going to ask you about firearms or guns in your home. Are any firearms currently kept in or around your home? |
1::4; -888; -999
|
1=Yes; 2=No; 3=Maybe/Don't Know/Unsure; 4=Refused; -888=Not Applicable; -999=Missing;
|
f1 |
| Query
|
wk6f2 |
Integer |
|
Recommended |
After you enrolled in the study on enroll until now, did your household obtain any new firearms? |
1::4; -888; -999
|
1=Yes; 2=No; 3=Maybe/Don't Know/Unsure; 4=Refused; -888=Not Applicable; -999=Missing;
|
f2 |
| Query
|
wk6f3 |
Integer |
|
Recommended |
Are any of the firearms in your household kept loaded? |
1::4; -888; -999
|
1=Yes; 2=No; 3=Maybe/Don't Know/Unsure; 4=Refused; -888=Not Applicable; -999=Missing;
|
f3 |
| Query
|
wk6f4 |
Integer |
|
Recommended |
Are any of the firearms in your household unlocked? |
1::4; -888; -999
|
1=Yes; 2=No; 3=Maybe/Don't Know/Unsure; 4=Refused; -888=Not Applicable; -999=Missing;
|
f4 |
| Query
|
wk6f5 |
Integer |
|
Recommended |
How would you describe your access to firearms in your household? Would you say you have easy access, have access but with difficulty, or have no access? |
1::3; -888; -999
|
1=Easy access; 2=Access but with difficulty; 3=No access; -888=Not Applicable; -999=Missing;
|
f5 |
| Query
|
wk6f6 |
Integer |
|
Recommended |
In the past weeks, did anyone lock up the firearms in your household? |
1::4; -888; -999
|
1=Yes; 2=No; 3=Maybe/Don't Know/Unsure; 4=Refused; -888=Not Applicable; -999=Missing;
|
f6 |
| Query
|
wk6f7 |
Integer |
|
Recommended |
Who locked up the firearms in your household? Is it you or someone else? |
1;2; -888;-999
|
1=Respondent; 2=Someone else (Please specify); -888=Not Applicable; -999=Missing;
|
f7 |
|
|
wk6f7_2_other |
String |
100
|
Recommended |
Who locked up the firearms in your household? Is it you or someone else? - Other |
|
|
f7_2_other |
| Query
|
wk6f8 |
Integer |
|
Recommended |
In the past weeks, did anyone removeany guns from your household? |
1::4; -888; -999
|
1=Yes; 2=No; 3=Maybe/Don't Know/Unsure; 4=Refused; -888=Not Applicable; -999=Missing;
|
f8 |
| Query
|
wk6f8a |
Integer |
|
Recommended |
Who removed the firearms from your household? Is it you or someone else? |
1;2; -888;-999
|
1=Respondent; 2=Someone else(Please specify); -888=Not Applicable; -999=Missing;
|
f8a |
|
|
wk6f8a_2_other |
String |
100
|
Recommended |
Who removed the firearms from your household? Is it you or someone else? - Other |
|
|
f8a_2_other |
|
|
wk6f9f |
String |
100
|
Recommended |
Other change to the firearms in your household that I have not mentioned (please specify) |
|
|
f9f |
| Query
|
wk6f9_1 |
Integer |
|
Recommended |
Sold or gave away the firearms (What was the specific change to the firearms in your household? Im going to read some options and you can respond yes or no.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
f9_1 |
| Query
|
wk6f9_2 |
Integer |
|
Recommended |
Turned them into the police (What was the specific change to the firearms in your household? Im going to read some options and you can respond yes or no.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
f9_2 |
| Query
|
wk6f9_3 |
Integer |
|
Recommended |
Stored them elsewhere (What was the specific change to the firearms in your household? Im going to read some options and you can respond yes or no.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
f9_3 |
| Query
|
wk6f9_4 |
Integer |
|
Recommended |
Locked the firearms(s) in a container like a cabinet, closet, or safe (What was the specific change to the firearms in your household? Im going to read some options and you can respond yes or no.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
f9_4 |
| Query
|
wk6f9_5 |
Integer |
|
Recommended |
Locked them with a cable or trigger lock (What was the specific change to the firearms in your household? Im going to read some options and you can respond yes or no.) |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
f9_5 |
| Query
|
wk6transfer |
Integer |
|
Recommended |
[For interviewer only]Do you want to transfer this respondent to Boystown? |
1;2; 98; -888; -999
|
1=Do not refer; 2=Refer to Boystown; -888=Not Applicable; -999=Missing;
|
|
| Query
|
wk6withdraw |
Integer |
|
Recommended |
I hope you don't mind me asking but can you please tell me more about why you want to withdraw from the study? |
1;2; -888;-999
|
1=Changed his or her mind.; 2=Other:; -888=Not Applicable; -999=Missing;
|
|
|
|
wk6withdraw_2_other |
String |
100
|
Recommended |
I hope you don't mind me asking but can you please tell me more about why you want to withdraw from the study? - Other |
|
|
|
| Query
|
wk6c3 |
Integer |
|
Recommended |
Could you please tell me the approximate date when this attempt happened? |
|
|
c3 |
| Query
|
wk6c3a1 |
Integer |
|
Recommended |
Could you please tell me the approximate dates these attempts happened starting with the most recent? |
|
|
c3a1 |
| Query
|
wk6c3a10 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your tenth to last attempt? |
|
|
c3a10 |
| Query
|
wk6c3a2 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your second to last attempt? |
|
|
c3a2 |
| Query
|
wk6c3a3 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your third to last attempt? |
|
|
c3a3 |
| Query
|
wk6c3a4 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your fourth to last attempt? |
|
|
c3a4 |
| Query
|
wk6c3a5 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your fifth to last attempt? |
|
|
c3a5 |
| Query
|
wk6c3a6 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your sixth to last attempt? |
|
|
c3a6 |
| Query
|
wk6c3a7 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your seventh to last attempt? |
|
|
c3a7 |
| Query
|
wk6c3a8 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your eighth to last attempt? |
|
|
c3a8 |
| Query
|
wk6c3a9 |
Integer |
|
Recommended |
Could you please tell me the approximate dates of your ninth to last attempt? |
|
|
c3a9 |
| Query
|
wk6c4c |
Integer |
|
Recommended |
You reported that you made more than one suicide attempt since you enrolled in the study on enroll. Which one of these attempts was the most serious? Would you say: (WK6C3A1)(WK6C3A2)(WK6 |
|
|
c4c |
| Query
|
wk6compdate |
Integer |
|
Recommended |
WK6CompDate |
|
|
compdate |
| Query
|
wk6d2b |
Integer |
|
Recommended |
Can you tell me when did this happen? |
|
|
d2b |
| Query
|
wk6deathdate |
Integer |
|
Recommended |
Okay, thank you for talking with me. Can you tell me when died? |
|
|
deathdate |
| Query
|
wk6e7a1 |
Integer |
|
Recommended |
Can you tell me the date of your most recent hospital visit? |
|
|
e7a1 |
| Query
|
wk6e7a10 |
Integer |
|
Recommended |
Can you tell me the date of your tenth to last hospital visit? |
|
|
e7a10 |
| Query
|
wk6e7a2 |
Integer |
|
Recommended |
Can you tell me the date of your second to last hospital visit? |
|
|
e7a2 |
| Query
|
wk6e7a3 |
Integer |
|
Recommended |
Can you tell me the date of your third to last hospital visit? |
|
|
e7a3 |
| Query
|
wk6e7a4 |
Integer |
|
Recommended |
Can you tell me the date of your fourth to last hospital visit? |
|
|
e7a4 |
| Query
|
wk6e7a5 |
Integer |
|
Recommended |
Can you tell me the date of your fifth to last hospital visit? |
|
|
e7a5 |
| Query
|
wk6e7a6 |
Integer |
|
Recommended |
Can you tell me the date of your sixth to last hospital visit? |
|
|
e7a6 |
| Query
|
wk6e7a7 |
Integer |
|
Recommended |
Can you tell me the date of your seventh to last hospital visit? |
|
|
e7a7 |
| Query
|
wk6e7a8 |
Integer |
|
Recommended |
Can you tell me the date of your eighth to last hospital visit? |
|
|
e7a8 |
| Query
|
wk6e7a9 |
Integer |
|
Recommended |
Can you tell me the date of your ninth to last hospital visit? |
|
|
e7a9 |
|
|
preferredlanguage |
String |
100
|
Recommended |
Background Variable: Preferred Language for interview |
|
|
|
| Query
|
awol1 |
Integer |
|
Recommended |
Please select if this respondent is AWOL.(No number tocall or making appointment outside the 10-day window) |
0::2; -888;-999
|
0=Normal; 1=UNR; 2=AWOL; -888=Not Applicable; -999=Missing;
|
|
| Query
|
devi_1 |
Integer |
|
Recommended |
Deviation: completed assessment outside the call window for 6wk survey |
0;1; -888; -999
|
0=False; 1=True; -888=Not Applicable; -999=Missing;
|
|
| Query
|
p1day10 |
Integer |
|
Recommended |
10th (last) calling date for WK6 |
|
|
|
| Query
|
p1day5 |
Integer |
|
Recommended |
5th calling date for WK6 (for the purpose of marking unreachable flag and calling EC |
|
|
|
| Query
|
p1_unavail |
Integer |
|
Recommended |
Indicates if the subject was unreachable or awol |
0::2; -888;-999
|
0=Normal; 1=UNR; 2=AWOL; -888=Not Applicable; -999=Missing;
|
|
| Query
|
phase |
Integer |
|
Recommended |
Phase |
|
9 =follow up
|
baseline_phase, studyphase |
| Query
|
date_p1 |
Integer |
|
Recommended |
First date of each assessment period (each call phase) |
|
|
date_p |
| Query
|
length_of_stay_1 |
Integer |
|
Recommended |
Length of stay - Encounter 1 (days) |
|
|
length_of_stay |
| Query
|
encounter1_005 |
Integer |
|
Recommended |
Visit Type |
1::3; -888; -999
|
1=ED visit not resulting in hospital admission; 2=ED visit resulting in hospital admission; 3=Direct admission or transfer from another facility (no ED visit at the admitting hospital); -888=Not Applicable; -999=Missing;
|
encounter_005 |
| Query
|
encounter1_005a |
Integer |
|
Recommended |
Type of hospital admission |
1::3; -888;-999
|
1=Medical hospital admission and discharge; 2=Psychiatric admission (no medical hosptial admission); 3=Medical hospital admission and transfer to psychiatric admission; -888=Not Applicable; -999=Missing;
|
encounter_005a |
| Query
|
encounter1_005b |
Integer |
|
Recommended |
Type of direct admission |
1::3; -888;-999
|
1=Medical hospital admission and discharge; 2=Psychiatric admission (no medical hosptial admission); 3=Medical hospital admission and transfer to psychiatric admission; -888=Not Applicable; -999=Missing;
|
encounter_005b |
| Query
|
encounter1_006 |
Integer |
|
Recommended |
Did any part of the visit occur at the index hospital where the patient was initially enrolled in the study? |
0;1; 9;-888; -999
|
0=No/not documented; 1=Yes; 9=Unsure; -888=Not Applicable; -999=Missing;
|
encounter_006 |
| Query
|
encounter1_006a |
Integer |
|
Recommended |
Is documentation available for this visit? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
encounter_006a |
| Query
|
encounter1_007a |
Integer |
|
Recommended |
ED arrival date |
|
|
encounter_007a, v1_ed_arrival_date1 |
| Query
|
encounter1_007b |
Integer |
|
Recommended |
ED discharge date |
|
|
encounter_007b, v1_ed_discharge_date1 |
| Query
|
encounter1_007c |
Integer |
|
Recommended |
ED arrival date |
|
|
encounter_007c, v1_ed_arrival_date2 |
| Query
|
encounter1_007d |
Integer |
|
Recommended |
Hospital admission date |
|
|
encounter_007d, v1_hosp_admit_date1 |
| Query
|
encounter1_007d1_6m |
Integer |
|
Recommended |
Is the hospital discharge date available? |
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing;
|
encounter_007d1, v1_hosp_discharge_avail1 |
| Query
|
encounter1_007e |
Integer |
|
Recommended |
Hospital discharge date |
|
|
encounter_007e, v1_hosp_discharge_date1 |
| Query
|
encounter1_007f |
Integer |
|
Recommended |
Hospital admission date |
|
|
encounter_007f, v1_hosp_admit_date2 |
| Query
|
encounter1_007g |
Integer |
|
Recommended |
Hospital discharge date |
|
|
encounter_007g, v1_hosp_discharge_date2 |
| Query
|
encounter1_009 |
Integer |
|
Recommended |
Did the person die? |
|
0=No/Not Documented; 1=Yes; -888=Not Applicable; -999=Missing;
|
encounter_009, v1_visit_die |
| Query
|
encounter1_010 |
Integer |
|
Recommended |
Was there evidence of intentional self-injury? |
0::3; -888; -999
|
0=No, clearly not intentional(e.g.,natural causes); 1=Unsure or not documented insufficient detail to determine; 2=Probable, but inconclusive(e.g., apparent intentional overdose but not witnessed, self-reported, or suicide note); 3=Yes, clear evidence (e.g., witnessed, suicide note, self-reported to health care provider prior to death); -888=Not Applicable; -999=Missing;
|
encounter_010, v1_selfinjury |
| Query
|
encounter1_011 |
Integer |
|
Recommended |
Is there evidence of current or recent intentional self-harm ideation OR behavior? This includes NON-SUICIDAL OR SUICIDAL thoughts or behaviors. |
0::4; -888; -999
|
0=No, subject documented as not having recent self-harm ideation/behavior; 1=Not Documented; 2=Yes, current or within past week; 3=Yes, but not current or within past week; 4=Yes, documented but insufficient information to determine timing; -888=Not Applicable; -999=Missing;
|
encounter_011, v1_harm_ideation |
| Query
|
encounter1_012 |
Integer |
|
Recommended |
Was there ANY injury sustained? This includes loss of consciousness, delirium, vomiting, any harm to tissue, or organ dysfunction. |
0::2; -888; -999
|
0=No, no injury sustained; 1=Not Documented; 2=Yes; -888=Not Applicable; -999=Missing;
|
encounter_012, v1_injury |
| Query
|
encounter1_013 |
Integer |
|
Recommended |
Was there suicidal ideation present? i.e., was there evidence that the individual had thoughts or intentions of killing him or herself? |
0::3; -888; -999
|
0=No, clearly no intent to die(e.g.,denied SI/SA, stated was just trying to get attention, stated accidental); 1=Unsure or not documented insufficient detail to determine; 2=Probable, but inconclusive(e.g., apparent attempt but inconsistent or vague); 3=Yes, clear evidence(e.g.,positive SI/SA, stated wanted to kill him/herself, witnessed); -888=Not Applicable; -999=Missing;
|
encounter_013, v1_ideation_present |
| Query
|
encounter1_014 |
Integer |
|
Recommended |
Was this a suicide attempt? i.e., was there evidence that the individual intentionally harmed himself with even some intention to die? |
0::3; -888; -999
|
0=No, clearly no intent to die(e.g.,denied SI/SA, stated was just trying to get attention, stated accidental); 1=Unsure or not documented insufficient detail to determine; 2=Probable, but inconclusive(e.g., apparent attempt but inconsistent or vague); 3=Yes, clear evidence(e.g.,positive SI/SA, stated wanted to kill him/herself, witnessed); -888=Not Applicable; -999=Missing;
|
encounter_014, v1_suicide_attempt |
|
|
encounter1_019 |
String |
100
|
Recommended |
Primary ICD Diagnosis Code |
|
|
encounter_019 |
|
|
encounter1_019a |
String |
100
|
Recommended |
Primary ICD Code |
|
|
encounter_019a |
|
|
encounter1_020 |
String |
100
|
Recommended |
Secondary ICD Diagnosis Code |
|
|
encounter_020 |
|
|
encounter1_020b |
String |
100
|
Recommended |
Secondary ICD Code |
|
|
encounter_020b |
|
|
encounter1_021 |
String |
100
|
Recommended |
Third ICD Diagnosis Code |
|
|
encounter_021 |
|
|
encounter1_021c |
String |
100
|
Recommended |
Third ICD Code |
|
|
encounter_021c |
|
|
encounter1_029a |
String |
100
|
Recommended |
Primary E Code |
|
|
encounter_029a |
|
|
encounter1_029b |
String |
100
|
Recommended |
Secondary E Code |
|
|
encounter_029b |
|
|
encounter1_029c |
String |
100
|
Recommended |
Third E Code |
|
|
encounter_029c |
|
|
encounter1_029d |
String |
100
|
Recommended |
Fourth E Code |
|
|
encounter_029d |
|
|
encounter1_029e |
String |
100
|
Recommended |
Fifth E Code |
|
|
encounter_029e |
|
|
encounter1_030a |
String |
100
|
Recommended |
Primary V Code |
|
|
encounter_030a |
|
|
encounter1_030b |
String |
100
|
Recommended |
Secondary V Code |
|
|
encounter_030b |
|
|
encounter1_030c |
String |
100
|
Recommended |
Third V Code |
|
|
encounter_030c |
|
|
encounter1_030d |
String |
100
|
Recommended |
Fourth V Code |
|
|
encounter_030d |
|
|
encounter1_030e |
String |
100
|
Recommended |
Fifth V Code |
|
|
encounter_030e |
| Query
|
encounter1_031 |
Integer |
|
Recommended |
Please provide the CPT ED visit level (99281-99285) OR critical care code (99291) associated with this ED visit. If the CPT ED visit level code or critical care code is not available and the subjec |
|
|
encounter_031 |
| Query
|
encounter1_031a |
Integer |
|
Recommended |
Please provide the emergency physician CPT level code (99281-99285) OR critical care code (99291) associated with this ED visit. If the emergency physician CPT code or critical care code is not avail |
|
|
encounter_031a |
|
|
encounter1_035a |
String |
100
|
Recommended |
Primary DRG Code |
|
|
encounter_035a |
|
|
encounter1_035b |
String |
100
|
Recommended |
Secondary DRG Code |
|
|
encounter_035b |
| Query
|
encounter1_complete |
Integer |
|
Recommended |
Complete? |
0::2; -888; -999
|
0=Incomplete; 1=Unverified; 2=Complete; -888=Not Applicable; -999=Missing;
|
encounter_complete |
| Query
|
locator002 |
Integer |
|
Recommended |
What is your preferred language? |
1::3; -888; -999
|
1=English; 2=Spanish; 3=Either English or Spanish (no preference); -888=Not Applicable; -999=Missing;
|
|
| Query
|
locator026a |
Integer |
|
Recommended |
When is the best time to reach you by phone on weekdays? |
1::4; -888; -999
|
1=Morning; 2=Afternoon; 3=Evening; 4=All of the Above; -888=Not Applicable; -999=Missing;
|
|
| Query
|
locator027a |
Integer |
|
Recommended |
When is the best time to reach you by phone on weekends? |
1::4; -888; -999
|
1=Morning; 2=Afternoon; 3=Evening; 4=All of the Above; -888=Not Applicable; -999=Missing;
|
|
| Query
|
utilization001_1 |
Integer |
|
Recommended |
Source of data (check all that apply): Electronic records for the ED/Hospital where the subject was enrolled) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
utilization001___1 |
| Query
|
utilization001_2 |
Integer |
|
Recommended |
Source of data (check all that apply): Paper-based charts for the ED/Hospital where the subject was enrolled) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
utilization001___2 |
| Query
|
utilization001_3 |
Integer |
|
Recommended |
Source of data (check all that apply): Electronic records for the larger healthcare system affiliated with the ED/Hospital where the subject was enrolled (i.e., includes more than 1 ED/hospita |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
utilization001___3 |
| Query
|
utilization001_4 |
Integer |
|
Recommended |
Source of data (check all that apply): Other) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
utilization001___4 |
|
|
utilization002 |
String |
100
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
utilization003 |
Integer |
|
Recommended |
Which review is this? |
1::3; -888; -999
|
1=Baseline review (i.e.=initial enrollment); 2=6-month review (first 6 months after index visit); 3=12-month review (from>6months to 12 months after index visit - take care to account for visits documented on the 6-month form to avoid duplicate entry and to identify visits that may have occurred in the first 6 months but which were not available for the original review); -888=Not Applicable; -999=Missing;
|
|
| Query
|
utilization004 |
Integer |
|
Recommended |
Start date -- start date of period being reviewed (e.g., at enrollment, it should be 6 months prior to the index visit date- for 6-month, it should be the index visit date + 1 day. For 12-month, it sh |
|
|
|
| Query
|
utilization005 |
Integer |
|
Recommended |
End date -- end date of the review (i.e., for baseline, should be the index visit date- for 6-month, should be index + 6 months. For 12-month, should be 12 months after index visit) |
|
|
|
| Query
|
utilization006 |
Integer |
|
Recommended |
TOTAL ED visits not resulting in admission |
|
|
|
|
|
utilization006a |
String |
100
|
Recommended |
How many of these ED visits not resulting in admission were for suicidal behavior or ideation? |
|
|
|
|
|
utilization007 |
String |
100
|
Recommended |
Please list the dates of each ED visit not resulting in admission |
|
|
utilization008, utilization009, utilization010, utilization011, utilization012, utilization013, utilization014, utilization015, utilization015a |
| Query
|
utilization016 |
Integer |
|
Recommended |
TOTAL number of ED visits resulting in hospital admission |
|
|
|
|
|
utilization016a |
String |
100
|
Recommended |
How many of these ED visits resulting in admission were for suicidal behavior or ideation? |
|
|
|
|
|
utilization017 |
String |
100
|
Recommended |
Please specify the number of ED visits resulting in a medical hospital admission and discharge |
|
|
|
|
|
utilization027_6m |
String |
100
|
Recommended |
Please specify the number of ED visits resulting in a psychiatric admission (no medical hospital admission) |
|
|
utilization027, utilization028, utilization029, utilization030, utilization031, utilization032, utilization033, utilization034, utilization035, utilization036, utilization036a |
|
|
utilization037_6m |
String |
100
|
Recommended |
Please specify the number of ED visits resulting in a medical hospital admission and a transfer to psychiatric admission |
|
|
utilization037, utilization038, utilization039, utilization040, utilization041, utilization042, utilization043, utilization044, utilization045, utilization046 |
| Query
|
utilization046a |
Integer |
|
Recommended |
The calculated number of total ER visits resulting in a hospital admission. |
|
|
|
|
|
utilization046b |
String |
100
|
Recommended |
The calculated number ER visits resulting in hospital admissions in the sub-categories above does not match with the TOTAL Number of ER visits resulting in hospital admissionis that was entered at the |
|
|
|
| Query
|
utilization046c |
Integer |
|
Recommended |
Please specify the dates of each ED visit resulting in a medical hospital admission and transfer to a psychiatric admission |
|
|
|
| Query
|
utilization047 |
Integer |
|
Recommended |
TOTAL number of direct admits |
|
|
|
|
|
utilization047a |
String |
100
|
Recommended |
How many of these direct admissions were for suicidal behavior or ideation? |
|
|
|
|
|
utilization048 |
String |
100
|
Recommended |
Please specify the number of direct admission or transfers resulting in a medical hospital admission and discharge |
|
|
|
|
|
utilization049 |
String |
100
|
Recommended |
Please list the dates of each direct admissions or transfers resulting in a medical hospital admission and discharge |
|
|
utilization050, utilization051, utilization052, utilization053, utilization054, utilization055, utilization056, utilization057, utilization057a |
|
|
utilization058 |
String |
100
|
Recommended |
Please specify the number of direct admissions or transfers resulting in a psychiatric admission (no medical hospital admission) |
|
|
|
|
|
utilization059_6m |
String |
100
|
Recommended |
Please list the dates of each direct admissions or transfers resulting in a psychiatric admission (no medical hospital admission) |
|
|
utilization059, utilization060, utilization061, utilization062, utilization063, utilization064, utilization065, utilization066, utilization067, utilization067a |
| Query
|
utilization067a_6m |
Integer |
|
Recommended |
Please list the dates of each direct admissions or transfers resulting in a psychiatric admission (no medical hospital admission) |
|
|
|
|
|
utilization068_6m |
String |
100
|
Recommended |
Please specify the number of direct admission or transfers resulting in a medical hospital admission and transfer to a psychiatric admission: |
|
|
utilization068 |
|
|
utilization077_6m |
String |
100
|
Recommended |
Please list the dates of each direct admissions or transfers resulting in a medical hospital admission and transfer to a psychiatric admission |
|
|
utilization069, utilization070, utilization071, utilization072, utilization073, utilization074, utilization075, utilization076, utilization077, utilization077c |
| Query
|
utilization077a_6m |
Integer |
|
Recommended |
The calculated number of total direct hospital admissions. |
|
|
utilization077a |
|
|
utilization077b_6m |
String |
100
|
Recommended |
The calculated number direct hospital admits in the sub-categories above does not match with the TOTAL Number of direct admissions that was entered at the beginning of this section, please check your |
|
|
utilization077b |
| Query
|
utilization077c_6m |
Integer |
|
Recommended |
Please list the dates of each direct admissions or transfers resulting in a medical hospital admission and transfer to a psychiatric admission |
|
|
|
| Query
|
utilization078_6m |
Integer |
|
Recommended |
The subject had the following number of healthcare encounters. A healthcare encounter form should be completed for each of the healthcare encounter dates documented above. If there are more than 10 |
|
|
utilization078 |
| Query
|
utilization_complete_6m |
Integer |
|
Recommended |
Complete? |
0::2; -888; -999
|
0=Incomplete; 1=Unverified; 2=Complete; -888=Not Applicable; -999=Missing;
|
utilization_complete |
| Query
|
death005_12m |
Integer |
|
Recommended |
Age at last birthday (years) |
|
|
death005 |
| Query
|
baseline_h_001 |
Integer |
|
Recommended |
Faintness or dizziness |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_1 |
| Query
|
baseline_h_002 |
Integer |
|
Recommended |
Feeling no interest in things |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_2 |
| Query
|
baseline_h_003 |
Integer |
|
Recommended |
Nervousness or shakiness inside |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_3 |
| Query
|
baseline_h_004 |
Integer |
|
Recommended |
Pains in heart or chest |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_4 |
| Query
|
baseline_h_005 |
Integer |
|
Recommended |
Feeling lonely |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_5 |
| Query
|
baseline_h_006 |
Integer |
|
Recommended |
Feeling tense or keyed up |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_6 |
| Query
|
baseline_h_007 |
Integer |
|
Recommended |
Nausea or upset stomach |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_7 |
| Query
|
baseline_h_008 |
Integer |
|
Recommended |
Feeling blue |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_8 |
| Query
|
baseline_h_009 |
Integer |
|
Recommended |
Suddenly scared for no reason |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_9 |
| Query
|
baseline_h_010 |
Integer |
|
Recommended |
Trouble getting your breath |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_10 |
| Query
|
baseline_h_011 |
Integer |
|
Recommended |
Feelings of worthlessness |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_11 |
| Query
|
baseline_h_012 |
Integer |
|
Recommended |
Spells of terror or panic |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_12 |
| Query
|
baseline_h_013 |
Integer |
|
Recommended |
Numbness or tingling in parts of your body |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_13 |
| Query
|
baseline_h_014 |
Integer |
|
Recommended |
Feeling hopeless about the future |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_14 |
| Query
|
baseline_h_015 |
Integer |
|
Recommended |
Feeling so restless you couldnt sit still |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_15 |
| Query
|
baseline_h_016 |
Integer |
|
Recommended |
Feeling weak in parts of your body |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_16 |
| Query
|
baseline_h_017 |
Integer |
|
Recommended |
Thoughts of ending your life |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_17 |
| Query
|
baseline_h_018 |
Integer |
|
Recommended |
Feeling fearful |
0::4; -888; -999
|
0=Not at all; 1=A little bit; 2=Moderately; 3=Quite a bit; 4=Extremely; -888=Not Applicable; -999=Missing
|
g_18 |
| Query
|
length_of_stay_0 |
Integer |
|
Recommended |
Length of stay - index (days) |
|
|
|
| Query
|
cssrs_ideation |
Integer |
|
Recommended |
C-SSRS suicidal ideation severity (continuous) |
|
|
|
| Query
|
cssrs_ideation_cat |
Integer |
|
Recommended |
C-SSRS suicidal ideation severity (categorical) |
0::5; -888; -999
|
0=No ideation present; 1=Wish to be dead; 2=Non-specific active suicidal thoughts; 3=Active suicidal ideation without plan or intent to act; 4=Active suicidal ideation with some intent to act (serious suicidal ideation); 5=Active ideation with plan and intent (serious suicidal ideation); -888=Not Applicable; -999=Missing
|
cssrs_ideationwk_cat |
| Query
|
cssrs_attempt |
Integer |
|
Recommended |
C-SSRS suicide attempt severity |
0::4; -888; -999
|
0=No physical damage or very minor physical damage; 1=Minor physical damage; 2=Moderate physical damage, medical attention needed; 3=Moderately severe physical damage, medical hospitalization and likely intensive care required; 4=Severe physical damage, medical hospitalization with intensive care required; -888=Not Applicable; -999=Missing
|
|
| Query
|
cssrs_si_intensity |
Integer |
|
Recommended |
C-SSRS suicidal ideation intensity |
|
|
|
| Query
|
somatization_score |
Integer |
|
Recommended |
Somatization Raw Score |
|
|
|
| Query
|
depression_score |
Integer |
|
Recommended |
Depression Raw Score |
|
|
|
| Query
|
anxiety_score |
Integer |
|
Recommended |
Anxiety Raw Score |
|
|
|
| Query
|
global_index |
Integer |
|
Recommended |
Global Severity Index |
|
|
|
| Query
|
suicide_behavior_high |
Integer |
|
Recommended |
Highest level of suicidal behavior individual ever had at time of baseline |
0::8; -888; -999
|
0=No suicidal behavior ;1=Preparatory acts; 2=Aborted attempt; 3=Interrupted atempt; 4=Attempt but no physical damage or very minor; 5=Minor physical damage; 6=Moderate physical damage; 7=Moderately severe physical damage; 8=Severe physical damage; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_sisa |
Integer |
|
Recommended |
Completed both C-SSRS ideation and behavior scales at baseline |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_onlysi |
Integer |
|
Recommended |
Completed only C-SSRS ideation scale at baseline |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_onlysa |
Integer |
|
Recommended |
Completed only C-SSRS behavior scale at baseline |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_nonesisa |
Integer |
|
Recommended |
Completed neither C-SSRS ideation or behavior scales at baseline |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
omnibus_sa |
Integer |
|
Recommended |
Attempt at baseline |
|
|
sa |
| Query
|
omnibus_si |
Integer |
|
Recommended |
Ideation only at baseline (no attempt) |
|
|
si |
| Query
|
encounter_033a |
String |
100
|
Recommended |
Primary E Code |
|
|
|
| Query
|
encounter_033b |
String |
100
|
Recommended |
Secondary E Code |
|
|
|
| Query
|
encounter_033c |
String |
100
|
Recommended |
Third E Code |
|
|
|
| Query
|
encounter_033d |
String |
100
|
Recommended |
Fourth E Code |
|
|
|
| Query
|
encounter_033e |
String |
100
|
Recommended |
Fifth E Code |
|
|
|
| Query
|
encounter_034a |
String |
100
|
Recommended |
Primary V Code |
|
|
|
| Query
|
encounter_034b |
String |
100
|
Recommended |
Secondary V Code |
|
|
|
| Query
|
encounter_034c |
String |
100
|
Recommended |
Third V Code |
|
|
|
| Query
|
encounter_034d |
String |
100
|
Recommended |
Fourth V Code |
|
|
|
| Query
|
encounter_034e |
String |
100
|
Recommended |
Fifth V Code |
|
|
|
| Query
|
length_of_stay_e |
Integer |
|
Recommended |
Length of stay ED only - Encounter 1 (days) |
|
|
|
| Query
|
length_of_stay_h |
Integer |
|
Recommended |
Length of stay hospital admission - Encounter 1 (days) |
|
|
|
| Query
|
length_of_stay_d |
Integer |
|
Recommended |
Length of stay direct admission only - Encounter 1 (days) |
|
|
|
| Query
|
lifeline_005 |
Integer |
|
Recommended |
Date of Call Start |
|
|
|
| Query
|
lifeline_006 |
Integer |
|
Recommended |
Date of Call End |
|
|
|
|
|
lifeline_007 |
String |
25
|
Recommended |
Time of Call Start |
|
|
|
|
|
lifeline_008 |
String |
25
|
Recommended |
Time of Call End |
|
|
|
| Query
|
lifeline_011_1 |
Integer |
|
Recommended |
A-Addiction (choice=Information/Education) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_011___1 |
| Query
|
lifeline_011_2 |
Integer |
|
Recommended |
A-Addiction (choice=Substance Abuse) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_011___2 |
| Query
|
lifeline_011_3 |
Integer |
|
Recommended |
A-Addiction (choice=Other Addictions) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_011___3 |
| Query
|
lifeline_012_1 |
Integer |
|
Recommended |
B-Base Needs (choice=Base Needs) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_012___1 |
| Query
|
lifeline_012_2 |
Integer |
|
Recommended |
B-Base Needs (choice=Runaway) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_012___2 |
| Query
|
lifeline_013_1 |
Integer |
|
Recommended |
H-Health (choice=Health) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_013___1 |
| Query
|
lifeline_014_1 |
Integer |
|
Recommended |
L-Life Process/Adjustments (choice=School/Education) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_014___1 |
| Query
|
lifeline_014_2 |
Integer |
|
Recommended |
L-Life Process/Adjustments (choice=Relocation/Moving) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_014___2 |
| Query
|
lifeline_014_3 |
Integer |
|
Recommended |
L-Life Process/Adjustments (choice=Employment) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_014___3 |
| Query
|
lifeline_014_4 |
Integer |
|
Recommended |
L-Life Process/Adjustments (choice=Legal) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_014___4 |
| Query
|
lifeline_015_1 |
Integer |
|
Recommended |
M-Mental Health (choice=Mental Health Info/Education) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___1 |
| Query
|
lifeline_015_2 |
Integer |
|
Recommended |
M-Mental Health (choice=Grief) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___2 |
| Query
|
lifeline_015_3 |
Integer |
|
Recommended |
M-Mental Health (choice=Anxiety) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___3 |
| Query
|
lifeline_015_4 |
Integer |
|
Recommended |
M-Mental Health (choice=Eating Disorder) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___4 |
| Query
|
lifeline_015_5 |
Integer |
|
Recommended |
M-Mental Health (choice=Depression) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___5 |
| Query
|
lifeline_015_6 |
Integer |
|
Recommended |
M-Mental Health (choice=Psychiatric Disorder) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___6 |
| Query
|
lifeline_015_7 |
Integer |
|
Recommended |
M-Mental Health (choice=Self-Injury) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___7 |
| Query
|
lifeline_015_8 |
Integer |
|
Recommended |
M-Mental Health (choice=Loneliness) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___8 |
| Query
|
lifeline_015_9 |
Integer |
|
Recommended |
M-Mental Health (choice=Anger Management) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___9 |
| Query
|
lifeline_015_10 |
Integer |
|
Recommended |
M-Mental Health (choice=Current Event Anxiety) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_015___10 |
| Query
|
lifeline_016_1 |
Integer |
|
Recommended |
Parenting (choice=Parenting Assistance) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_016___1 |
| Query
|
lifeline_016_2 |
Integer |
|
Recommended |
Parenting (choice=Relative Concern about Youth) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_016___2 |
| Query
|
lifeline_017_1 |
Integer |
|
Recommended |
R-Relationships (choice=Friendships) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___1 |
| Query
|
lifeline_017_2 |
Integer |
|
Recommended |
R-Relationships (choice=Peer Pressure/Bullying/Gangs) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___2 |
| Query
|
lifeline_017_3 |
Integer |
|
Recommended |
R-Relationships (choice=Boyfriend/Girlfriend/Significant Other) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___3 |
| Query
|
lifeline_017_4 |
Integer |
|
Recommended |
R-Relationships (choice=Marriage/Divorce) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___4 |
| Query
|
lifeline_017_5 |
Integer |
|
Recommended |
R-Relationships (choice=Parent/Child) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___5 |
| Query
|
lifeline_017_6 |
Integer |
|
Recommended |
R-Relationships (choice=Sibling/Other Family Relationships) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___6 |
| Query
|
lifeline_017_7 |
Integer |
|
Recommended |
R-Relationships (choice=Professional Relationship) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_017___7 |
| Query
|
lifeline_018_1 |
Integer |
|
Recommended |
S-Suicide (choice=Suicide Info/Education) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_018___1 |
| Query
|
lifeline_018_2 |
Integer |
|
Recommended |
S-Suicide (choice=Suicide Ideation) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_018___2 |
| Query
|
lifeline_018_3 |
Integer |
|
Recommended |
S-Suicide (choice=Suicide in Progress) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_018___3 |
| Query
|
lifeline_018_4 |
Integer |
|
Recommended |
S-Suicide (choice=Suicide Survivor) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_018___4 |
| Query
|
lifeline_019_1 |
Integer |
|
Recommended |
V-Victim/Offender (choice=Victim/Offender Info/Education) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_019___1 |
| Query
|
lifeline_019_2 |
Integer |
|
Recommended |
V-Victim/Offender (choice=Victim Child) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_019___2 |
| Query
|
lifeline_019_3 |
Integer |
|
Recommended |
V-Victim/Offender (choice=Victim/Adult) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_019___3 |
| Query
|
lifeline_019_4 |
Integer |
|
Recommended |
V-Victim/Offender (choice=Offender Child) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_019___4 |
| Query
|
lifeline_019_5 |
Integer |
|
Recommended |
V-Victim/Offender (choice=Offender Adult) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_019___5 |
| Query
|
lifeline_019_6 |
Integer |
|
Recommended |
V-Victim/Offender (choice=Domestic Violence Victim) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_019___6 |
| Query
|
lifeline_020_1 |
Integer |
|
Recommended |
X-Pregnancy/Sexuality (choice=Sexuality Information/Education) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_020___1 |
| Query
|
lifeline_020_2 |
Integer |
|
Recommended |
X-Pregnancy/Sexuality (choice=Sexuality Concerns) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_020___2 |
| Query
|
lifeline_020_3 |
Integer |
|
Recommended |
X-Pregnancy/Sexuality (choice=Pregnancy) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_020___3 |
| Query
|
lifeline_021_1 |
Integer |
|
Recommended |
G-General Information (choice=General Information) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_021___1 |
| Query
|
lifeline_022_1 |
Integer |
|
Recommended |
Resolution (choice=BT Related) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___1 |
| Query
|
lifeline_022_2 |
Integer |
|
Recommended |
Resolution (choice=Contracted) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___2 |
| Query
|
lifeline_022_3 |
Integer |
|
Recommended |
Resolution (choice=Referrals) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___3 |
| Query
|
lifeline_022_4 |
Integer |
|
Recommended |
Resolution (choice=Conference Call) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___4 |
| Query
|
lifeline_022_5 |
Integer |
|
Recommended |
Resolution (choice=Child Protective Services) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___5 |
| Query
|
lifeline_022_6 |
Integer |
|
Recommended |
Resolution (choice=Police/Emergency Medical) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___6 |
| Query
|
lifeline_022_7 |
Integer |
|
Recommended |
Resolution (choice=N/A (No interventions/referrals)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___7 |
| Query
|
lifeline_022_8 |
Integer |
|
Recommended |
Resolution (choice=Family Related) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___8 |
| Query
|
lifeline_022_9 |
Integer |
|
Recommended |
Resolution (choice=BT Admissions) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___9 |
| Query
|
lifeline_022_10 |
Integer |
|
Recommended |
Resolution (choice=BT Brochure/Catalog) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___10 |
| Query
|
lifeline_022_11 |
Integer |
|
Recommended |
Resolution (choice=Faxed to BT Dept) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___11 |
| Query
|
lifeline_022_12 |
Integer |
|
Recommended |
Resolution (choice=BT Transfer) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___12 |
| Query
|
lifeline_022_13 |
Integer |
|
Recommended |
Resolution (choice=Third Party Contact) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___13 |
| Query
|
lifeline_022_14 |
Integer |
|
Recommended |
Resolution (choice=Clinical Resource) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_022___14 |
| Query
|
lifeline_023_1 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Suicidal/Depressed Statements) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___1 |
| Query
|
lifeline_023_2 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Self-abuse/Injury) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___2 |
| Query
|
lifeline_023_3 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Final Arrangements) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___3 |
| Query
|
lifeline_023_4 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Contagion (suicide of relative, friend, other)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___4 |
| Query
|
lifeline_023_5 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Psychiatric Problems) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___5 |
| Query
|
lifeline_023_6 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Anxiety) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___6 |
| Query
|
lifeline_023_7 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Hopeless) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___7 |
| Query
|
lifeline_023_8 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Helpless) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___8 |
| Query
|
lifeline_023_9 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Feelings of being Trapped) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___9 |
| Query
|
lifeline_023_10 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Mood Changes) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___10 |
| Query
|
lifeline_023_11 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Out of Touch with Reality) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___11 |
| Query
|
lifeline_023_12 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Eating/Sleeping Changes) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___12 |
| Query
|
lifeline_023_13 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Psychological Pain) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___13 |
| Query
|
lifeline_023_14 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Depression) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___14 |
| Query
|
lifeline_023_15 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Current Substance Abuse) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___15 |
| Query
|
lifeline_023_16 |
Integer |
|
Recommended |
Mental/Emotional State (choice=Chemical Addiction) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_023___16 |
| Query
|
lifeline_024_1 |
Integer |
|
Recommended |
Situational Concerns (choice=Financial Loss) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___1 |
| Query
|
lifeline_024_2 |
Integer |
|
Recommended |
Situational Concerns (choice=Other Loss) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___2 |
| Query
|
lifeline_024_3 |
Integer |
|
Recommended |
Situational Concerns (choice=School Problems (truancy, learning disabilities, grades)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___3 |
| Query
|
lifeline_024_4 |
Integer |
|
Recommended |
Situational Concerns (choice=Runaway) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___4 |
| Query
|
lifeline_024_5 |
Integer |
|
Recommended |
Situational Concerns (choice=Unplanned Pregnancy) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___5 |
| Query
|
lifeline_024_6 |
Integer |
|
Recommended |
Situational Concerns (choice=Sexual Identity) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___6 |
| Query
|
lifeline_024_7 |
Integer |
|
Recommended |
Situational Concerns (choice=Legal Issues) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___7 |
| Query
|
lifeline_024_8 |
Integer |
|
Recommended |
Situational Concerns (choice=Homeless) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___8 |
| Query
|
lifeline_024_9 |
Integer |
|
Recommended |
Situational Concerns (choice=Veteran (for Lifeline calls)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_024___9 |
| Query
|
lifeline_025_1 |
Integer |
|
Recommended |
Relationship Concerns (choice=Isolated/Withdrawn) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___1 |
| Query
|
lifeline_025_2 |
Integer |
|
Recommended |
Relationship Concerns (choice=Lack of Support) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___2 |
| Query
|
lifeline_025_3 |
Integer |
|
Recommended |
Relationship Concerns (choice=Feels Intolerably Alone) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___3 |
| Query
|
lifeline_025_4 |
Integer |
|
Recommended |
Relationship Concerns (choice=Relationship Loss (divorce, breakup, friend, other)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___4 |
| Query
|
lifeline_025_5 |
Integer |
|
Recommended |
Relationship Concerns (choice=Relationhips Conflicts) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___5 |
| Query
|
lifeline_025_6 |
Integer |
|
Recommended |
Relationship Concerns (choice=Perceived Burden on Others) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___6 |
| Query
|
lifeline_025_7 |
Integer |
|
Recommended |
Relationship Concerns (choice=Family Instability (arguing, violence, substance abuse)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___7 |
| Query
|
lifeline_025_8 |
Integer |
|
Recommended |
Relationship Concerns (choice=Parental Frustration) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___8 |
| Query
|
lifeline_025_9 |
Integer |
|
Recommended |
Relationship Concerns (choice=Abuse Victim) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___9 |
| Query
|
lifeline_025_10 |
Integer |
|
Recommended |
Relationship Concerns (choice=Peer Pressure/Bullying) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___10 |
| Query
|
lifeline_025_11 |
Integer |
|
Recommended |
Relationship Concerns (choice=Current Rage/Aggression) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___11 |
| Query
|
lifeline_025_12 |
Integer |
|
Recommended |
Relationship Concerns (choice=Past History of Violence) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_025___12 |
| Query
|
lifeline_026 |
String |
500
|
Recommended |
Other Risk Factors |
|
|
|
| Query
|
lifeline_027_1 |
Integer |
|
Recommended |
Sometimes people in similar situations to you have suicidal thoughts. Are you feeling suicidal today? (choice=Current thought) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_027___1 |
| Query
|
lifeline_027_2 |
Integer |
|
Recommended |
Sometimes people in similar situations to you have suicidal thoughts. Are you feeling suicidal today? (choice=Current plan) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_027___2 |
| Query
|
lifeline_027_3 |
Integer |
|
Recommended |
Sometimes people in similar situations to you have suicidal thoughts. Are you feeling suicidal today? (choice=Attempt in progress) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_027___3 |
| Query
|
lifeline_027_4 |
Integer |
|
Recommended |
Sometimes people in similar situations to you have suicidal thoughts. Are you feeling suicidal today? (choice=No) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_027___4 |
| Query
|
lifeline_027_5 |
Integer |
|
Recommended |
Sometimes people in similar situations to you have suicidal thoughts. Are you feeling suicidal today? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
lifeline_027___5 |
|
|
lifeline_028 |
String |
500
|
Recommended |
Do you know the method of suicide |
|
|
|
|
|
lifeline_029 |
String |
500
|
Recommended |
Ho you have means for suicide available |
|
|
|
|
|
lifeline_030 |
String |
500
|
Recommended |
Do you know where you're planing to commit suicide |
|
|
|
|
|
lifeline_031 |
String |
500
|
Recommended |
Do you know when you're planing to commit suicide |
|
|
|
| Query
|
lifeline_032 |
Integer |
|
Recommended |
Anyone else know about your suicidal thought |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_033 |
Integer |
|
Recommended |
In the last six months have you thought about suicide? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_034 |
Integer |
|
Recommended |
Have you ever attempted suicide before? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
|
|
lifeline_035 |
String |
500
|
Recommended |
Previous suicide.Method? |
|
|
|
|
|
lifeline_036 |
String |
500
|
Recommended |
Most Recent? |
|
|
|
|
|
lifeline_037 |
String |
500
|
Recommended |
Most recent suicide. Help Received? |
|
|
|
| Query
|
lifeline_038 |
Integer |
|
Recommended |
Does the caller have family/other support? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_39 |
Integer |
|
Recommended |
Is anyone there with them? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_040 |
Integer |
|
Recommended |
Does caller have plans for their future? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_041 |
Integer |
|
Recommended |
Does caller have sense of purpose or feel responsibility for someone/thing |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_042 |
Integer |
|
Recommended |
Does caller want help? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_043 |
Integer |
|
Recommended |
Are they able to problem solve/coping skills |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_044 |
Integer |
|
Recommended |
Does caller have desire to live? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_045 |
Integer |
|
Recommended |
Does caller have religious beliefs/spiritual connection? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_046 |
Integer |
|
Recommended |
Does the caller engage with CC, likely to call back? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_047 |
Integer |
|
Recommended |
Are they working with a therapist? |
0;1; 88;-888; -999
|
0=No; 1=Yes; 88=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_048 |
Integer |
|
Recommended |
Next appointment with therapist? |
|
|
|
|
|
lifeline_049 |
String |
500
|
Recommended |
Prescribed medication(s)? |
|
|
|
| Query
|
lifeline_050 |
Integer |
|
Recommended |
Can you promise not to attempt suicide and if you feel like hurting yourself, will you let an adult or therapist know, or call back to this hotline? |
0;1;-888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_051 |
Integer |
|
Recommended |
Lethality risk assessment |
1::4; -888; -999
|
1=None; 2=Low; 3=Moderate; 4=High; -888=Not Applicable; -999=Missing
|
|
| Query
|
lifeline_complete |
Integer |
|
Recommended |
Complete? |
0::2; -888; -999
|
0=Incomplete; 1=Unverified; 2=Complete; -888=Not Applicable; -999=Missing
|
|
| Query
|
death001a |
Integer |
|
Recommended |
Death Certificate Search Outcome |
0::2; -888; -999
|
0=no certificate found; 1=certificate found; 2=search not performed, subject confirmed alive; -888=Not Applicable; -999=Missing
|
|
| Query
|
death001b |
Integer |
|
Recommended |
Confirmed alive |
1;2; -888; -999
|
1=at 12-month outcome call; 2=through healthcare utilization review; -888=Not Applicable; -999=Missing
|
|
| Query
|
death006_9 |
Integer |
|
Recommended |
If Age at last birthday is missing, why? (choice=Not Documented (field present on death certificate but left blank or otherwise ambiguous)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death006___9 |
| Query
|
death006_8 |
Integer |
|
Recommended |
If Age at last birthday is missing, why? (choice=Not Collected on this states death certificate (field not present)) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death006___8 |
| Query
|
death009 |
Integer |
|
Recommended |
Did death occur in a hospital? |
|
0=No; 1= Yes;8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death010 |
Integer |
|
Recommended |
Please indicate where in the hospital the death took place: |
|
1=Inpatient; 2=Emergency Room/Outpatient; 3=Dead on Arrival; 8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death011 |
Integer |
|
Recommended |
Please indicate where the death took place: |
|
1=Home; 2=Hospice facility; 3=Nursing home or long term care facility; 4=Other; 8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
|
|
death012 |
String |
50
|
Recommended |
If other, please specify |
|
|
|
| Query
|
death014_9 |
Integer |
|
Recommended |
If date of death missing, why? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death014___9 |
| Query
|
death014_8 |
Integer |
|
Recommended |
If date of death missing, why? (choice=Not Collected) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death014___8 |
|
|
death015 |
String |
50
|
Recommended |
Time pronounced dead |
|
|
|
| Query
|
death016_9 |
Integer |
|
Recommended |
If time of death missing, why? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death016___9 |
| Query
|
death016_8 |
Integer |
|
Recommended |
If time of death missing, why? (choice=Not Collected) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death016___8 |
| Query
|
death017 |
String |
500
|
Recommended |
Immediate cause of death (Final disease or condition resulting in death) |
|
|
|
| Query
|
death018_9 |
Integer |
|
Recommended |
If immediate cause of death missing, why? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death018___9 |
| Query
|
death018_8 |
Integer |
|
Recommended |
If immediate cause of death missing, why? (choice=Not Collected) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death018___8 |
|
|
death019 |
String |
50
|
Recommended |
First underlying cause of death |
|
|
|
| Query
|
death020_9 |
Integer |
|
Recommended |
If First underlying cause of death missing, why? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death020___9 |
| Query
|
death020_8 |
Integer |
|
Recommended |
If First underlying cause of death missing, why? (choice=Not Collected) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death020___8 |
|
|
death021 |
String |
50
|
Recommended |
Second underlying cause of death |
|
|
|
| Query
|
death022_9 |
Integer |
|
Recommended |
If Second underlying cause of death missing, why? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death022___9 |
| Query
|
death022_8 |
Integer |
|
Recommended |
If Second underlying cause of death missing, why? (choice=Not Collected) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death022___8 |
| Query
|
death023 |
String |
500
|
Recommended |
Third underlying cause of death |
|
|
|
| Query
|
death024_9 |
Integer |
|
Recommended |
If Third underlying cause of death missing, why? (choice=Not Documented) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death024___9 |
| Query
|
death024_8 |
Integer |
|
Recommended |
If Third underlying cause of death missing, why? (choice=Not Collected) |
0;1; -888; -999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing
|
death024___8 |
| Query
|
death025 |
Integer |
|
Recommended |
Did tobacco use contribute to death? |
0;1;8;9; -999;-888
|
0=No; 1= Yes;8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death026 |
Integer |
|
Recommended |
If female, pregnancy status |
|
1=Not pregnant in past year; 2=Pregnant at time of death; 3=Not pregnant, but pregnant within 42 days of death; 4=Not pregnant, but pregnant within 43 days to 1 year before death; 5=Unknown if pregnant within the past year; 6=Not applicable (male subject); 8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death027 |
Integer |
|
Recommended |
Manner of death |
|
1=Natural; 2=Homicide; 3=Accident; 4=Pending investigation; 5=Suicide; 6=Could not be determined; 8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death028 |
Integer |
|
Recommended |
Was death due to an injury? |
|
0=No; 1= Yes;8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death029 |
String |
30
|
Recommended |
Date of injury |
|
|
|
| Query
|
death030 |
Integer |
|
Recommended |
If Date of injury missing, why? |
8;9; -888; -999
|
8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
|
|
death031 |
String |
50
|
Recommended |
Time of injury |
|
|
|
| Query
|
death032 |
Integer |
|
Recommended |
If Time of injury missing, why? |
8;9; -888; -999
|
8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
death033 |
String |
500
|
Recommended |
Describe how injury occurred |
|
|
|
| Query
|
death034 |
Integer |
|
Recommended |
If Description of how injury occurred is missing, why? |
8;9; -888; -999
|
8=Not Collected; 9=Not Documented; -888=Not Applicable; -999=Missing
|
|
|
|
dthdate |
String |
30
|
Recommended |
Date of death |
|
|
death013 |
| Query
|
death_complete |
Integer |
|
Recommended |
Death assessment. Complete? |
0::2; -888; -999
|
0=Incomplete; 1=Unverified; 2=Complete; -888=Not Applicable; -999=Missing
|
|
|
|
phasescompleted |
String |
15
|
Recommended |
Phase completed |
|
|
|
|
|
deathdescription |
String |
510
|
Recommended |
INTERVIEWER: Please enter the description here. |
|
|
|
| Query
|
transfer |
Integer |
|
Recommended |
[For interviewer only]Do you want to transfer this respondent to Boystown? |
1; 2; -888; -999
|
1=Do not refer; 2=Refer to Boystown; -888=Not Applicable; -999=Missing
|
|
| Query
|
omnibus_h1 |
Integer |
|
Recommended |
How often have you had a drink containing alcohol in the past GetWeeks() weeks since getLastCompleted() ? |
1::7; 97; 98; -888; -999
|
1=Never; 2=Less than monthly; 3=Monthly; 4=Weekly; 5=2-3 times a week; 6=4-6 times a week; 7=Daily; 97=(Do not read) Don't know; 98=(Do not read) Refused; -888=Not Applicable; -999=Missing
|
h1 |
| Query
|
omnibus_h2 |
Integer |
|
Recommended |
In the past GetWeeks() weeks,how many drinks containing alcohol do you have on a typical day when you are drinking? |
|
|
h2 |
| Query
|
omnibus_h3 |
Integer |
|
Recommended |
How often do you have four or more drinks on one occasion? |
1::7; 97; 98; -888; -999
|
1=Never; 2=Less than monthly; 3=Monthly; 4=Weekly; 5=2-3 times a week; 6=4-6 times a week; 7=Daily; 97=(Do not read) Don't know; 98=(Do not read) Refused; -888=Not Applicable; -999=Missing
|
h3 |
| Query
|
omnibus_i1 |
Integer |
|
Recommended |
In the past GetWeeks() weeks since getLastCompleted(), have you used drugs other than those required for medical reasons? |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i1 |
| Query
|
omnibus_i3 |
Integer |
|
Recommended |
Marijuana |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i3 |
| Query
|
omnibus_i4 |
Integer |
|
Recommended |
Painkillers like Oxycontin, Percocet, and Vicadin |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i4 |
| Query
|
omnibus_i5 |
Integer |
|
Recommended |
Cocaine |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i5 |
| Query
|
omnibus_i6 |
Integer |
|
Recommended |
Tranquilizers or Sedatives like Xanax, Ativan, and Valium |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i6 |
| Query
|
omnibus_i7 |
Integer |
|
Recommended |
Hallucinogens like LSD and Acid |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i7 |
| Query
|
omnibus_i8 |
Integer |
|
Recommended |
Stimulants like Amphetimines, Speed, or Crystal Meth |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i8 |
| Query
|
omnibus_i9 |
Integer |
|
Recommended |
Ecstasy |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i9 |
| Query
|
omnibus_i10 |
Integer |
|
Recommended |
Heroin |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i10 |
| Query
|
omnibus_i11 |
Integer |
|
Recommended |
Cold or cough medicines |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i11 |
| Query
|
omnibus_i12 |
Integer |
|
Recommended |
Inhalants |
1;2;97; 98; -888;-999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing
|
i12 |
|
|
omnibus_i13 |
String |
50
|
Recommended |
Any Other drugs?(specify) |
|
|
i13 |
| Query
|
omnibus_j1 |
Integer |
|
Recommended |
The following question is about activities you might do during a typical day. Does your health now limit you inMODERATE activities, such as moving a table, pushing a vacuum cleaner, bowling, or playi |
1::3; 98; -888; -999
|
1=No, not limited at all;2=Yes, limited a little; 3=Yes, limited a lot; 98=(Do not read) Refused; -888=Not Applicable; -999=Missing
|
j1 |
| Query
|
omnibus_j2 |
Integer |
|
Recommended |
In the past 4 weeks, how much of the time were you limited in the kind of work or other regularDAILY ACTIVITIESyou do as a result of your physical health? |
1::5; 98; -888; -999
|
5=All of the time; 4=Most of the time; 3=Some of the time; 2=A little of the time; 1=None of the time; 98=refused; -888=Not Applicable; -999=Missing
|
j2 |
| Query
|
omnibus_j3 |
Integer |
|
Recommended |
In the past 4 weeks, how much did pain interfere with yourNORMAL WORK(including both work outside the home and housework)? |
1::5; 97; 98; -888; -999
|
1=Not at all; 2=A little bit; 3=Moderately; 4=Quite a bit; 5=Extremely; 97=(Do not read) Don't know; 98=(Do not read) Refused; -888=Not Applicable; -999=Missing
|
j3 |
| Query
|
omnibus_j4 |
Integer |
|
Recommended |
How much of the time in the past 4 weeks did you have a lot of energy? |
1::5; 98; -888; -999
|
5=All of the time; 4=Most of the time; 3=Some of the time; 2=A little of the time; 1=None of the time; 98=refused; -888=Not Applicable; -999=Missing
|
j4 |
| Query
|
omnibus_j5 |
Integer |
|
Recommended |
How much of the timein the past 4 weeks, have you felt downhearted and depressed? |
1::5; 98; -888; -999
|
5=All of the time; 4=Most of the time; 3=Some of the time; 2=A little of the time; 1=None of the time; 98=refused; -888=Not Applicable; -999=Missing
|
j5 |
| Query
|
omnibus_j6 |
Integer |
|
Recommended |
In the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? |
1::5; 98; -888; -999
|
5=All of the time; 4=Most of the time; 3=Some of the time; 2=A little of the time; 1=None of the time; 98=refused; -888=Not Applicable; -999=Missing
|
j6 |
| Query
|
sa_total_6 |
Integer |
|
Recommended |
Additive suicide attempt totals through |
|
|
|
| Query
|
sa_any_6 |
Integer |
|
Recommended |
Suicide attempt reported through |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
suicide_behavior_high_6 |
Integer |
|
Recommended |
Highest level of suicidal behavior individual had during follow-up period |
0::8; -888; -999
|
0=No suicidal behavior; 1=Preparatory acts; 2=Aborted attempt; 3=Interrupted atempt; 4=Attempt but no physical damage or very minor; 5=Minor physical damage; 6=Moderate physical damage; 7=Moderately severe physical damage; 8=Severe physical damage; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_sisa_6 |
Integer |
|
Recommended |
Completed both C-SSRS ideation and behavior scales for entire follow-up period |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_onlysi_6 |
Integer |
|
Recommended |
Completed only C-SSRS ideation scale for entire follow-up period |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_onlysa_6 |
Integer |
|
Recommended |
Completed only C-SSRS behavior scale for entire follow-up period |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
complete_cssrs_nonesisa_6 |
Integer |
|
Recommended |
Completed neither C-SSRS ideation or behavior scales for entire follow-up period |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
screened_sh |
Integer |
|
Recommended |
Screened for Self Harm? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scr |
Integer |
|
Recommended |
Screened |
0;1
|
0=No; 1=Yes;
|
screened |
| Query
|
scrn_si_sa |
Integer |
|
Recommended |
Screened positive for suicidal ideation or suicide attempt |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_si |
Integer |
|
Recommended |
Suicide ideation, current and past |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_currsi_a |
Integer |
|
Recommended |
Suicide ideation, current |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_pastsi_b |
Integer |
|
Recommended |
Suicide ideation, past |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_sa |
Integer |
|
Recommended |
Suicide attempts, current and past |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_currsa_a |
Integer |
|
Recommended |
Suicide attempts, current |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_pastsa_b |
Integer |
|
Recommended |
Suicide attempts, past |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_currsisa |
Integer |
|
Recommended |
Screened positive for current suicidal ideation or suicide attempt |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
scrn_sisa |
Integer |
|
Recommended |
Screened positive for suicidal ideation or suicide attempt |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
any_mh |
Integer |
|
Recommended |
Utilized outpatient Mental Health |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
| Query
|
completed |
Integer |
|
Recommended |
Checks if completed |
0::3
|
0=No; 1=Yes; 2=Yes, lost; 3=Unverified
|
chart_review_complete, chartreview_complete |
| Query
|
chartreview005 |
Integer |
|
Recommended |
ED triage date not documented |
0;1; -888;-999
|
0=No;1=Yes;-888=Not Applicable;-999=Missing;
|
|
|
|
chartreview006 |
String |
50
|
Recommended |
ED triage time |
|
|
|
| Query
|
chartreview007 |
Integer |
|
Recommended |
ED triage time not documented |
0;1; -888;-999
|
0=No;1=Yes;-888=Not Applicable;-999=Missing;
|
|
|
|
chartreview008 |
String |
500
|
Recommended |
Complaint(s) at ED triage |
|
|
|
| Query
|
chartreview009 |
Integer |
|
Recommended |
Does the complaint involve psychiatric behavior? |
|
0=No/Not documented;1=Yes; 2 = Unsure; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview010 |
Integer |
|
Recommended |
Is self-harm behavior noted in complaint? |
|
0=No/Not documented; 1= yes;-888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview011 |
Integer |
|
Recommended |
Triage code |
|
1=1;2=2;3=3;4=4;5=5;6=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview016b |
Integer |
|
Recommended |
Does the Patient have insurance? |
0;1;9; -888; -999
|
0=No; 1=Yes; 9=Not documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview016c_1 |
Integer |
|
Recommended |
What type of insurance does the patient have? Private Health Insurance |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___1 |
| Query
|
chartreview016c_10 |
Integer |
|
Recommended |
What type of insurance does the patient have? Medicare |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___10 |
| Query
|
chartreview016c_2 |
Integer |
|
Recommended |
What type of insurance does the patient have? Medi-Gap |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___2 |
| Query
|
chartreview016c_3 |
Integer |
|
Recommended |
What type of insurance does the patient have? Medicaid |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___3 |
| Query
|
chartreview016c_4 |
Integer |
|
Recommended |
What type of insurance does the patient have? SCHIP (CHIP/Childrens Health Insurance Program) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___4 |
| Query
|
chartreview016c_5 |
Integer |
|
Recommended |
What type of insurance does the patient have? Military Health Care (Tricare/VA/CHAMP-VA) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___5 |
| Query
|
chartreview016c_6 |
Integer |
|
Recommended |
What type of insurance does the patient have? Indian Health Service |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___6 |
| Query
|
chartreview016c_7 |
Integer |
|
Recommended |
What type of insurance does the patient have? State-sponsored health plan |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___7 |
| Query
|
chartreview016c_8 |
Integer |
|
Recommended |
What type of insurance does the patient have? Other government program |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___8 |
| Query
|
chartreview016c_9 |
Integer |
|
Recommended |
What type of insurance does the patient have? Single service plan (e.g., dental, vision, prescriptions) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview016c___9 |
|
|
chartreview016d |
String |
75
|
Recommended |
Please specify type of other government program |
|
|
|
|
|
chartreview016e |
String |
75
|
Recommended |
Please specify type of single service program |
|
|
|
| Query
|
chartreview017 |
Integer |
|
Recommended |
Alcohol abuse (current intoxication or evidence of any problem use) |
|
0=No; 1=Yes; 9=Not documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview018 |
Integer |
|
Recommended |
Blood alcohol level indicates intoxication |
|
0=No; 1=Yes; 9=Not documented/Not done; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview019 |
Integer |
|
Recommended |
Intentional illegal or prescription drug misuse |
|
0=No; 1=Yes; 9=Not documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview020 |
Integer |
|
Recommended |
Any positive urine tox screen |
|
0=No; 1=Yes; 9=Not documented/Not done; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview021 |
String |
15
|
Recommended |
Suicidal ideation |
|
0=No; 1=Yes,in past week; 2=Yes, >1 week ago; 3=Yes, no time specified; 5 = Yes, in current visit; 9=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview022 |
String |
15
|
Recommended |
Suicide attempt |
|
0=No; 1=Yes,in past week; 2=Yes, >1 week ago; 3=Yes, no time specified; 5 = Yes, in current visit; 9=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview023 |
Integer |
|
Recommended |
If the index ED visit was for a suicide attempt, rate the lethality of the attempt |
|
0=Not applicable(suicide attempt in the pastweek=but not the reason for the ED visit of interest);1=No physical damage or very minor physical damage (e.g.=surface scratches);2=Minor physical damage (e.g.lethargic speech; first-degree burns; mild bleeding; sprains); 3=Moderate physical damage; medical attention needed (e.g.=conscious but sleepy; second-degree burns; bleeding of major vessel); 4=Moderately severe physical damage; medical hospitalization and likely intensive care required (e.g.=comatose; third-degree burns; extensive blood loss but can recover; 5=Severe physical damage; medical hospitalization with intensive care required (e.g., comatose; third-degree burns over most of body; extensive blood loss with unstable vital signs; major damage to a vital area)
maj; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview024 |
Integer |
|
Recommended |
Documentation, either positive or negative, of suicide ideation or attempt from above questions constitutes a suicide screening. The following questions should only be answered if a suicide attempt/ideation screen was documented (either yes or no). Where w |
1;2; -888; -999
|
1=Yes; 2=Notes not available; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview025 |
Integer |
|
Recommended |
Primary nursing notes: |
1;2; -888; -999
|
1=Yes; 2=Notes not available; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview026 |
Integer |
|
Recommended |
Physician notes: |
1;2; -888; -999
|
1=Yes; 2=Notes not available; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview027 |
Integer |
|
Recommended |
Mental health provider notes: |
1;2; -888; -999
|
1=Yes; 2=Notes not available; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview028 |
Integer |
|
Recommended |
Other: |
1;2; -888; -999
|
1=Yes; 2=Notes not available; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview030 |
Integer |
|
Recommended |
Was a safety plan created for the patient? |
0::2; -888;-999
|
0=No/Not Documented;1=Yes; 2 = Partial; -888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview031_1 |
Integer |
|
Recommended |
Who created the safety plan? Social worker |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___1 |
| Query
|
chartreview031_2 |
Integer |
|
Recommended |
Who created the safety plan? Staff nurse (RN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___2 |
| Query
|
chartreview031_3 |
Integer |
|
Recommended |
Who created the safety plan? Advance practice nurse (APRN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___3 |
| Query
|
chartreview031_4 |
Integer |
|
Recommended |
Who created the safety plan? Psychologist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___4 |
| Query
|
chartreview031_5 |
Integer |
|
Recommended |
Who created the safety plan? Psychiatrist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___5 |
| Query
|
chartreview031_6 |
Integer |
|
Recommended |
Who created the safety plan? EM physician |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___6 |
| Query
|
chartreview031_7 |
Integer |
|
Recommended |
Who created the safety plan? Other |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview031___7 |
|
|
chartreview032 |
String |
500
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
chartreview033 |
Integer |
|
Recommended |
Was the presence of means to complete suicide assessed (e.g., firearms or presence of medications)? |
|
0=No/Not Documented; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview034 |
Integer |
|
Recommended |
Were referral resources for mental health services provided to the patient, such as provider lists, hotline numbers, or educational brochures? |
0;1; -888;-999
|
0=No/Not Documented; 1=Yes; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview035_1 |
Integer |
|
Recommended |
Who provided the referral resources? Social worker |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___1 |
| Query
|
chartreview035_2 |
Integer |
|
Recommended |
Who provided the referral resources? Staff nurse (RN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___2 |
| Query
|
chartreview035_3 |
Integer |
|
Recommended |
Who provided the referral resources? Advance practice nurse (APRN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___3 |
| Query
|
chartreview035_4 |
Integer |
|
Recommended |
Who provided the referral resources? Psychologist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___4 |
| Query
|
chartreview035_5 |
Integer |
|
Recommended |
Who provided the referral resources? Psychiatrist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___5 |
| Query
|
chartreview035_6 |
Integer |
|
Recommended |
Who provided the referral resources? EM physician |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___6 |
| Query
|
chartreview035_7 |
Integer |
|
Recommended |
Who provided the referral resources? Other |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview035___7 |
|
|
chartreview036 |
String |
75
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
chartreview037 |
Integer |
|
Recommended |
Was an appointment made with an outpatient mental health treatment provider before the patient left the ED? |
0;1; -888;-999
|
0=No/Not Documented;1=Yes;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview038_1 |
Integer |
|
Recommended |
Who made the appointment? Social worker |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___1 |
| Query
|
chartreview038_2 |
Integer |
|
Recommended |
Who made the appointment? Staff nurse (RN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___2 |
| Query
|
chartreview038_3 |
Integer |
|
Recommended |
Who made the appointment? Advance practice nurse (APRN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___3 |
| Query
|
chartreview038_4 |
Integer |
|
Recommended |
Who made the appointment? Psychologist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___4 |
| Query
|
chartreview038_5 |
Integer |
|
Recommended |
Who made the appointment? Psychiatrist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___5 |
| Query
|
chartreview038_6 |
Integer |
|
Recommended |
Who made the appointment? EM physician |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___6 |
| Query
|
chartreview038_7 |
Integer |
|
Recommended |
Who made the appointment? Other |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview038___7 |
|
|
chartreview039 |
String |
500
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
chartreview040 |
Integer |
|
Recommended |
Non-suicidal intentional self-harm ideation |
0::3; 9; -888; -999
|
0=No; 1=Yes, in past week; 2=Yes, >1week ago; 3=Yes, no time specified; 9=Not Documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview041 |
Integer |
|
Recommended |
Non-suicidal intentional self-harm behavior |
0::3; 9; -888; -999
|
0=No; 1=Yes, in past week; 2=Yes, >1week ago; 3=Yes, no time specified; 9=Not Documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview042 |
String |
15
|
Recommended |
Thoughts or threats of harm toward other people |
|
0=No; 1=Yes,in past week; 2=Yes, >1 week ago; 3=Yes, no time specified; 5 = Yes, in current visit; 9=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview043 |
String |
15
|
Recommended |
Interpersonal violence (any) |
|
0=No; 1=Yes,in past week; 2=Yes, >1 week ago; 3=Yes, no time specified; 5 = Yes, in current visit; 9=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview044 |
Integer |
|
Recommended |
Domestic violence |
|
0=No; 1=Yes,in past week; 2=Yes, >1 week ago; 3=Yes, no time specified; 5 = Yes, in current visit; 9=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview045 |
String |
15
|
Recommended |
Depressed mood |
|
0=No; 1=Yes,in past week; 2=Yes, >1 week ago; 3=Yes, no time specified; 5 = Yes, in current visit; 9=Not Documented;-888=Not Applicable;-999=Missing;
|
|
| Query
|
chartreview046 |
Integer |
|
Recommended |
Was the patient evaluated by a mental health professional during this visit? |
|
0=No; 1=Yes; 9=Not Documented; -888=Not Applicable;- 999=Missing;
|
|
| Query
|
chartreview047_1 |
Integer |
|
Recommended |
Who performed the evaluation? Social worker |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview047___1 |
| Query
|
chartreview047_2 |
Integer |
|
Recommended |
Who performed the evaluation? Staff psyc nurse (RN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview047___2 |
| Query
|
chartreview047_3 |
Integer |
|
Recommended |
Who performed the evaluation? Advance psyc practice nurse (APRN) |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview047___3 |
| Query
|
chartreview047_4 |
Integer |
|
Recommended |
Who performed the evaluation? Psychologist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview047___4 |
| Query
|
chartreview047_5 |
Integer |
|
Recommended |
Who performed the evaluation? Psychiatrist |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview047___5 |
| Query
|
chartreview047_6 |
Integer |
|
Recommended |
Who performed the evaluation? Other |
0;1; -888;-999
|
0=Unchecked; 1=Checked; -888=Not Applicable; -999=Missing;
|
chartreview047___6 |
|
|
chartreview048 |
String |
500
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
chartreview049 |
Integer |
|
Recommended |
Over the past 2 weeks, have you felt down, depressed, or hopeless? |
0;1; -888;-999
|
0=No; 1=Yes; 2=Refused; 3=Patient unable to complete; 9=Not documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview050 |
String |
500
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
chartreview051 |
Integer |
|
Recommended |
ED disposition |
1::10; -888;-999
|
1=Home; 2=Admitted to medical ward/observation; 3=Admitted to ICU; 4=Admitted to psychiatric ward/facility; 5=Admitted to substance abuse treatement facility; 6=Transferred to other mental health evaluation facility; 7=Left against medical advice; 8=Left without being seen; 9=Other; 10=Not documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview052 |
String |
500
|
Recommended |
If Other, please specify |
|
|
|
| Query
|
chartreview053 |
String |
500
|
Recommended |
Primary ED physician discharge diagnosis |
|
|
|
| Query
|
chartreview054 |
String |
10
|
Recommended |
ED discharge/transfer/left ED date |
|
|
|
| Query
|
chartreview055_1 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Too sick / Injured |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___1 |
| Query
|
chartreview055_2 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Altered mental status (intoxicated, unconscious, hallucinating) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___2 |
| Query
|
chartreview055_3 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Agitated, hostile, violent, or abusive |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___3 |
| Query
|
chartreview055_4 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Insurmountable language barrier |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___4 |
| Query
|
chartreview055_5 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Not currently community-dwelling (e.g. in psychiatric facility, rehab) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___5 |
| Query
|
chartreview055_6 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Homeless |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___6 |
| Query
|
chartreview055_7 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? Other |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___7 |
| Query
|
chartreview055_8 |
Integer |
|
Recommended |
Were any of the following patient characteristics documented during any time of the visit that would have indicated an inability to be enrolled in the study? None of the above |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing;
|
chartreview055___8 |
|
|
chartreview056 |
String |
500
|
Recommended |
ED discharge/transfer/left ED time |
|
|
|
| Query
|
chartreview057 |
Integer |
|
Recommended |
ED disposition time not documented |
0;1; -888;-999
|
0=No; 1=Yes; -888=Not Applicable;- 999=Missing
|
|
|
|
chartreview058 |
String |
75
|
Recommended |
Number of ED visits in the previous 6 months: |
|
|
|
|
|
chartreview059 |
String |
500
|
Recommended |
Medical inpatient hospitalizations |
|
|
|
| Query
|
chartreview060 |
Integer |
|
Recommended |
Substance abuse inpatient hospitalizations |
|
|
|
| Query
|
chartreview061 |
Integer |
|
Recommended |
Psychiatric inpatient hospitalizations |
|
|
|
|
|
chartreview062 |
String |
50
|
Recommended |
Other inpatient hospitalizations |
|
|
|
| Query
|
chartreview063 |
String |
500
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
| Query
|
chartreview064 |
String |
500
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
| Query
|
chartreview065 |
String |
500
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
| Query
|
chartreview066 |
String |
500
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
| Query
|
chartreview067 |
String |
500
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
| Query
|
chartreview068 |
String |
500
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
|
|
chartreview069 |
String |
50
|
Recommended |
Other inpatient hospitalizations 1 |
|
|
|
|
|
chartreview070 |
String |
50
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
|
|
chartreview071 |
String |
50
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
|
|
chartreview072 |
String |
50
|
Recommended |
BILLING CODES (ICD-9 CODES) FOR THIS ED VISIT |
|
|
|
|
|
chartreview073 |
String |
50
|
Recommended |
Other inpatient hospitalizations 5 |
|
|
|
|
|
chartreview074 |
String |
50
|
Recommended |
Other inpatient hospitalizations 6 |
|
|
|
|
|
chartreview075 |
String |
50
|
Recommended |
Other inpatient hospitalizations 7 |
|
|
|
|
|
chartreview076 |
String |
50
|
Recommended |
Other inpatient hospitalizations 8 |
|
|
|
| Query
|
chartreviewlos |
Integer |
|
Recommended |
Length of stay (days): Random chart review |
|
|
|
| Query
|
sitenum |
Integer |
|
Recommended |
Site Number |
|
900=Marlborough Hospital; 200=Maricopa Medical Center; 300=Memorial Hospital of Rhode Island; 400=Ohio State University Medical Center; 500=University of Arkansas Medical Center; 600=Beth Israel Deaconess Medical Center; 700=University of Nebraska Medical Center; 800=University of Colorado Hospital; 100=University of Massachusetts Memorial Hospital; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview024_1 |
Integer |
|
Recommended |
Documentation, either positive or negative, of suicide ideation or attempt from above questions constitutes a suicide screening. (choice=Yes) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview024___1 |
| Query
|
chartreview024_2 |
Integer |
|
Recommended |
Documentation, either positive or negative, of suicide ideation or attempt from above questions constitutes a suicide screening. (choice=Notes not available) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview024___2 |
| Query
|
chartreview025_1 |
Integer |
|
Recommended |
Primary nursing notes: (choice=Yes) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview025___1 |
| Query
|
chartreview025_2 |
Integer |
|
Recommended |
Primary nursing notes: (choice=Notes not available) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview025___2 |
| Query
|
chartreview026_1 |
Integer |
|
Recommended |
Physician notes: (choice=Yes) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview026___1 |
| Query
|
chartreview026_2 |
Integer |
|
Recommended |
Physician notes: (choice=Notes not available) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview026___2 |
| Query
|
chartreview027_1 |
Integer |
|
Recommended |
Mental health provider notes: (choice=Yes) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview027___1 |
| Query
|
chartreview027_2 |
Integer |
|
Recommended |
Mental health provider notes: (choice=Notes not available) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview027___2 |
| Query
|
chartreview028_1 |
Integer |
|
Recommended |
Other: (choice=Yes) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview028___1 |
| Query
|
chartreview045a |
Integer |
|
Recommended |
Over the past 2 weeks, have you felt down, depressed, or hopeless? |
0::3; 9;-888;-999
|
0=No; 1=Yes; 2=Refused; 3=Patient unable to complete; 9=Not documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
chartreview045b |
Integer |
|
Recommended |
Over the past 2 weeks, have you had thoughts of killing yourself? |
0::3; 9;-888;-999
|
0=No; 1=Yes; 2=Refused; 3=Patient unable to complete; 9=Not documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
chartreview045c |
Integer |
|
Recommended |
Have you ever attempted to kill yourself? |
0::3; 9;-888;-999
|
0=No; 1=Yes; 2=Refused; 3=Patient unable to complete; 9=Not documented; -888=Not Applicable; -999=Missing
|
|
| Query
|
chartreview045d |
Integer |
|
Recommended |
If YES, when did this last happen? |
1::6; 9; -888;-999
|
1=Within the past 24 hours (including today); 2=Within the last month (but not today); 3=Between 1 and 6 months ago;4=More than six months ago; 5=Refused; 6=Patient unable to complete; 9=Not documented;-888=Not Applicable; -999=Missing
|
|
| Query
|
chartreview045e |
Integer |
|
Recommended |
Is there documentation that the emergency physician completed his/her own assessment of the patients suicide risk? |
0;1;9;-888;-999
|
0=No; 1=Yes; 9=Not documented; -888=Not Applicable; -999=Missing;
|
|
| Query
|
chartreview045f |
Integer |
|
Recommended |
Was the ED-SAFE structured secondary screening completed? |
0::2; -888;-999
|
0=No, not completed at all; 1=Yes, completed fully; 2=Yes, completed partially; -888=Not Applicable; -999=Missing
|
|
| Query
|
chartreview049_1 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Too sick / Injured) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___1 |
| Query
|
chartreview049_2 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Altered mental status) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___2 |
| Query
|
chartreview049_3 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Agitated, hostile, violent, or abusive) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___3 |
| Query
|
chartreview049_4 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Insurmountable language barrier) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___4 |
| Query
|
chartreview049_5 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Not currently community-dwelling) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___5 |
| Query
|
chartreview049_6 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Homeless) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___6 |
| Query
|
chartreview049_7 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=Other (specify)) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___7 |
| Query
|
chartreview049_8 |
Integer |
|
Recommended |
Were any of the following characteristics documented during visit that would indicate an inability for the patient to be enrolled?(choice=None of the above) |
0;1; -888;-999
|
0=Unchecked;1=Checked;-888=Not Applicable;-999=Missing
|
chartreview049___8 |
| Query
|
chartreview055 |
Integer |
|
Recommended |
ED disposition date not documented |
0;1; -888;-999
|
0=No; 1=Yes; -888=Not Applicable;- 999=Missing
|
|
|
|
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 |
|
|
|
|
|
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.
|
|
|
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
|
|
|
sex |
String |
20
|
Required |
Sex of subject at birth |
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender, sex |
| Query
|
race |
String |
30
|
Recommended |
Race of study subject |
American Indian/Alaska Native; Asian; Hawaiian or Pacific Islander; Black or African American; White; More than one race; Unknown or not reported; Other Non-White; Other
|
|
|
| Query
|
visit |
String |
60
|
Recommended |
Visit name |
|
|
|
|
|
utilization018 |
String |
100
|
Recommended |
Please list the dates of each ED visit resulting in a medical hospital admission and discharge |
|
|
utilization019, utilization020, utilization021, utilization022, utilization023, utilization024, utilization025, utilization026, utilization026a |
| Query
|
e7c1 |
Integer |
|
Recommended |
1. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d1 |
Integer |
|
Recommended |
1. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e1 |
Integer |
|
Recommended |
1. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f1 |
Integer |
|
Recommended |
1. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g1 |
Integer |
|
Recommended |
1. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h1 |
Integer |
|
Recommended |
1. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c2 |
Integer |
|
Recommended |
2. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d2 |
Integer |
|
Recommended |
2. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e2 |
Integer |
|
Recommended |
2. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f2 |
Integer |
|
Recommended |
2. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g2 |
Integer |
|
Recommended |
2. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h2 |
Integer |
|
Recommended |
2. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c3 |
Integer |
|
Recommended |
3. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d3 |
Integer |
|
Recommended |
3. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e3 |
Integer |
|
Recommended |
3. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f3 |
Integer |
|
Recommended |
3. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g3 |
Integer |
|
Recommended |
3. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h3 |
Integer |
|
Recommended |
3. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c4 |
Integer |
|
Recommended |
4. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d4 |
Integer |
|
Recommended |
4. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e4 |
Integer |
|
Recommended |
4. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f4 |
Integer |
|
Recommended |
4. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g4 |
Integer |
|
Recommended |
4. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h4 |
Integer |
|
Recommended |
4. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c5 |
Integer |
|
Recommended |
5. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d5 |
Integer |
|
Recommended |
5. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e5 |
Integer |
|
Recommended |
5. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f5 |
Integer |
|
Recommended |
5. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g5 |
Integer |
|
Recommended |
5. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h5 |
Integer |
|
Recommended |
5. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c6 |
Integer |
|
Recommended |
6. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d6 |
Integer |
|
Recommended |
6. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e6 |
Integer |
|
Recommended |
6. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f6 |
Integer |
|
Recommended |
6. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g6 |
Integer |
|
Recommended |
6. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h6 |
Integer |
|
Recommended |
6. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c7 |
Integer |
|
Recommended |
7. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d7 |
Integer |
|
Recommended |
7. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e7 |
Integer |
|
Recommended |
7. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f7 |
Integer |
|
Recommended |
7. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g7 |
Integer |
|
Recommended |
7. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h7 |
Integer |
|
Recommended |
7. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c8 |
Integer |
|
Recommended |
8. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d8 |
Integer |
|
Recommended |
8. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e8 |
Integer |
|
Recommended |
8. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f8 |
Integer |
|
Recommended |
8. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g8 |
Integer |
|
Recommended |
8. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h8 |
Integer |
|
Recommended |
8. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7c9 |
Integer |
|
Recommended |
9. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7d9 |
Integer |
|
Recommended |
9. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e9 |
Integer |
|
Recommended |
9. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7f9 |
Integer |
|
Recommended |
9. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7g9 |
Integer |
|
Recommended |
9. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7h9 |
Integer |
|
Recommended |
9. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7ctf |
Integer |
|
Recommended |
10. Did you go to the Emergency Room during this hospital visit? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7dtf |
Integer |
|
Recommended |
10. Did you stay overnight in the hospital? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7e10 |
Integer |
|
Recommended |
10. How many nights did you stay in the hospital? |
|
|
|
| Query
|
e7ftf |
Integer |
|
Recommended |
10. At any time during this hospital visit, were you admitted to a psychiatric or substance abuse ward? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7gtf |
Integer |
|
Recommended |
10. Was this visit prompted by or the result of a suicide attempt? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
| Query
|
e7htf |
Integer |
|
Recommended |
10. Did you already tell me about this visit when we talked about suicide attempts earlier in the survey? |
1;2; 98; -888; -999
|
1=Yes; 2=No; 98=Refused; -888=Not Applicable; -999=Missing;
|
|
|
|
bima_5b |
String |
100
|
Recommended |
Have you had to be admitted to the hospital here or at any other hospital? Where? |
|
|
v1_location |
|
|
strreasonhosp1 |
String |
50
|
Recommended |
Reason for 1st hospitalization. |
|
|
v1_visit_reason |
|
|
tesi_c_101 |
String |
100
|
Recommended |
What happened? Additional information about event |
|
|
v1_happened |
|
|
suicide_symptoms_specify |
String |
255
|
Recommended |
Suicide: If yes, specify symptoms |
|
|
v1_symptoms |
|
|
strdurhosp1 |
String |
255
|
Recommended |
If dates not given, duration of 1st hospitalization |
|
|
v1_time |
| Query
|
region |
Integer |
|
Recommended |
Is this participant located in the geographic region relevant to this chart review? |
|
0 = No; 1 = Yes
|
|
| Query
|
total_visits |
Integer |
|
Recommended |
Total # of Hospital and ED visits at this time point |
|
|
|
|
|
v1_cause |
String |
500
|
Recommended |
What caused the suicidal/self-harming event? What were the circumstances around the event? |
|
|
|
|
|
v1_transport |
String |
100
|
Recommended |
How was the participant transported to the hospital/ED? |
|
|
|
|
|
v1_care |
String |
500
|
Recommended |
Describe care received |
|
|
|
|
|
v1_aftercare |
String |
300
|
Recommended |
Was any aftercare scheduled? If yes, specify. |
|
|
|
|
|
v1_status |
String |
300
|
Recommended |
What was the participant's status at discharge? |
|
|
|
| Query
|
visnum |
Float |
|
Recommended |
Numeric Visit Number |
|
-1.5 = Pre-Screening; -1 = Screening; 0 = Baseline; ## = Visit ## (from 1 to 10); Whole numbers = standard monthly visits; #.001 - #.009 = Unscheduled; #.1 = End of Phase 1; #.2 = End of Phase 2; #.3 = End of Phase 3; #.4 = End of Open Choice Phase; #.5 = End of Study; #.6 = Genetic Analysis; 1000=all visits
|
|
| Query
|
daymstrecnt |
Integer |
|
Recommended |
Study day most recent scheduled assessment was completed |
|
|
|
| Query
|
dayasmnt |
Integer |
|
Recommended |
Study Day of Assessment |
|
|
|
| Query
|
aescode |
Integer |
|
Recommended |
Staff code number of person completing this form |
|
999= Missing Data
|
|
| Query
|
bsit0 |
Float |
|
Recommended |
Weeks from Time 0/baseline to assessment |
|
|
|
| Query
|
suicidal_ideation |
Integer |
|
Recommended |
Suicide Ideation Severity |
1::6
|
6 = Extreme; 5 = Severe; 4 = Moderate; 3 = Mild; 2 = Slight; 1 = Not at all
|
|
|
|
ed1_presentdate |
Date |
|
Recommended |
Emergency Department Presentation Date |
|
MM/DD/YYYY
|
|
|
|
hufu1 |
String |
10
|
Recommended |
Source of data (check all that apply) |
|
1 = Electronic records for the ED/Hospital where the subject was enrolled; 2 = Electronic records for the larger healthcare system affiliated with ED/Hospital where the subject was enrolled (i.e., includes more than 1 ED/hospital); 3 = Electronic records for other EDs/Hospitals visible within your electronic record system (though not affiliated with your healthcare system); 4 = Other (specify)
|
|
|
|
hufu1_other |
String |
100
|
Recommended |
Source of data, Other |
|
|
|
| Query
|
hufu3 |
Integer |
|
Recommended |
In the date range being reviewed, how many total ED visits did the subject have (for any reason)? Do not include the index ED visit in this count. |
|
|
|
| Query
|
hufu6 |
Integer |
|
Recommended |
Of the ED visits resulting in admission, how many admissions were to a psychiatric or substance abuse hospital/unit? |
|
|
|
| Query
|
hufu7 |
Integer |
|
Recommended |
How many TOTAL ED visits were for suicidal behavior or ideation? |
|
|
|
|
|
hufu8_date2 |
Date |
|
Recommended |
Emergency department visit date 2 |
|
|
|
|
|
hufu8_date3 |
Date |
|
Recommended |
Emergency department visit date 3 |
|
|
|
|
|
hufu8_date4 |
Date |
|
Recommended |
Emergency department visit date 4 |
|
|
|
|
|
hufu8_date5 |
Date |
|
Recommended |
Emergency department visit date 5 |
|
|
|
|
|
hufu8_date6 |
Date |
|
Recommended |
Emergency department visit date 6 |
|
|
|
|
|
hufu8_date7 |
Date |
|
Recommended |
Emergency department visit date 7 |
|
|
|
|
|
hufu8_date8 |
Date |
|
Recommended |
Emergency department visit date 8 |
|
|
|
|
|
hufu8_date9 |
Date |
|
Recommended |
Emergency department visit date 9 |
|
|
|
| Query
|
hufu9 |
Integer |
|
Recommended |
How many times was the subject directly admitted to the hospital (i.e., without an ED visit) in the date range being reviewed? |
|
|
|
| Query
|
hufu10 |
Integer |
|
Recommended |
Number of healthcare encounters (direct admits plus ED visits) |
|
|
|
|
|
hufu9e_date1 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 1 |
|
|
|
|
|
hufu9e_date2 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 2 |
|
|
|
|
|
hufu9e_date3 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 3 |
|
|
|
|
|
hufu9e_date4 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 4 |
|
|
|
|
|
hufu9e_date5 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 5 |
|
|
|
|
|
hufu9e_date6 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 6 |
|
|
|
|
|
hufu9e_date7 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 7 |
|
|
|
|
|
hufu9e_date8 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 8 |
|
|
|
|
|
hufu9e_date9 |
Date |
|
Recommended |
If there has been at least one direct admission to a hospital (without an ED visit), then please specify date of direct admit or transfer: Date 9 |
|
|
|
| Query
|
mra_5 |
Integer |
|
Recommended |
|
|
|
|
| Query
|
mra_7_other |
Integer |
|
Recommended |
|
|
|
|
|
|
ethnicity |
String |
30
|
Recommended |
Ethnicity of participant |
|
|
|
|
|
fsprg |
String |
150
|
Recommended |
In your own words, to which race(s) or racial group(s) do you belong? |
|
|
|
|
|
mra_1 |
String |
10
|
Recommended |
Emergency Department triage date |
|
99 = Not documented
|
|
|
|
mra_2 |
String |
10
|
Recommended |
Emergency Department triage time |
|
99 = Not documented
|
|
|
|
mra_3 |
String |
300
|
Recommended |
Complaint(s) at ED triage (write in complete complaint(s)) |
|
|
|
| Query
|
mra_14c |
Integer |
|
Recommended |
If the patient was evaluated by a mental health professional during this visit: was any evaluator from an outside facility? |
0;1;99
|
0 = No; 1 = Yes; 99 = Not documented
|
|
|
|
mra_18b |
String |
25
|
Recommended |
If it was documented that there was assessment of means to complete suicide, who assessed the presence of means? Mark all that apply. |
|
1 = social worker; 2 = staff nurse; 3 = midlevel provider; 4 = psychologist; 5 = psychiatrist; 6 = EM physician; 9 = Other (specify)
|
|
|
|
mra_18b_other |
String |
100
|
Recommended |
If it was documented that there was assessment of means to complete suicide, who assessed the presence of means? Specify other interviewer |
|
|
|
| Query
|
mra_18c |
Integer |
|
Recommended |
If it was documented that there was assessment of means to complete suicide, were firearms specifically mentioned? |
0;1;99
|
0 = No; 1 = Yes; 99 = Not documented
|
|
|
|
mra_18d |
String |
25
|
Recommended |
If it was documented that there was assessment of means to complete suicide, who assessed access to firearms? Mark all that apply. |
|
1 = social worker; 2 = staff nurse; 3 = midlevel provider; 4 = psychologist; 5 = psychiatrist; 6 = EM physician; 9 = Other (specify)
|
|
|
|
mra_18d_other |
String |
100
|
Recommended |
If it was documented that there was assessment of means to complete suicide, who assessed access to firearms? Specify other assessor |
|
|
|
| Query
|
mra_19 |
Integer |
|
Recommended |
Was a way to reduce access to means to complete suicide addressed? |
0;1;99
|
0 = No; 1 = Yes; 99 = Not documented
|
|
|
|
mra_19b |
String |
25
|
Recommended |
If assessment included discussion of a way to reduce access to means to complete suicide, who addressed this? Mark all that apply |
|
1 = social worker; 2 = staff nurse; 3 = midlevel provider; 4 = psychologist; 5 = psychiatrist; 6 = EM physician; 9 = Other (specify)
|
|
|
|
mra_19b_other |
String |
100
|
Recommended |
If assessment included discussion of a way to reduce access to means to complete suicide, who addressed this? Specify other assessor |
|
|
|
| Query
|
mra_19c |
Integer |
|
Recommended |
If assessment included discussion of a way to reduce access to means to complete suicide, were firearms specifically mentioned? |
0;1;99
|
0 = No; 1 = Yes; 99 = Not documented
|
|
|
|
mra_19d |
String |
25
|
Recommended |
If assessment included discussion of a way to reduce access to means to complete suicide, who addressed reducing access to firearms? Mark all that apply |
|
1 = social worker; 2 = staff nurse; 3 = midlevel provider; 4 = psychologist; 5 = psychiatrist; 6 = EM physician; 9 = Other (specify)
|
|
|
|
mra_19d_other |
String |
100
|
Recommended |
If assessment included discussion of a way to reduce access to means to complete suicide, who addressed reducing access to firearms? Specify other assessor |
|
|
|
| Query
|
mra_22 |
Integer |
|
Recommended |
Is there any indication from the chart that a provider knew which study arm patient was randomized to? |
0;1
|
0 = No; 1 = Yes
|
|
|
|
mra_22d |
String |
785
|
Recommended |
If chart gave any indication that a provider knew the study arm a patient was randomized to, then provide the text from that portion of chart verbatim: |
|
|
|
|
|
g17 |
Integer |
|
Recommended |
If the index ED visit was for a suicide attempt, rate the lethality of the attempt: (Was there ANY injury sustained? This includes loss of consciousness, delirium, vomiting, any harm to tissue, or organ dysfunction). |
|
1 = No physical damage or very minor physical damage (e.g. surface scratches). ; 2 = Minor physical damage (e.g. lethargic speech; first-degree burns; mild bleeding; sprains). ; -888 = Not applicable (suicide attempt in the past week, but not the reason for the ED visit of interest). ; 88 = Emergency Department visit was not for suicide attempt.
|
|
|
|
batlq31 |
Integer |
|
Recommended |
Have you ever been hospitalized or seen in an emergency room for because of: Poisoning? |
0;1;97
|
0 = No; 1 = Yes; 97 = Unsure/Don't Know
|
|
|
|
h_all_cause |
Integer |
|
Recommended |
Have you ever been hospitalized or seen in an emergency room for because of: All-cause? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
|
|
mco_helpline |
Integer |
|
Recommended |
Have you used the Managed Care Organizion helpline? |
0;1; -888; -999
|
0=No; 1=Yes; -888=Not Applicable; -999=Missing
|
|
|
|
adi_natrank |
Float |
|
Recommended |
Area Deprivation Index National Percentile Ranking |
-9::-6; 1::100
|
-6 = suppressed due to low population and/or housing within the census block group; -7 = suppressed due to high population housed in group quarters within the census block group; -8 = suppressed due to both low total population and high group quarters population; -9 = unable to calculate due to missing key input variables from ACS; 1 (Least disadvantaged); 100 (Most disadvantaged)
|
|
|
|
mh_hpsa_score |
Integer |
|
Recommended |
Mental health HPSA score |
0::26
|
|
|
|
|
pc_incarceration_rate |
Integer |
|
Recommended |
Per capita incarceration rate per 100000 |
0::100000
|
|
|
