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Researcher Code Book
Depression History Questionnaire - 1.0.4 (exported at 1/28/2013 6:44:11 AM)
Questionnaire Completion History
Total completed=4783, AssignedCount=11005, ActiveCount=0, PercentCompleted=43.5%
Section 1: History of Depressive Illness
When joining IAN, mothers and fathers of children with autism spectrum disorders answer brief medical history questionnaires. The rate of depression reportedby parents answering these questionnaires has been much higher than expected. This in-depth Depression History Questionnaire is meant to help researchersbetter understand the nature and timing of depression in parents of children on the autism spectrum.
It is important for all parents in IAN to complete this questionnaire, reguardless of whether or not they have a history of depressive illness/symptoms.
Section 1, Question 1 - field name: hx_sad (ItemRefID=2787)
Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty, or depressed?
Coded Value Response
0 No
1 Yes
Section 1, Question 2 - field name: hx_discouraged (ItemRefID=2788)
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Have you ever had a period lasting several days or longer when most of the day you were very discouraged about how things weregoing in your life?
Coded Value Response
0 No
1 Yes
Section 1, Question 3 - field name: hx_lost_interest (ItemRefID=2789)
Have you ever had a period lasting several days or longer when you lost interest in most things you usually enjoy like work,hobbies, and personal relationships?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_sad != "1" and hx_discouraged != "1" and hx_lost_interest != "1" 2792
Section 1, Question 4 - field name: age_first_felt_dp (ItemRefID=2790)
When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) youlost interest in most things you usually enjoy...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_dp
> patient.age2541
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
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Section 1, Question 5 - field name: hx_see_pro_dp (ItemRefID=2791)
Did you ever see a medical or mental health professional because a) you felt sad, empty or depressed, b) you felt discouragedabout your life, or c) you lost interest in most things you usually enjoy?
Coded Value Response
0 No
1 Yes
Section 1, Question 6 - field name: dx_dp_pro (ItemRefID=2792)
Have you ever been diagnosed by a medical or mental health professional with a depressive illness (or a mood disorder with adepressive component)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "0" or dx_dp_pro = null 2797
Section 1, Question 7 - field name: age_first_dx_dp (ItemRefID=2793)
When you were first diagnosed by a medical or mental health professional with a depressive illness...How old were you?
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Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_dp
> patient.age2544
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, you
may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
Section 1, Question 8 - field name: type_pro_dp (ItemRefID=2794)
What type of professional first diagnosed you with a depressive illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 1, Question 9 - field name: type_dx_dp_fem (ItemRefID=2795)
(Females only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
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8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender != "F" 2795
Section 1, Question 10 - field name: type_dx_dp_male (ItemRefID=2796)
(Males only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2796
SkipRule dx_dp_pro = "1" 2801
Section 1, Question 11 - field name: hx_self_dx_dp (ItemRefID=2797)
Have you ever diagnosed yourself with a depressive illness, perhaps through an internet self-assessment tool, an informationalbrochure at the doctor's office, or symptoms listed in a medication advertisement?
Coded Value Response
0 No
1 Yes
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Rule Type Severity Expression TargetItemID Message
SkipRule hx_self_dx_dp = "0" or hx_self_dx_dp = null 2801
Section 1, Question 12 - field name: self_dx_type_dp_fem (ItemRefID=2798)
(Females only) Which of the following diagnoses did you give yourself?
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2798
Section 1, Question 13 - field name: self_dx_type_male (ItemRefID=2799)
(Males only) Which of the following diagnoses did you give yourself?
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
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9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2799
Section 1, Question 14 - field name: reason_no_pro_dx (ItemRefID=2800)
There are many reasons that a person coping with a depressive illness may not see a medical or mental health professional about theircondition. Please tell us why you did not see a medical or mental health professional about your depressive illness. Check all that apply.
(This question refers to reasons for not seeking professional assistance at the time of your self-diagnosis irrespective of any earlier contact with mental health professionals).
Coded Value Response
1 No insurance for mental health issues
2 Not enough money (whether insured or not)
3 No time
4 No energy
5 Other family member in greater need
6 Fear about impact of diagnosis on future health or life insurance eligibility
7 Worry about what other will think of you
8 Inability to find a medical or mental health professional you trust
9 I did see a professional but they did not diagnose depression
10 Other
Section 1, Question 15 - field name: hx_dp_tx (ItemRefID=2801)
Treatment for depressive symptoms may include medication and/or therapy. Whether or not you have been diagnosed by a medical ormental health professional, have you ever been treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
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SkipRule hx_dp_tx != "1" 2805
Section 1, Question 16 - field name: type_tx_dp (ItemRefID=2802)
Have you used any of the following treatments or techniques to deal with a depressive illness? Check all that apply.
Coded Value Response
1 Medication
2 Alternative Medicine (herbs, homeopathic remedies, acupuncture, vitamins, etc)
3 Individual Therapy or Counseling (for example, talk therapy or cognitive behavioral therapy)
4 Group Therapy
5 Marital or Family Therapy
6 Support Group, in person
7 Support Group, online
8 Spiritual practice (such as prayer or meditation)
9 Speaking with a pastor, rabbi, etc.
10 Life-style changes (such as diet or exercise)
11 Self-help books
12 Other
Section 1, Question 17 - field name: current_tx_dp (ItemRefID=2803)
Are you currently being treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
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Section 1, Question 18 - field name: hx_hosp_dp (ItemRefID=2804)
Have you ever been hospitalized due to a depressive illness?
Coded Value Response
0 No
1 Yes
Section 1, Question 19 - field name: hx_thought_hurt_self_dp (ItemRefID=2805)
Have you ever thought about hurting yourself?
Coded Value Response
0 No
1 Yes
Section 1, Question 20 - field name: hx_attempted_hurtself_dp (ItemRefID=2806)
Have you ever attempted to hurt yourself?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro != "1" and hx_self_dx_dp != "1" and hx_dp_tx != "1" 2825
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Section 1, Question 21 - field name: hx_pattern_dp (ItemRefID=2807)
Over your lifetime, what pattern has your depressive illness tended to have? Check all that apply.
Coded Value Response
1 I go through long periods of a fairly constant level of depression.
2 There are times when I have energetic "up" periods, and there are times when I have depressed "down" periods.
3 I have had one or more distinct episodes of depression lasting at least 2 weeks.
Section 1, Question 22 - field name: hx_number_dp (ItemRefID=2808)
How many periods of depressive illness do you estimate you have had?
Coded Value Response
1 1
2 2
3 3
4 4 or more
Section 1, Question 23 - field name: coping_asd_freq_dp (ItemRefID=2809)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the frequency of yourdepressive illness?
Coded Value Response
1 All my periods of depressive illness were associated with coping with my child's ASD.
2 Some of my periods of depressive illness were associated with coping with my child's ASD.
3 None of my periods of depressive illness were associated with coping with my child's ASD.
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Section 1, Question 24 - field name: coping_asd_severity_dp (ItemRefID=2810)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the severity of yourdepressive illness?
Coded Value Response
1 Coping with my child's ASD has made my depressive illness much more severe.
2 Coping with my child's ASD has made my depressive illness somewhat more severe.
3 Coping with my child's ASD has had no effect on the severity of my depressive illness.
Section 1, Question 25 - field name: hx_before_children_dp (ItemRefID=2811)
Did you experience a depressive illness before having any children?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_before_children_dp = "1" 2813
Section 1, Question 26 - field name: before_asdchild_dp (ItemRefID=2812)
Did you experience a depressive illness before having your child who was later diagnosed with an Autism Spectrum Disorder(ASD)?
Coded Value Response
0 No
1 Yes
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Section 1, Question 27 - field name: first_concern_dp (ItemRefID=2813)
Did you experience a depressive illness as you first became concerned about your child who was later diagnosed with an AutismSpectrum Disorder (ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 28 - field name: twelve_month_dp (ItemRefID=2814)
Did you experience a depressive illness in the twelve months after your child was diagnosed with an ASD?
Coded Value Response
0 No
1 Yes
Section 1, Question 29 - field name: hx_other_times_dp (ItemRefID=2815)
Did you experience a depressive illness at any of the following times? Check all that apply.
Coded Value Response
1 At a transition point, such as when your child left elementary school to enter middle school, or left middle school to enter high school.
2 When you came to believe that your child might never "grow out of" having autism.
3 When you were unable to obtain services you felt were crucial for your child's progress.
4 When your child reached a crisis point of some kind either at home or school.
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Section 2: Information about Specific Episodes of Depressive Illness
Section 2, Question 1 - field name: length_first_dp (ItemRefID=2816)
Think of the very first time in your life you experienced a depressive illness. How long did this episode last?
Coded Value Response
1 Less than 1 month
2 1-3 months
3 4-7 months
4 8-12 months
5 More than 1 year
Section 2, Question 2 - field name: prior_life_event_dp (ItemRefID=2817)
Was there something going on in your life shortly before this first experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
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Section 2, Question 3 - field name: functioning_first_period_dp (ItemRefID=2818)
Which of the following best describes your functioning during this first period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 4 - field name: first_symptoms_dp (ItemRefID=2819)
What type of symptoms did you experience during this first depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
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18 Thoughts about death or suicide
Section 2, Question 5 - field name: first_worst_dp (ItemRefID=2820)
Was this first experience of depressive illness also the worst experience of depressive illness that you have had?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule first_worst_dp != "0" 2825
Section 2, Question 6 - field name: age_worst_dp (ItemRefID=2821)
Think of your worst experience of depressive illness. How old were you when this occurred?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
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Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_worst_dp> patient.age
2573You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
Section 2, Question 7 - field name: prior_life_event_worst_dp (ItemRefID=2822)
Was there something going on in your life shortly before this worst experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 8 - field name: functioning_worst_dp (ItemRefID=2823)
Which of the following best describes your functioning during this worst period of depressive illness?
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Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 9 - field name: type_symptoms_worst_dp (ItemRefID=2824)
What type of symptoms did you experience during this worst depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
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Section 3: History of Manic Illness
Section 3, Question 1 - field name: hx_manic_period (ItemRefID=2825)
Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds gotoo fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as drivingtoo fast or spending too much money. Have you ever had a period like this lasting several days or longer?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_manic_period = "0" or hx_manic_period = null 2827
Section 3, Question 2 - field name: age_first_felt_manic (ItemRefID=2826)
When you first experienced a period of elevated mood, decreased need for sleep, racing thoughts, and intense bursts of activity...Howold were you?
Please enter your age in YEARS to the nearest b irthday.
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Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_manic> patient.age
2578You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 3 - field name: dx_manic_pro (ItemRefID=2827)
Have you ever been diagnosed by a medical or mental health professional with manic depression, bipolar disorder, or cyclothymia?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_manic_pro = "0" or dx_manic_pro = null 2832
Section 3, Question 4 - field name: age_first_dx_manic (ItemRefID=2828)
When you were first diagnosed by a medical or mental health professional with manic depression, bipolar disorder, orcyclothymia...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_manic> patient.age
2580You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]
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Section 3, Question 5 - field name: type_pro_manic (ItemRefID=2829)
What type of professional first diagnosed you with manic depression, bipolar disorder, or cyclothymia?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 3, Question 6 - field name: type_dx_pro_manic (ItemRefID=2830)
Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Coded Value Response
1 Bipolar Disorder (also known as manic depression)
2 Cyclothymic Disorder
3 Other
Section 3, Question 7 - field name: hx_hosp_manic (ItemRefID=2831)
Have you ever been hospitalized due to manic depression, bipolar disorder, or cyclothymia?
Coded Value Response
0 No
1 Yes
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Section 4: Family History
Section 4, Question 1 - field name: hx_family_dp (ItemRefID=2832)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a depressive illness, such asMajor Depressive Disorder, Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal AffectiveDisorder (SAD)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_dp != "1" 2834
Section 4, Question 2 - field name: hx_bio_rel_dp (ItemRefID=2833)
Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all thatapply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
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Section 4, Question 3 - field name: hx_family_manic (ItemRefID=2834)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a manic illness, such as BipolarDisorder (also known as Manic Depression)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_manic != "1" 2836
Section 4, Question 4 - field name: hx_bio_rel_manic (ItemRefID=2835)
Which of your biological relatives have been diagnosed with or treated for a manic illness, such as Biplar Disorder (also known as ManicDepression)? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
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8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 5 - field name: hx_family_suicide (ItemRefID=2836)
Has anyone in your immediate or extended biological family ever attempted or committed suicide?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_suicide != "1" 2838
Section 4, Question 6 - field name: hx_bio_rel_suicide (ItemRefID=2837)
Which of your biological relatives have attempted or committeed suicide? Check all that apply.
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Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 5: ASD and Life Impact
At some point in the future, IAN will launch extensive social and financial impact questionnaires. In the meantime, we are using this section of the DepressionHistory Questionnaire to begin to understand family stess and its impact. In the next section, we will ask briefly about various aspects of raising a child with anASD.
Section 5, Question 1 - field name: impact_childASD_beh (ItemRefID=2838)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficult behaviors of child with an ASD
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
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4 A great deal
5 Not applicable
Section 5, Question 2 - field name: impact_exhaustion (ItemRefID=2839)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Exhaustion due to a child's unusual sleep patterns (refusal to sleep, waking in the middle of the night, extensive bedtimerituals, etc.)
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 3 - field name: impact_support_difficulty (ItemRefID=2840)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficulty getting therapies, educational programs, or support you believe your child needs
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
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Section 5, Question 4 - field name: impact_disappointment_tx (ItemRefID=2841)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Disappointment when a treatment program did not yield the results you had hoped for
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 5 - field name: impact_problem_reversal (ItemRefID=2842)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Distress when your child experienced a major problem or reversal in progress at school or in some other area of life
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
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Section 5, Question 6 - field name: impact_worry_future (ItemRefID=2843)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Worry about your child's future
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 7 - field name: impact_relationship_partner (ItemRefID=2844)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with spouse or life partner
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
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Section 5, Question 8 - field name: impact_extended_fam (ItemRefID=2845)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with extended family
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 9 - field name: impact_friendship_social (ItemRefID=2846)
What impact, if any, has raising a child with an ASD had on the following:
Friendships and social network
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
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Section 5, Question 10 - field name: impact_career_education (ItemRefID=2847)
What impact, if any, has raising a child with an ASD had on the following:
Your own career or continuing education
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 11 - field name: impact_financial (ItemRefID=2848)
What impact, if any, has raising a child with an ASD had on the following:
Your financial situation
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
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Questionnaire Scoring
This questionnaire has no scoring defined
Additional Response CodesCoded Value Description
-444 Value is not present. (Skipped without filling in an answer)
-555 No proper value is applicable.
-666 Skipped due to form logic
-777 Patient delayed the answer
-888 Not known
-999 Patient was asked but refused to answer
Depression History Questionnaire - 1.0.3 (exported at 1/28/2013 6:44:11 AM)
Section 1: History of Depressive Illness
When joining IAN, mothers and fathers of children with autism spectrum disorders answer brief medical history questionnaires. The rate of depression reportedby parents answering these questionnaires has been much higher than expected. This in-depth Depression History Questionnaire is meant to help researchersbetter understand the nature and timing of depression in parents of children on the autism spectrum.
It is important for all parents in IAN to complete this questionnaire, reguardless of whether or not they have a history of depressive illness/symptoms.
Section 1, Question 1 - field name: hx_sad (ItemRefID=2725)
Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty, or depressed?
Coded Value Response
0 No
1 Yes
Section 1, Question 2 - field name: hx_discouraged (ItemRefID=2726)
Have you ever had a period lasting several days or longer when most of the day you were very discouraged about how things weregoing in your life?
Coded Value Response
0 No
1 Yes
Section 1, Question 3 - field name: hx_lost_interest (ItemRefID=2727)
Have you ever had a period lasting several days or longer when you lost interest in most things you usually enjoy like work,hobbies, and personal relationships?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_sad != "1" and hx_discouraged != "1" and hx_lost_interest != "1" 2730
Section 1, Question 4 - field name: age_first_felt_dp (ItemRefID=2728)
When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) you
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lost interest in most things you usually enjoy...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_dp
> patient.age2541
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
Section 1, Question 5 - field name: hx_see_pro_dp (ItemRefID=2729)
Did you ever see a medical or mental health professional because a) you felt sad, empty or depressed, b) you felt discouragedabout your life, or c) you lost interest in most things you usually enjoy?
Coded Value Response
0 No
1 Yes
Section 1, Question 6 - field name: dx_dp_pro (ItemRefID=2730)
Have you ever been diagnosed by a medical or mental health professional with a depressive illness (or a mood disorder with adepressive component)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "0" or dx_dp_pro = null 2735
Section 1, Question 7 - field name: age_first_dx_dp (ItemRefID=2731)
When you were first diagnosed by a medical or mental health professional with a depressive illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_dp
> patient.age2544
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
Section 1, Question 8 - field name: type_pro_dp (ItemRefID=2732)
What type of professional first diagnosed you with a depressive illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 1, Question 9 - field name: type_dx_dp_fem (ItemRefID=2733)
(Females only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
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4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender != "F" 2733
Section 1, Question 10 - field name: type_dx_dp_male (ItemRefID=2734)
(Males only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2734
SkipRule dx_dp_pro = "1" 2739
Section 1, Question 11 - field name: hx_self_dx_dp (ItemRefID=2735)
Have you ever diagnosed yourself with a depressive illness, perhaps through an internet self-assessment tool, an informationalbrochure at the doctor's office, or symptoms listed in a medication advertisement?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_self_dx_dp = "0" or hx_self_dx_dp = null 2739
Section 1, Question 12 - field name: self_dx_type_dp_fem (ItemRefID=2736)
(Females only) Which of the following diagnoses did you give yourself?
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2736
Section 1, Question 13 - field name: self_dx_type_male (ItemRefID=2737)
(Males only) Which of the following diagnoses did you give yourself?
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
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2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2737
Section 1, Question 14 - field name: reason_no_pro_dx (ItemRefID=2738)
There are many reasons that a person coping with a depressive illness may not see a medical or mental health professional about theircondition. Please tell us why you did not see a medical or mental health professional about your depressive illness. Check all that apply.
(This question refers to reasons for not seeking professional assistance at the time of your self-diagnosis irrespective of any earlier contact with mental health professionals).
Coded Value Response
1 No insurance for mental health issues
2 Not enough money (whether insured or not)
3 No time
4 No energy
5 Other family member in greater need
6 Fear about impact of diagnosis on future health or life insurance eligibility
7 Worry about what other will think of you
8 Inability to find a medical or mental health professional you trust
9 I did see a professional but they did not diagnose depression
10 Other
Section 1, Question 15 - field name: hx_dp_tx (ItemRefID=2739)
Treatment for depressive symptoms may include medication and/or therapy. Whether or not you have been diagnosed by a medical ormental health professional, have you ever been treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_dp_tx != "1" 2743
Section 1, Question 16 - field name: type_tx_dp (ItemRefID=2740)
Have you used any of the following treatments or techniques to deal with a depressive illness? Check all that apply.
Coded Value Response
1 Medication
2 Alternative Medicine (herbs, homeopathic remedies, acupuncture, vitamins, etc)
3 Individual Therapy or Counseling (for example, talk therapy or cognitive behavioral therapy)
4 Group Therapy
5 Marital or Family Therapy
6 Support Group, in person
7 Support Group, online
8 Spiritual practice (such as prayer or meditation)
9 Speaking with a pastor, rabbi, etc.
10 Life-style changes (such as diet or exercise)
11 Self-help books
12 Other
Section 1, Question 17 - field name: current_tx_dp (ItemRefID=2741)
Are you currently being treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Section 1, Question 18 - field name: hx_hosp_dp (ItemRefID=2742)
Have you ever been hospitalized due to a depressive illness?
Coded Value Response
0 No
1 Yes
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Section 1, Question 19 - field name: hx_thought_hurt_self_dp (ItemRefID=2743)
Have you ever thought about hurting yourself?
Coded Value Response
0 No
1 Yes
Section 1, Question 20 - field name: hx_attempted_hurtself_dp (ItemRefID=2744)
Have you ever attempted to hurt yourself?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro != "1" and hx_self_dx_dp != "1" and hx_dp_tx != "1" 2763
Section 1, Question 21 - field name: hx_pattern_dp (ItemRefID=2745)
Over your lifetime, what pattern has your depressive illness tended to have? Check all that apply.
Coded Value Response
1 I go through long periods of a fairly constant level of depression.
2 There are times when I have energetic "up" periods, and there are times when I have depressed "down" periods.
3 I have had one or more distinct episodes of depression lasting at least 2 weeks.
Section 1, Question 22 - field name: hx_number_dp (ItemRefID=2746)
How many periods of depressive illness do you estimate you have had?
Coded Value Response
1 1
2 2
3 3
4 4 or more
Section 1, Question 23 - field name: coping_asd_freq_dp (ItemRefID=2747)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the frequency of yourdepressive illness?
Coded Value Response
1 All my periods of depressive illness were associated with coping with my child's ASD.
2 Some of my periods of depressive illness were associated with coping with my child's ASD.
3 None of my periods of depressive illness were associated with coping with my child's ASD.
Section 1, Question 24 - field name: coping_asd_severity_dp (ItemRefID=2748)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the severity of yourdepressive illness?
Coded Value Response
1 Coping with my child's ASD has made my depressive illness much more severe.
2 Coping with my child's ASD has made my depressive illness somewhat more severe.
3 Coping with my child's ASD has had no effect on the severity of my depressive illness.
Section 1, Question 25 - field name: hx_before_children_dp (ItemRefID=2749)
Did you experience a depressive illness before having any children?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_before_children_dp = "1" 2751
Section 1, Question 26 - field name: before_asdchild_dp (ItemRefID=2750)
Did you experience a depressive illness before having your child who was later diagnosed with an Autism Spectrum Disorder(ASD)?
Coded Value Response
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0 No
1 Yes
Section 1, Question 27 - field name: first_concern_dp (ItemRefID=2751)
Did you experience a depressive illness as you first became concerned about your child who was later diagnosed with an AutismSpectrum Disorder (ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 28 - field name: twelve_month_dp (ItemRefID=2752)
Did you experience a depressive illness in the twelve months after your child was diagnosed with an ASD?
Coded Value Response
0 No
1 Yes
Section 1, Question 29 - field name: hx_other_times_dp (ItemRefID=2753)
Did you experience a depressive illness at any of the following times? Check all that apply.
Coded Value Response
1 At a transition point, such as when your child left elementary school to enter middle school, or left middle school to enter high school.
2 When you came to believe that your child might never "grow out of" having autism.
3 When you were unable to obtain services you felt were crucial for your child's progress.
4 When your child reached a crisis point of some kind either at home or school.
Section 2: Information about Specific Episodes of Depressive Illness
Section 2, Question 1 - field name: length_first_dp (ItemRefID=2754)
Think of the very first time in your life you experienced a depressive illness. How long did this episode last?
Coded Value Response
1 Less than 1 month
2 1-3 months
3 4-7 months
4 8-12 months
5 More than 1 year
Section 2, Question 2 - field name: prior_life_event_dp (ItemRefID=2755)
Was there something going on in your life shortly before this first experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 3 - field name: functioning_first_period_dp (ItemRefID=2756)
Which of the following best describes your functioning during this first period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
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Section 2, Question 4 - field name: first_symptoms_dp (ItemRefID=2757)
What type of symptoms did you experience during this first depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 2, Question 5 - field name: first_worst_dp (ItemRefID=2758)
Was this first experience of depressive illness also the worst experience of depressive illness that you have had?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule first_worst_dp = "1" 2763
Section 2, Question 6 - field name: age_worst_dp (ItemRefID=2759)
Think of your worst experience of depressive illness. How old were you when this occurred?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_worst_dp> patient.age
2573You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
Section 2, Question 7 - field name: prior_life_event_worst_dp (ItemRefID=2760)
Was there something going on in your life shortly before this worst experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 8 - field name: functioning_worst_dp (ItemRefID=2761)
Which of the following best describes your functioning during this worst period of depressive illness?
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Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 9 - field name: type_symptoms_worst_dp (ItemRefID=2762)
What type of symptoms did you experience during this worst depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 3: History of Manic Illness
Section 3, Question 1 - field name: hx_manic_period (ItemRefID=2763)
Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds gotoo fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as drivingtoo fast or spending too much money. Have you ever had a period like this lasting several days or longer?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_manic_period = "0" or hx_manic_period = null 2765
Section 3, Question 2 - field name: age_first_felt_manic (ItemRefID=2764)
When you first experienced a period of elevated mood, decreased need for sleep, racing thoughts, and intense bursts of activity...Howold were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_manic
> patient.age2578
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,
you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 3 - field name: dx_manic_pro (ItemRefID=2765)
Have you ever been diagnosed by a medical or mental health professional with manic depression, bipolar disorder, or cyclothymia?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
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SkipRule dx_manic_pro = "0" or dx_manic_pro = null 2770
Section 3, Question 4 - field name: age_first_dx_manic (ItemRefID=2766)
When you were first diagnosed by a medical or mental health professional with manic depression, bipolar disorder, orcyclothymia...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_manic
> patient.age2580
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered
an incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 5 - field name: type_pro_manic (ItemRefID=2767)
What type of professional first diagnosed you with manic depression, bipolar disorder, or cyclothymia?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 3, Question 6 - field name: type_dx_pro_manic (ItemRefID=2768)
Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Coded Value Response
1 Bipolar Disorder (also known as manic depression)
2 Cyclothymic Disorder
3 Other
Section 3, Question 7 - field name: hx_hosp_manic (ItemRefID=2769)
Have you ever been hospitalized due to manic depression, bipolar disorder, or cyclothymia?
Coded Value Response
0 No
1 Yes
Section 4: Family History
Section 4, Question 1 - field name: hx_family_dp (ItemRefID=2770)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a depressive illness, such asMajor Depressive Disorder, Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal AffectiveDisorder (SAD)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_dp != "1" 2772
Section 4, Question 2 - field name: hx_bio_rel_dp (ItemRefID=2771)
Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all thatapply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
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7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 3 - field name: hx_family_manic (ItemRefID=2772)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a manic illness, such as BipolarDisorder (also known as Manic Depression)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_manic != "1" 2774
Section 4, Question 4 - field name: hx_bio_rel_manic (ItemRefID=2773)
Which of your biological relatives have been diagnosed with or treated for a manic illness, such as Biplar Disorder (also known as ManicDepression)? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 5 - field name: hx_family_suicide (ItemRefID=2774)
Has anyone in your immediate or extended biological family ever attempted or committed suicide?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_suicide != "1" 2776
Section 4, Question 6 - field name: hx_bio_rel_suicide (ItemRefID=2775)
Which of your biological relatives have attempted or committeed suicide? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
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10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 5: ASD and Life Impact
At some point in the future, IAN will launch extensive social and financial impact questionnaires. In the meantime, we are using this section of the DepressionHistory Questionnaire to begin to understand family stess and its impact. In the next section, we will ask briefly about various aspects of raising a child with anASD.
Section 5, Question 1 - field name: impact_childASD_beh (ItemRefID=2776)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficult behaviors of child with an ASD
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 2 - field name: impact_exhaustion (ItemRefID=2777)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Exhaustion due to a child's unusual sleep patterns (refusal to sleep, waking in the middle of the night, extensive bedtimerituals, etc.)
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 3 - field name: impact_support_difficulty (ItemRefID=2778)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficulty getting therapies, educational programs, or support you believe your child needs
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 4 - field name: impact_disappointment_tx (ItemRefID=2779)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Disappointment when a treatment program did not yield the results you had hoped for
Coded Value Response
1 Not at all
2 A little
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3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 5 - field name: impact_problem_reversal (ItemRefID=2780)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Distress when your child experienced a major problem or reversal in progress at school or in some other area of life
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 6 - field name: impact_worry_future (ItemRefID=2781)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Worry about your child's future
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 7 - field name: impact_relationship_partner (ItemRefID=2782)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with spouse or life partner
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 8 - field name: impact_extended_fam (ItemRefID=2783)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with extended family
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 9 - field name: impact_friendship_social (ItemRefID=2784)
What impact, if any, has raising a child with an ASD had on the following:
Friendships and social network
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
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3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 10 - field name: impact_career_education (ItemRefID=2785)
What impact, if any, has raising a child with an ASD had on the following:
Your own career or continuing education
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 11 - field name: impact_financial (ItemRefID=2786)
What impact, if any, has raising a child with an ASD had on the following:
Your financial situation
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Depression History Questionnaire - 1.0.2 (exported at 1/28/2013 6:44:11 AM)
Section 1: History of Depressive Illness
When joining IAN, mothers and fathers of children with autism spectrum disorders answer brief medical history questionnaires. The rate of depression reportedby parents answering these questionnaires has been much higher than expected. This in-depth Depression History Questionnaire is meant to help researchersbetter understand the nature and timing of depression in parents of children on the autism spectrum.
It is important for all parents in IAN to complete this questionnaire, reguardless of whether or not they have a history of depressive illness/symptoms.
Section 1, Question 1 - field name: hx_sad (ItemRefID=2663)
Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty, or depressed?
Coded Value Response
0 No
1 Yes
Section 1, Question 2 - field name: hx_discouraged (ItemRefID=2664)
Have you ever had a period lasting several days or longer when most of the day you were very discouraged about how things weregoing in your life?
Coded Value Response
0 No
1 Yes
Section 1, Question 3 - field name: hx_lost_interest (ItemRefID=2665)
Have you ever had a period lasting several days or longer when you lost interest in most things you usually enjoy like work,hobbies, and personal relationships?
Coded Value Response
0 No
1 Yes
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Rule Type Severity Expression TargetItemID Message
SkipRule hx_sad != "1" and hx_discouraged != "1" and hx_lost_interest != "1" 2668
Section 1, Question 4 - field name: age_first_felt_dp (ItemRefID=2666)
When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) youlost interest in most things you usually enjoy...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_dp
> patient.age2541
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, you
may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 1, Question 5 - field name: hx_see_pro_dp (ItemRefID=2667)
Did you ever see a medical or mental health professional because a) you felt sad, empty or depressed, b) you felt discouragedabout your life, or c) you lost interest in most things you usually enjoy?
Coded Value Response
0 No
1 Yes
Section 1, Question 6 - field name: dx_dp_pro (ItemRefID=2668)
Have you ever been diagnosed by a medical or mental health professional with a depressive illness (or a mood disorder with adepressive component)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "0" or dx_dp_pro = null 2673
Section 1, Question 7 - field name: age_first_dx_dp (ItemRefID=2669)
When you were first diagnosed by a medical or mental health professional with a depressive illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warning age_first_dx_dp> patient.age
2544
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, you
may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 1, Question 8 - field name: type_pro_dp (ItemRefID=2670)
What type of professional first diagnosed you with a depressive illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 1, Question 9 - field name: type_dx_dp_fem (ItemRefID=2671)
(Females only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
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Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender != "F" 2671
Section 1, Question 10 - field name: type_dx_dp_male (ItemRefID=2672)
(Males only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2672
SkipRule dx_dp_pro = "1" 2677
Section 1, Question 11 - field name: hx_self_dx_dp (ItemRefID=2673)
Have you ever diagnosed yourself with a depressive illness, perhaps through an internet self-assessment tool, an informationalbrochure at the doctor's office, or symptoms listed in a medication advertisement?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_self_dx_dp = "0" or hx_self_dx_dp = null 2677
Section 1, Question 12 - field name: self_dx_type_dp_fem (ItemRefID=2674)
(Females only) Which of the following diagnoses did you give yourself?
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2674
Section 1, Question 13 - field name: self_dx_type_male (ItemRefID=2675)
(Males only) Which of the following diagnoses did you give yourself?
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Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2675
Section 1, Question 14 - field name: reason_no_pro_dx (ItemRefID=2676)
There are many reasons that a person coping with a depressive illness may not see a medical or mental health professional about theircondition. Please tell us why you did not see a medical or mental health professional about your depressive illness. Check all that apply.
(This question refers to reasons for not seeking professional assistance at the time of your self-diagnosis irrespective of any earlier contact with mental health professionals).
Coded Value Response
1 No insurance for mental health issues
2 Not enough money (whether insured or not)
3 No time
4 No energy
5 Other family member in greater need
6 Fear about impact of diagnosis on future health or life insurance eligibility
7 Worry about what other will think of you
8 Inability to find a medical or mental health professional you trust
9 I did see a professional but they did not diagnose depression
10 Other
Section 1, Question 15 - field name: hx_dp_tx (ItemRefID=2677)
Treatment for depressive symptoms may include medication and/or therapy. Whether or not you have been diagnosed by a medical ormental health professional, have you ever been treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_dp_tx != "1" 2681
Section 1, Question 16 - field name: type_tx_dp (ItemRefID=2678)
Have you used any of the following treatments or techniques to deal with a depressive illness? Check all that apply.
Coded Value Response
1 Medication
2 Alternative Medicine (herbs, homeopathic remedies, acupuncture, vitamins, etc)
3 Individual Therapy or Counseling (for example, talk therapy or cognitive behavioral therapy)
4 Group Therapy
5 Marital or Family Therapy
6 Support Group, in person
7 Support Group, online
8 Spiritual practice (such as prayer or meditation)
9 Speaking with a pastor, rabbi, etc.
10 Life-style changes (such as diet or exercise)
11 Self-help books
12 Other
Section 1, Question 17 - field name: current_tx_dp (ItemRefID=2679)
Are you currently being treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
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Section 1, Question 18 - field name: hx_hosp_dp (ItemRefID=2680)
Have you ever been hospitalized due to a depressive illness?
Coded Value Response
0 No
1 Yes
Section 1, Question 19 - field name: hx_thought_hurt_self_dp (ItemRefID=2681)
Have you ever thought about hurting yourself?
Coded Value Response
0 No
1 Yes
Section 1, Question 20 - field name: hx_attempted_hurtself_dp (ItemRefID=2682)
Have you ever attempted to hurt yourself?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro != "1" or hx_self_dx_dp != "1" 2701
Section 1, Question 21 - field name: hx_pattern_dp (ItemRefID=2683)
Over your lifetime, what pattern has your depressive illness tended to have? Check all that apply.
Coded Value Response
1 I go through long periods of a fairly constant level of depression.
2 There are times when I have energetic "up" periods, and there are times when I have depressed "down" periods.
3 I have had one or more distinct episodes of depression lasting at least 2 weeks.
Section 1, Question 22 - field name: hx_number_dp (ItemRefID=2684)
How many periods of depressive illness do you estimate you have had?
Coded Value Response
1 1
2 2
3 3
4 4 or more
Section 1, Question 23 - field name: coping_asd_freq_dp (ItemRefID=2685)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the frequency of yourdepressive illness?
Coded Value Response
1 All my periods of depressive illness were associated with coping with my child's ASD.
2 Some of my periods of depressive illness were associated with coping with my child's ASD.
3 None of my periods of depressive illness were associated with coping with my child's ASD.
Section 1, Question 24 - field name: coping_asd_severity_dp (ItemRefID=2686)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the severity of yourdepressive illness?
Coded Value Response
1 Coping with my child's ASD has made my depressive illness much more severe.
2 Coping with my child's ASD has made my depressive illness somewhat more severe.
3 Coping with my child's ASD has had no effect on the severity of my depressive illness.
Section 1, Question 25 - field name: hx_before_children_dp (ItemRefID=2687)
Did you experience a depressive illness before having any children?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
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SkipRule hx_before_children_dp = "1" 2689
Section 1, Question 26 - field name: before_asdchild_dp (ItemRefID=2688)
Did you experience a depressive illness before having your child who was later diagnosed with an Autism Spectrum Disorder(ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 27 - field name: first_concern_dp (ItemRefID=2689)
Did you experience a depressive illness as you first became concerned about your child who was later diagnosed with an AutismSpectrum Disorder (ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 28 - field name: twelve_month_dp (ItemRefID=2690)
Did you experience a depressive illness in the twelve months after your child was diagnosed with an ASD?
Coded Value Response
0 No
1 Yes
Section 1, Question 29 - field name: hx_other_times_dp (ItemRefID=2691)
Did you experience a depressive illness at any of the following times? Check all that apply.
Coded Value Response
1 At a transition point, such as when your child left elementary school to enter middle school, or left middle school to enter high school.
2 When you came to believe that your child might never "grow out of" having autism.
3 When you were unable to obtain services you felt were crucial for your child's progress.
4 When your child reached a crisis point of some kind either at home or school.
Section 2: Information about Specific Episodes of Depressive Illness
Section 2, Question 1 - field name: length_first_dp (ItemRefID=2692)
Think of the very first time in your life you experienced a depressive illness. How long did this episode last?
Coded Value Response
1 Less than 1 month
2 1-3 months
3 4-7 months
4 8-12 months
5 More than 1 year
Section 2, Question 2 - field name: prior_life_event_dp (ItemRefID=2693)
Was there something going on in your life shortly before this first experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 3 - field name: functioning_first_period_dp (ItemRefID=2694)
Which of the following best describes your functioning during this first period of depressive illness?
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Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 4 - field name: first_symptoms_dp (ItemRefID=2695)
What type of symptoms did you experience during this first depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 2, Question 5 - field name: first_worst_dp (ItemRefID=2696)
Was this first experience of depressive illness also the worst experience of depressive illness that you have had?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule first_worst_dp = "1" 2701
Section 2, Question 6 - field name: age_worst_dp (ItemRefID=2697)
Think of your worst experience of depressive illness. How old were you when this occurred?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_worst_dp> patient.age
2573
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, you
may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 2, Question 7 - field name: prior_life_event_worst_dp (ItemRefID=2698)
Was there something going on in your life shortly before this worst experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
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12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 8 - field name: functioning_worst_dp (ItemRefID=2699)
Which of the following best describes your functioning during this worst period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 9 - field name: type_symptoms_worst_dp (ItemRefID=2700)
What type of symptoms did you experience during this worst depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 3: History of Manic Illness
Section 3, Question 1 - field name: hx_manic_period (ItemRefID=2701)
Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds gotoo fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as drivingtoo fast or spending too much money. Have you ever had a period like this lasting several days or longer?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_manic_period = "0" or hx_manic_period = null 2708
Section 3, Question 2 - field name: age_first_felt_manic (ItemRefID=2702)
When you first experienced a period of elevated mood, decreased need for sleep, racing thoughts, and intense bursts of activity...Howold were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_manic> patient.age
2578You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered
an incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 3 - field name: dx_manic_pro (ItemRefID=2703)
Have you ever been diagnosed by a medical or mental health professional with a manic illness?
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Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_manic_pro = "0" or dx_manic_pro = null 2708
Section 3, Question 4 - field name: age_first_dx_manic (ItemRefID=2704)
When you were first diagnosed by a medical or mental health professional with a manic illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_manic> patient.age
2580You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered
an incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 5 - field name: type_pro_manic (ItemRefID=2705)
What type of professional first diagnosed you with a manic illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 3, Question 6 - field name: type_dx_pro_manic (ItemRefID=2706)
Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Coded Value Response
1 Bipolar Disorder (also known as manic depression)
2 Cyclothymic Disorder
3 Other
Section 3, Question 7 - field name: hx_hosp_manic (ItemRefID=2707)
Have you ever been hospitalized due to a manic illness?
Coded Value Response
0 No
1 Yes
Section 4: Family History
Section 4, Question 1 - field name: hx_family_dp (ItemRefID=2708)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a depressive illness, such asMajor Depressive Disorder, Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal AffectiveDisorder (SAD)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_dp != "1" 2710
Section 4, Question 2 - field name: hx_bio_rel_dp (ItemRefID=2709)
Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all thatapply.
Coded Value Response
1 Mother
2 Father
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3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 3 - field name: hx_family_manic (ItemRefID=2710)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a manic illness, such as BipolarDisorder (also known as Manic Depression)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_manic != "1" 2712
Section 4, Question 4 - field name: hx_bio_rel_manic (ItemRefID=2711)
Which of your biological relatives have been diagnosed with or treated for a manic illness, such as Biplar Disorder (also known as ManicDepression)? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 5 - field name: hx_family_suicide (ItemRefID=2712)
Has anyone in your immediate or extended biological family ever attempted or committed suicide?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_suicide != "1" 2714
Section 4, Question 6 - field name: hx_bio_rel_suicide (ItemRefID=2713)
Which of your biological relatives have attempted or committeed suicide? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
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6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 5: ASD and Life Impact
At some point in the future, IAN will launch extensive social and financial impact questionnaires. In the meantime, we are using this section of the DepressionHistory Questionnaire to begin to understand family stess and its impact. In the next section, we will ask briefly about various aspects of raising a child with anASD.
Section 5, Question 1 - field name: impact_childASD_beh (ItemRefID=2714)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficult behaviors of child with an ASD
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 2 - field name: impact_exhaustion (ItemRefID=2715)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Exhaustion due to a child's unusual sleep patterns (refusal to sleep, waking in the middle of the night, extensive bedtimerituals, etc.)
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 3 - field name: impact_support_difficulty (ItemRefID=2716)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficulty getting therapies, educational programs, or support you believe your child needs
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 4 - field name: impact_disappointment_tx (ItemRefID=2717)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Disappointment when a treatment program did not yield the results you had hoped for
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Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 5 - field name: impact_problem_reversal (ItemRefID=2718)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Distress when your child experienced a major problem or reversal in progress at school or in some other area of life
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 6 - field name: impact_worry_future (ItemRefID=2719)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Worry about your child's future
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 7 - field name: impact_relationship_partner (ItemRefID=2720)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with spouse or life partner
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 8 - field name: impact_extended_fam (ItemRefID=2721)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with extended family
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 9 - field name: impact_friendship_social (ItemRefID=2722)
What impact, if any, has raising a child with an ASD had on the following:
Friendships and social network
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Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 10 - field name: impact_career_education (ItemRefID=2723)
What impact, if any, has raising a child with an ASD had on the following:
Your own career or continuing education
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 11 - field name: impact_financial (ItemRefID=2724)
What impact, if any, has raising a child with an ASD had on the following:
Your financial situation
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Depression History Questionnaire - 1.0.1 (exported at 1/28/2013 6:44:11 AM)
Section 1: History of Depressive Illness
When joining IAN, mothers and fathers of children with autism spectrum disorders answer brief medical history questionnaires. The rate of depression reportedby parents answering these questionnaires has been much higher than expected. This in-depth Depression History Questionnaire is meant to help researchersbetter understand the nature and timing of depression in parents of children on the autism spectrum.
It is important for all parents in IAN to complete this questionnaire, reguardless of whether or not they have a history of depressive illness/symptoms.
Section 1, Question 1 - field name: hx_sad (ItemRefID=2601)
Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty, or depressed?
Coded Value Response
0 No
1 Yes
Section 1, Question 2 - field name: hx_discouraged (ItemRefID=2602)
Have you ever had a period lasting several days or longer when most of the day you were very discouraged about how things weregoing in your life?
Coded Value Response
0 No
1 Yes
Section 1, Question 3 - field name: hx_lost_interest (ItemRefID=2603)
Have you ever had a period lasting several days or longer when you lost interest in most things you usually enjoy like work,hobbies, and personal relationships?
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Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_sad != "1" and hx_discouraged != "1" and hx_lost_interest != "1" 2639
Section 1, Question 4 - field name: age_first_felt_dp (ItemRefID=2604)
When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) youlost interest in most things you usually enjoy...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_dp
> patient.age2541
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 1, Question 5 - field name: hx_see_pro_dp (ItemRefID=2605)
Did you ever see a medical or mental health professional because a) you felt sad, empty or depressed, b) you felt discouragedabout your life, or c) you lost interest in most things you usually enjoy?
Coded Value Response
0 No
1 Yes
Section 1, Question 6 - field name: dx_dp_pro (ItemRefID=2606)
Have you ever been diagnosed by a medical or mental health professional with a depressive illness (or a mood disorder with adepressive component)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "0" or dx_dp_pro = null 2611
Section 1, Question 7 - field name: age_first_dx_dp (ItemRefID=2607)
When you were first diagnosed by a medical or mental health professional with a depressive illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_dp> patient.age
2544You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered an
incorrect birthdate when you registered, please contact [email protected]
Section 1, Question 8 - field name: type_pro_dp (ItemRefID=2608)
What type of professional first diagnosed you with a depressive illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
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Section 1, Question 9 - field name: type_dx_dp_fem (ItemRefID=2609)
(Females only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender != "F" 2609
Section 1, Question 10 - field name: type_dx_dp_male (ItemRefID=2610)
(Males only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2610
SkipRule dx_dp_pro = "1" 2615
Section 1, Question 11 - field name: hx_self_dx_dp (ItemRefID=2611)
Have you ever diagnosed yourself with a depressive illness, perhaps through an internet self-assessment tool, an informationalbrochure at the doctor's office, or symptoms listed in a medication advertisement?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_self_dx_dp = "0" or hx_self_dx_dp = null 2615
Section 1, Question 12 - field name: self_dx_type_dp_fem (ItemRefID=2612)
(Females only) Which of the following diagnoses did you give yourself?
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
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DisableRule patient.gender = "F" 2612
Section 1, Question 13 - field name: self_dx_type_male (ItemRefID=2613)
(Males only) Which of the following diagnoses did you give yourself?
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
DisableRule patient.gender = "F" 2613
Section 1, Question 14 - field name: reason_no_pro_dx (ItemRefID=2614)
There are many reasons that a person coping with a depressive illness may not see a medical or mental health professional about theircondition. Please tell us why you did not see a medical or mental health professional about your depressive illness. Check all that apply.
(This question refers to reasons for not seeking professional assistance at the time of your self-diagnosis irrespective of any earlier contact with mental health professionals).
Coded Value Response
1 No insurance for mental health issues
2 Not enough money (whether insured or not)
3 No time
4 No energy
5 Other family member in greater need
6 Fear about impact of diagnosis on future health or life insurance eligibility
7 Worry about what other will think of you
8 Inability to find a medical or mental health professional you trust
9 I did see a professional but they did not diagnose depression
10 Other
Section 1, Question 15 - field name: hx_dp_tx (ItemRefID=2615)
Treatment for depressive symptoms may include medication and/or therapy. Whether or not you have been diagnosed by a medical ormental health professional, have you ever been treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_dp_tx != "1" 2619
Section 1, Question 16 - field name: type_tx_dp (ItemRefID=2616)
Have you used any of the following treatments or techniques to deal with a depressive illness? Check all that apply.
Coded Value Response
1 Medication
2 Alternative Medicine (herbs, homeopathic remedies, acupuncture, vitamins, etc)
3 Individual Therapy or Counseling (for example, talk therapy or cognitive behavioral therapy)
4 Group Therapy
5 Marital or Family Therapy
6 Support Group, in person
7 Support Group, online
8 Spiritual practice (such as prayer or meditation)
9 Speaking with a pastor, rabbi, etc.
10 Life-style changes (such as diet or exercise)
11 Self-help books
12 Other
Section 1, Question 17 - field name: current_tx_dp (ItemRefID=2617)
Are you currently being treated for depressive symptoms?
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Coded Value Response
0 No
1 Yes
Section 1, Question 18 - field name: hx_hosp_dp (ItemRefID=2618)
Have you ever been hospitalized due to a depressive illness?
Coded Value Response
0 No
1 Yes
Section 1, Question 19 - field name: hx_thought_hurt_self_dp (ItemRefID=2619)
Have you ever thought about hurting yourself?
Coded Value Response
0 No
1 Yes
Section 1, Question 20 - field name: hx_attempted_hurtself_dp (ItemRefID=2620)
Have you ever attempted to hurt yourself?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro != "1" or hx_self_dx_dp != "1" 2639
Section 1, Question 21 - field name: hx_pattern_dp (ItemRefID=2621)
Over your lifetime, what pattern has your depressive illness tended to have? Check all that apply.
Coded Value Response
1 I go through long periods of a fairly constant level of depression.
2 There are times when I have energetic "up" periods, and there are times when I have depressed "down" periods.
3 I have had one or more distinct episodes of depression lasting at least 2 weeks.
Section 1, Question 22 - field name: hx_number_dp (ItemRefID=2622)
How many periods of depressive illness do you estimate you have had?
Coded Value Response
1 1
2 2
3 3
4 4 or more
Section 1, Question 23 - field name: coping_asd_freq_dp (ItemRefID=2623)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the frequency of yourdepressive illness?
Coded Value Response
1 All my periods of depressive illness were associated with coping with my child's ASD.
2 Some of my periods of depressive illness were associated with coping with my child's ASD.
3 None of my periods of depressive illness were associated with coping with my child's ASD.
Section 1, Question 24 - field name: coping_asd_severity_dp (ItemRefID=2624)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the severity of yourdepressive illness?
Coded Value Response
1 Coping with my child's ASD has made my depressive illness much more severe.
2 Coping with my child's ASD has made my depressive illness somewhat more severe.
3 Coping with my child's ASD has had no effect on the severity of my depressive illness.
Section 1, Question 25 - field name: hx_before_children_dp (ItemRefID=2625)
Did you experience a depressive illness before having any children?
Coded Value Response
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0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_before_children_dp = "1" 2627
Section 1, Question 26 - field name: before_asdchild_dp (ItemRefID=2626)
Did you experience a depressive illness before having your child who was later diagnosed with an Autism Spectrum Disorder(ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 27 - field name: first_concern_dp (ItemRefID=2627)
Did you experience a depressive illness as you first became concerned about your child who was later diagnosed with an AutismSpectrum Disorder (ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 28 - field name: twelve_month_dp (ItemRefID=2628)
Did you experience a depressive illness in the twelve months after your child was diagnosed with an ASD?
Coded Value Response
0 No
1 Yes
Section 1, Question 29 - field name: hx_other_times_dp (ItemRefID=2629)
Did you experience a depressive illness at any of the following times? Check all that apply.
Coded Value Response
1 At a transition point, such as when your child left elementary school to enter middle school, or left middle school to enter high school.
2 When you came to believe that your child might never "grow out of" having autism.
3 When you were unable to obtain services you felt were crucial for your child's progress.
4 When your child reached a crisis point of some kind either at home or school.
Section 2: Information about Specific Episodes of Depressive Illness
Section 2, Question 1 - field name: length_first_dp (ItemRefID=2630)
Think of the very first time in your life you experienced a depressive illness. How long did this episode last?
Coded Value Response
1 Less than 1 month
2 1-3 months
3 4-7 months
4 8-12 months
5 More than 1 year
Section 2, Question 2 - field name: prior_life_event_dp (ItemRefID=2631)
Was there something going on in your life shortly before this first experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
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Section 2, Question 3 - field name: functioning_first_period_dp (ItemRefID=2632)
Which of the following best describes your functioning during this first period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 4 - field name: first_symptoms_dp (ItemRefID=2633)
What type of symptoms did you experience during this first depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 2, Question 5 - field name: first_worst_dp (ItemRefID=2634)
Was this first experience of depressive illness also the worst experience of depressive illness that you have had?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule first_worst_dp = "1" 2639
Section 2, Question 6 - field name: age_worst_dp (ItemRefID=2635)
Think of your worst experience of depressive illness. How old were you when this occurred?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_worst_dp> patient.age
2573
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, you
may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 2, Question 7 - field name: prior_life_event_worst_dp (ItemRefID=2636)
Was there something going on in your life shortly before this worst experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
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8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 8 - field name: functioning_worst_dp (ItemRefID=2637)
Which of the following best describes your functioning during this worst period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 9 - field name: type_symptoms_worst_dp (ItemRefID=2638)
What type of symptoms did you experience during this worst depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 3: History of Manic Illness
Section 3, Question 1 - field name: hx_manic_period (ItemRefID=2639)
Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds gotoo fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as drivingtoo fast or spending too much money. Have you ever had a period like this lasting several days or longer?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_manic_period = "0" or hx_manic_period = null 2646
Section 3, Question 2 - field name: age_first_felt_manic (ItemRefID=2640)
When you first experienced a period of elevated mood, decreased need for sleep, racing thoughts, and intense bursts of activity...Howold were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_manic
> patient.age2578
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered
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an incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 3 - field name: dx_manic_pro (ItemRefID=2641)
Have you ever been diagnosed by a medical or mental health professional with a manic illness?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_manic_pro = "0" or dx_manic_pro = null 2646
Section 3, Question 4 - field name: age_first_dx_manic (ItemRefID=2642)
When you were first diagnosed by a medical or mental health professional with a manic illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warning age_first_dx_manic> patient.age
2580
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,
you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 5 - field name: type_pro_manic (ItemRefID=2643)
What type of professional first diagnosed you with a manic illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 3, Question 6 - field name: type_dx_pro_manic (ItemRefID=2644)
Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Coded Value Response
1 Bipolar Disorder (also known as manic depression)
2 Cyclothymic Disorder
3 Other
Section 3, Question 7 - field name: hx_hosp_manic (ItemRefID=2645)
Have you ever been hospitalized due to a manic illness?
Coded Value Response
0 No
1 Yes
Section 4: Family History
Section 4, Question 1 - field name: hx_family_dp (ItemRefID=2646)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a depressive illness, such asMajor Depressive Disorder, Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal AffectiveDisorder (SAD)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_dp != "1" 2648
Section 4, Question 2 - field name: hx_bio_rel_dp (ItemRefID=2647)
Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all that
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apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 3 - field name: hx_family_manic (ItemRefID=2648)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a manic illness, such as BipolarDisorder (also known as Manic Depression)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_manic != "1" 2650
Section 4, Question 4 - field name: hx_bio_rel_manic (ItemRefID=2649)
Which of your biological relatives have been diagnosed with or treated for a manic illness, such as Biplar Disorder (also known as ManicDepression)? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 5 - field name: hx_family_suicide (ItemRefID=2650)
Has anyone in your immediate or extended biological family ever attempted or committed suicide?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_suicide != "1" 2652
Section 4, Question 6 - field name: hx_bio_rel_suicide (ItemRefID=2651)
Which of your biological relatives have attempted or committeed suicide? Check all that apply.
Coded Value Response
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1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 5: ASD and Life Impact
At some point in the future, IAN will launch extensive social and financial impact questionnaires. In the meantime, we are using this section of the DepressionHistory Questionnaire to begin to understand family stess and its impact. In the next section, we will ask briefly about various aspects of raising a child with anASD.
Section 5, Question 1 - field name: impact_childASD_beh (ItemRefID=2652)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficult behaviors of child with an ASD
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 2 - field name: impact_exhaustion (ItemRefID=2653)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Exhaustion due to a child's unusual sleep patterns (refusal to sleep, waking in the middle of the night, extensive bedtimerituals, etc.)
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 3 - field name: impact_support_difficulty (ItemRefID=2654)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficulty getting therapies, educational programs, or support you believe your child needs
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 4 - field name: impact_disappointment_tx (ItemRefID=2655)
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To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Disappointment when a treatment program did not yield the results you had hoped for
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 5 - field name: impact_problem_reversal (ItemRefID=2656)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Distress when your child experienced a major problem or reversal in progress at school or in some other area of life
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 6 - field name: impact_worry_future (ItemRefID=2657)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Worry about your child's future
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 7 - field name: impact_relationship_partner (ItemRefID=2658)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with spouse or life partner
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 8 - field name: impact_extended_fam (ItemRefID=2659)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with extended family
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
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Section 5, Question 9 - field name: impact_friendship_social (ItemRefID=2660)
What impact, if any, has raising a child with an ASD had on the following:
Friendships and social network
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 10 - field name: impact_career_education (ItemRefID=2661)
What impact, if any, has raising a child with an ASD had on the following:
Your own career or continuing education
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 11 - field name: impact_financial (ItemRefID=2662)
What impact, if any, has raising a child with an ASD had on the following:
Your financial situation
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Depression History Questionnaire - 1.0.0 (exported at 1/28/2013 6:44:11 AM)
Section 1: History of Depressive Illness
When joining IAN, mothers and fathers of children with autism spectrum disorders answer brief medical history questionnaires. The rate of depression reportedby parents answering these questionnaires has been much higher than expected. This in-depth Depression History Questionnaire is meant to help researchersbetter understand the nature and timing of depression in parents of children on the autism spectrum.
It is important for all parents in IAN to complete this questionnaire, reguardless of whether or not they have a history of depressive illness/symptoms.
Section 1, Question 1 - field name: hx_sad (ItemRefID=2537)
Have you ever in your life had a period lasting several days or longer when most of the day you felt sad, empty, or depressed?
Coded Value Response
0 No
1 Yes
Section 1, Question 2 - field name: hx_discouraged (ItemRefID=2538)
Have you ever had a period lasting several days or longer when most of the day you were very discouraged about how things weregoing in your life?
Coded Value Response
0 No
1 Yes
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Section 1, Question 3 - field name: hx_lost_interest (ItemRefID=2539)
Have you ever had a period lasting several days or longer when you lost interest in most things you usually enjoy like work,hobbies, and personal relationships?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_sad != "1" and hx_discouraged != "1" and hx_lost_interest != "1" 2577
Section 1, Question 4 - field name: age_first_felt_dp (ItemRefID=2541)
When you first experienced a period when a) you felt sad, empty, or depressed, b) you felt discouraged about your life, or c) youlost interest in most things you usually enjoy...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_dp
> patient.age2541
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 1, Question 5 - field name: hx_see_pro_dp (ItemRefID=2542)
Did you ever see a medical or mental health professional because a) you felt sad, empty or depressed, b) you felt discouragedabout your life, or c) you lost interest in most things you usually enjoy?
Coded Value Response
0 No
1 Yes
Section 1, Question 6 - field name: dx_dp_pro (ItemRefID=2543)
Have you ever been diagnosed by a medical or mental health professional with a depressive illness (or a mood disorder with adepressive component)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "0" or dx_dp_pro = null 2548
Section 1, Question 7 - field name: age_first_dx_dp (ItemRefID=2544)
When you were first diagnosed by a medical or mental health professional with a depressive illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_dp
> patient.age2544
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 1, Question 8 - field name: type_pro_dp (ItemRefID=2545)
What type of professional first diagnosed you with a depressive illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
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2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Rule Type Severity Expression TargetItemID Message
SkipRule patient.gender != "F" 2547
Section 1, Question 9 - field name: type_dx_dp_fem (ItemRefID=2546)
(Females only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "1" 2552
SkipRule patient.gender != "M" 2552
Section 1, Question 10 - field name: type_dx_dp_male (ItemRefID=2547)
(Males only) Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro = "1" 2552
Section 1, Question 11 - field name: hx_self_dx_dp (ItemRefID=2548)
Have you ever diagnosed yourself with a depressive illness, perhaps through an internet self-assessment tool, an informationalbrochure at the doctor's office, or symptoms listed in a medication advertisement?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_self_dx_dp = "1" 2550
SkipRule hx_self_dx_dp = "0" or hx_self_dx_dp = null 2552
Section 1, Question 12 - field name: self_dx_type_dp_fem (ItemRefID=2549)
(Females only) Which of the following diagnoses did you give yourself?
Note: If you are male, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
3 Postpartum Depression
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4 Depression associated with Premenstrual Syndrome, Premenstrual Dysphoric Disorder, or Menopause
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
SkipRule patient.gender = "F" 2552
SkipRule hx_see_pro_dp = "1" 2552
Section 1, Question 13 - field name: self_dx_type_male (ItemRefID=2550)
(Males only) Which of the following diagnoses did you give yourself?
Note: If you are female, you have reached this question in error. Please contact [email protected]
Coded Value Response
1 Major Depressive Disorder
2 Dysthymic Disorder
5 Seasonal Affective Disorder (SAD)
6 Bipolar Disorder (also known as manic depression)
7 Cyclothymic Disorder
8 Not sure, but it was some type of depression
9 Other
Rule Type Severity Expression TargetItemID Message
SkipRule hx_see_pro_dp = "1" 2552
Section 1, Question 14 - field name: reason_no_pro_dx (ItemRefID=2551)
There are many reasons that a person coping with a depressive illness may not see a medical or mental health professional about theircondition. Please tell us why you did not see a medical or mental health professional about your depressive illness. Check all that apply.
Coded Value Response
1 No insurance for mental health issues
2 Not enough money (whether insured or not)
3 No time
4 No energy
5 Other family member in greater need
6 Fear about impact of diagnosis on future health or life insurance eligibility
7 Worry about what other will think of you
8 Inability to find a medical or mental health professional you trust
9 Other
Section 1, Question 15 - field name: hx_dp_tx (ItemRefID=2552)
Treatment for depressive symptoms may include medication and/or therapy. Whether or not you have been diagnosed by a medical ormental health professional, have you ever been treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_dp_tx != "1" 2556
Section 1, Question 16 - field name: type_tx_dp (ItemRefID=2553)
Have you used any of the following treatments or techniques to deal with a depressive illness? Check all that apply.
Coded Value Response
1 Medication
2 Alternative Medicine (herbs, homeopathic remedies, acupuncture, vitamins, etc)
3 Individual Therapy or Counseling (for example, talk therapy or cognitive behavioral therapy)
4 Group Therapy
5 Marital or Family Therapy
6 Support Group, in person
7 Support Group, online
8 Spiritual practice (such as prayer or meditation)
9 Speaking with a pastor, rabbi, etc.
10 Life-style changes (such as diet or exercise)
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11 Self-help books
12 Other
Section 1, Question 17 - field name: current_tx_dp (ItemRefID=2554)
Are you currently being treated for depressive symptoms?
Coded Value Response
0 No
1 Yes
Section 1, Question 18 - field name: hx_hosp_dp (ItemRefID=2555)
Have you ever been hospitalized due to a depressive illness?
Coded Value Response
0 No
1 Yes
Section 1, Question 19 - field name: hx_thought_hurt_self_dp (ItemRefID=2556)
Have you ever thought about hurting yourself?
Coded Value Response
0 No
1 Yes
Section 1, Question 20 - field name: hx_attempted_hurtself_dp (ItemRefID=2557)
Have you ever attempted to hurt yourself?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_dp_pro != "1" or hx_self_dx_dp != "1" 2577
Section 1, Question 21 - field name: hx_pattern_dp (ItemRefID=2558)
Over your lifetime, what pattern has your depressive illness tended to have? Check all that apply.
Coded Value Response
1 I go through long periods of a fairly constant level of depression.
2 There are times when I have energetic "up" periods, and there are times when I have depressed "down" periods.
3 I have had one or more distinct episodes of depression lasting at least 2 weeks.
Section 1, Question 22 - field name: hx_number_dp (ItemRefID=2559)
How many periods of depressive illness do you estimate you have had?
Coded Value Response
1 1
2 2
3 3
4 4 or more
Section 1, Question 23 - field name: coping_asd_freq_dp (ItemRefID=2560)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the frequency of yourdepressive illness?
Coded Value Response
1 All my periods of depressive illness were associated with coping with my child's ASD.
2 Some of my periods of depressive illness were associated with coping with my child's ASD.
3 None of my periods of depressive illness were associated with coping with my child's ASD.
Section 1, Question 24 - field name: coping_asd_severity_dp (ItemRefID=2561)
In your opinion, to what extent has coping with your child's Autism Spectrum Disorder (ASD) contributed to the severity of yourdepressive illness?
Coded Value Response
1 Coping with my child's ASD has made my depressive illness much more severe.
2 Coping with my child's ASD has made my depressive illness somewhat more severe.
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3 Coping with my child's ASD has had no effect on the severity of my depressive illness.
Section 1, Question 25 - field name: hx_before_children_dp (ItemRefID=2562)
Did you experience a depressive illness before having any children?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_before_children_dp = "1" 2564
Section 1, Question 26 - field name: before_asdchild_dp (ItemRefID=2563)
Did you experience a depressive illness before having your child who was later diagnosed with an Autism Spectrum Disorder(ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 27 - field name: first_concern_dp (ItemRefID=2564)
Did you experience a depressive illness as you first became concerned about your child who was later diagnosed with an AutismSpectrum Disorder (ASD)?
Coded Value Response
0 No
1 Yes
Section 1, Question 28 - field name: twelve_month_dp (ItemRefID=2565)
Did you experience a depressive illness in the twelve months after your child was diagnosed with an ASD?
Coded Value Response
0 No
1 Yes
Section 1, Question 29 - field name: hx_other_times_dp (ItemRefID=2566)
Did you experience a depressive illness at any of the following times? Check all that apply.
Coded Value Response
1 At a transition point, such as when your child left elementary school to enter middle school, or left middle school to enter high school.
2 When you came to believe that your child might never "grow out of" having autism.
3 When you were unable to obtain services you felt were crucial for your child's progress.
4 When your child reached a crisis point of some kind either at home or school.
Section 2: Information about Specific Episodes of Depressive Illness
Section 2, Question 1 - field name: length_first_dp (ItemRefID=2567)
Think of the very first time in your life you experienced a depressive illness. How long did this episode last?
Coded Value Response
1 Less than 1 month
2 1-3 months
3 4-7 months
4 8-12 months
5 More than 1 year
Section 2, Question 2 - field name: prior_life_event_dp (ItemRefID=2568)
Was there something going on in your life shortly before this first experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
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8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 3 - field name: functioning_first_period_dp (ItemRefID=2570)
Which of the following best describes your functioning during this first period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 4 - field name: first_symptoms_dp (ItemRefID=2571)
What type of symptoms did you experience during this first depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 2, Question 5 - field name: first_worst_dp (ItemRefID=2572)
Was this first experience of depressive illness also the worst experience of depressive illness that you have had?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule first_worst_dp = "1" 2577
Section 2, Question 6 - field name: age_worst_dp (ItemRefID=2573)
Think of your worst experience of depressive illness. How old were you when this occurred?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_worst_dp> patient.age
2573You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday, youmay have entered your age incorrectly. Please double-check your entry. If you think that you may have entered anincorrect birthdate when you registered, please contact [email protected]
Section 2, Question 7 - field name: prior_life_event_worst_dp (ItemRefID=2574)
Was there something going on in your life shortly before this worst experience of depressive illness that you believe contributed to it?Check all that apply.
Coded Value Response
1 Major job or school related stress
1/29/2014 DataExplorer - IAN Stats
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2 Job loss
3 Divorce or end of close relationship
4 Marital or relationship difficulties
5 Abusive relationship
6 Death of a loved one
7 Violent crime (rape, mugging, carjacking, etc.)
8 Illness or injury involving a loved one
9 Illness or injury involving yourself
10 Financial crisis
11 Pregnancy (yours or your partner's)
12 Events related to your child with an Autism Spectrum Disorder
13 Other
Section 2, Question 8 - field name: functioning_worst_dp (ItemRefID=2575)
Which of the following best describes your functioning during this worst period of depressive illness?
Coded Value Response
1 I was so ill that I needed to spend time in an inpatient clinic or hospital.
2 I was barely able to function, but was not hospitalized.
3 I was somewhat able to function.
4 I functioned fairly well.
Section 2, Question 9 - field name: type_symptoms_worst_dp (ItemRefID=2576)
What type of symptoms did you experience during this worst depressive illness? Check all that apply.
Coded Value Response
1 Feeling sad or empty
2 Loss of interest or pleasure in daily activities
3 Weight loss or gain
4 Sleeping problems (sleeping a great deal or being unable to sleep that is not due to child's sleep problems)
5 Frequent crying
6 Fatigue or low energy
7 Feeling worthless or guilty
8 Inability to concentrate, think, or make decisions
9 Low sex drive
10 Feeling isolated from others
11 Digestive problems
12 Restlessness
13 Loss of interest in interaction with others
14 Loss of appetite or eating too much
15 Slowed speech and physical movement
16 Drop in school or work performance
17 Drug or alcohol abuse
18 Thoughts about death or suicide
Section 3: History of Manic Illness
Section 3, Question 1 - field name: hx_manic_period (ItemRefID=2577)
Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds gotoo fast. They talk a lot. They are very restless or unable to sit still and they sometimes do things that are unusual for them, such as drivingtoo fast or spending too much money. Have you ever had a period like this lasting several days or longer?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_manic_period = "0" or hx_manic_period = null 2584
Section 3, Question 2 - field name: age_first_felt_manic (ItemRefID=2578)
When you first experienced a period of elevated mood, decreased need for sleep, racing thoughts, and intense bursts of activity...Howold were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
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Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_felt_manic> patient.age
2578
You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,
you may have entered your age incorrectly. Please double-check your entry. If you think that you may have enteredan incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 3 - field name: dx_manic_pro (ItemRefID=2579)
Have you ever been diagnosed by a medical or mental health professional with a manic illness?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule dx_manic_pro = "0" or dx_manic_pro = null 2584
Section 3, Question 4 - field name: age_first_dx_manic (ItemRefID=2580)
When you were first diagnosed by a medical or mental health professional with a manic illness...How old were you?
Please enter your age in YEARS to the nearest b irthday.
Coded Value Response
Value User Entered Coded Value
Rule Type Severity Expression TargetItemID Message
ValidationRule Warningage_first_dx_manic> patient.age
2580You have entered an age that is greater than your current age. If you are not rounding up to the nearest birthday,you may have entered your age incorrectly. Please double-check your entry. If you think that you may have entered
an incorrect birthdate when you registered, please contact [email protected]
Section 3, Question 5 - field name: type_pro_manic (ItemRefID=2581)
What type of professional first diagnosed you with a manic illness?
Coded Value Response
1 Physician other than a psychiatrist (family doctor, internist, etc.)
2 Psychiatrist
3 Psychologist
4 Other Therapist or Counselor
5 Other
Section 3, Question 6 - field name: type_dx_pro_manic (ItemRefID=2582)
Which of the following diagnoses have you received from a medical or mental health professional? Check all that apply.
Coded Value Response
1 Bipolar Disorder (also known as manic depression)
2 Cyclothymic Disorder
3 Other
Section 3, Question 7 - field name: hx_hosp_manic (ItemRefID=2583)
Have you ever been hospitalized due to a manic illness?
Coded Value Response
0 No
1 Yes
Section 4: Family History
Section 4, Question 1 - field name: hx_family_dp (ItemRefID=2584)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a depressive illness, such asMajor Depressive Disorder, Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal AffectiveDisorder (SAD)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
1/29/2014 DataExplorer - IAN Stats
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SkipRule hx_family_dp != "1" 2586
Section 4, Question 2 - field name: hx_bio_rel_dp (ItemRefID=2585)
Which of your biological relatives have been diagnosed with or treated for a depressive illness, such as Major Depressive Disorder,Dysthymic Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder, or Seasonal Affective Disorder (SAD)? Check all thatapply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 3 - field name: hx_family_manic (ItemRefID=2586)
Has anyone in your immediate or extended biological family ever been diagnosed with or treated for a manic illness, such as BipolarDisorder (also known as Manic Depression)?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_manic != "1" 2588
Section 4, Question 4 - field name: hx_bio_rel_manic (ItemRefID=2587)
Which of your biological relatives have been diagnosed with or treated for a manic illness, such as Biplar Disorder (also known as ManicDepression)? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 4, Question 5 - field name: hx_family_suicide (ItemRefID=2588)
Has anyone in your immediate or extended biological family ever attempted or committed suicide?
Coded Value Response
0 No
1 Yes
Rule Type Severity Expression TargetItemID Message
SkipRule hx_family_suicide != "1" 2590
1/29/2014 DataExplorer - IAN Stats
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Section 4, Question 6 - field name: hx_bio_rel_suicide (ItemRefID=2589)
Which of your biological relatives have attempted or committeed suicide? Check all that apply.
Coded Value Response
1 Mother
2 Father
3 Brother
4 Sister
5 Son
6 Daughter
7 Maternal grandmother (mother's mother)
8 Maternal grandfather (mother's father)
9 Maternal aunt (mother's sister)
10 Maternal uncle (mother's brother)
11 First cousin on your mother's side
12 Paternal grandmother (father's mother)
13 Paternal grandfather (father's father)
14 Paternal aunt (father's sister)
15 Paternal uncle (father's brother)
16 First cousin on your father's side
17 Other
Section 5: ASD and Life Impact
At some point in the future, IAN will launch extensive social and financial impact questionnaires. In the meantime, we are using this section of the DepressionHistory Questionnaire to begin to understand family stess and its impact. In the next section, we will ask briefly about various aspects of raising a child with anASD.
Section 5, Question 1 - field name: impact_childASD_beh (ItemRefID=2590)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficult behaviors of child with an ASD
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 2 - field name: impact_exhaustion (ItemRefID=2591)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Exhaustion due to a child's unusual sleep patterns (refusal to sleep, waking in the middle of the night, extensive bedtimerituals, etc.)
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 3 - field name: impact_support_difficulty (ItemRefID=2592)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Difficulty getting therapies, educational programs, or support you believe your child needs
Coded Value Response
1 Not at all
2 A little
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3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 4 - field name: impact_disappointment_tx (ItemRefID=2593)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Disappointment when a treatment program did not yield the results you had hoped for
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 5 - field name: impact_problem_reversal (ItemRefID=2594)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Distress when your child experienced a major problem or reversal in progress at school or in some other area of life
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 6 - field name: impact_worry_future (ItemRefID=2595)
To what extent has this possible aspect of raising a child with an ASD had a negative impact on your life?
Worry about your child's future
Coded Value Response
1 Not at all
2 A little
3 A moderate amount
4 A great deal
5 Not applicable
Section 5, Question 7 - field name: impact_relationship_partner (ItemRefID=2596)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with spouse or life partner
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 8 - field name: impact_extended_fam (ItemRefID=2597)
What impact, if any, has raising a child with an ASD had on the following:
Relationship with extended family
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
1/29/2014 DataExplorer - IAN Stats
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3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 9 - field name: impact_friendship_social (ItemRefID=2598)
What impact, if any, has raising a child with an ASD had on the following:
Friendships and social network
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 10 - field name: impact_career_education (ItemRefID=2599)
What impact, if any, has raising a child with an ASD had on the following:
Your own career or continuing education
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact
Section 5, Question 11 - field name: impact_financial (ItemRefID=2600)
What impact, if any, has raising a child with an ASD had on the following:
Your financial situation
Coded Value Response
1 Very positive impact
2 Somewhat positive impact
3 No impact
4 Somewhat negative impact
5 Very negative impact