SECTION 5 - LOW MOOD CHECK ITEM DID SUBJECT MEET CRITERIA FOR PMD OR SIMD IN SECTION 4A? NO SKIP TO Q.2 5.1

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1 Statement D.1: Sometimes people have milder low moods than the kind I just asked about. CHECK ITEM DID SUBJECT MEET CRITERIA FOR PMD OR SIMD IN SECTION 4A? NO SKIP TO Q (IS CHECK ITEM 4A.18 OR 4A.19, PAGE 53 CODED ""?) CHECK ITEM DID PMD/SIMD CODED IN SECTION 4A FULLY REMIT? NO 5.2 (IS Q.48, PAGE 52 CODED "3"?) SKIP TO Q.2 1. Before you were depressed at age (SEE Q. 46, PAGE 52), was there a time in your life lasting at least 2 years, when more days than not you were in a low mood? Can you describe how you were feeling? Low mood lasting 2(+) years prior to PMD or SIMD - low mood must be present for at least 2 years prior to onset of PMD/SIMD coded in Q.46, page 52 - low mood can be described as depressed, down, unhappy, sad SKIP TO SECTION 6, SKIP TO Q.3 2. Was there ever a time in your life lasting at least 2 years, when more days than not you were in a low mood? Can you describe how you were feeling? Low mood lasting 2(+) years - low mood can be described as depressed, down, unhappy, sad SKIP TO SECTION 6, 3. When was the most recent time you felt (low/ SOE) for 2 years or more? (How old were you when your low mood began at that time?) Was that a definite change from before? Was your mood okay for a couple of months before your low mood began? How long did your low mood last? Onset of most recent episode of low mood lasting 2(+) years - must be definite change from usual mood (unless describes persistent low mood for whole life) - onset of low mood must follow 2(+) months of feeling good or okay SPECIFY DURATION AGE AT ONSET CHECK ITEM DID SUBJECT EVER MEET CRITERIA FOR PMD OR SIMD? NO - SKIP TO STATEMENT 5.3 D.2, PAGE 97 (IS CHECK ITEM 4A.18 OR 4A.19, PAGE 53 OR CHECK ITEM 4B.14, PAGE 70 OR CHECK ITEM 4C.17, PAGE 90 CODED ""?) 95

2 4a.. > Onset of dysthymia relative to most recent Major Depression: 2(+) years before or after full remission (Section 4A) SKIP TO SECTION 6, - check Q.49, page 52, and Q.46, page 52 for dates of onset and remission - no Major Depression coded in section 4A = 3 4b.. > Onset of dysthymia relative to prior PMD: 2(+) years before or after full remission (Section 4B) - check Q.52, page 71 and Q.49, page 70 for dates of onset and remission - no PMD coded in section 4B = 3 SKIP TO SECTION 6, 4c.. > Onset of dysthymia relative to prior SIMD: 2(+) years before or after full remission (Section 4C) - check Q.52, page 91 and Q.49, page 90 for dates of onset and remission - no SIMD coded in section 4C = 3 SKIP TO SECTION 6, 5. I d like you to think about the first 2 years of your low mood, beginning at age (SEE Q.3, PAGE 95]. During those first 2 years, did your low mood ever get much worse, so that you felt very depressed almost all day for at least 2 weeks? 2(+) weeks of distinctly more severe depressed mood and symptoms within first 2 years of low mood - depressed mood must last all or almost all day for 2(+) weeks - must have 5+ symptoms of depression Can you describe how you were feeling? Was that a definite change from how you felt before, when you had a milder low mood? How long did that worse time last? During that worse time, did you also have some of the experiences we discussed before, such as (REPEAT SYMPTOMS CODED IN SECTION 4A, BOXES 1A-9A OR SECTION 4B, BOXES 1B-9B OR SECTION 4C, BOXES 1C- 9C) SPECIFY SYMPTOMS 96

3 Statement D.2: I'll be asking you now about experiences that can go along with being in a low mood. During that period of low mood that began at age (SEE Q.3, PAGE 95), did you often... (REPEAT AS NECESSARY) 6a....lose your appetite?...find that you overate? Poor appetite or overeating - lost appetite or overate = 3 6b....have trouble falling asleep? wake up too early? wake up frequently during the night?...sleep more than usual? Insomnia or hypersomnia - insomnia or hypersomnia = 3 6c....feel tired out, or feel you didn't have much energy? Low energy or fatigue 6d....feel down on yourself? feel you weren't as good as other people? feel that you were inadequate, or a failure? Low self-esteem 6e....feel that things were bad and would never get better? feel life would never work out the way you wanted? Feelings of hopelessness 6f...have trouble thinking, concentrating, or keeping your mind on things? have difficulty making everyday decisions? Poor concentration or difficulty making decisions - difficulty in deciding what to wear, what to eat, what to buy at the store = 3 CHECK ITEM DID SUBJECT HAVE 2 OR MORE DYSTHYMIC SYMPTOMS NO - SKIP TO SECTION 6, 5.4 CO-OCCURRING WITH LOW MOOD? (ARE AT LEAST 2 Q. S 6a-6f CODED "3"?) 97

4 7. Did these experiences go along with low mood for at least 2 years? Low mood and symptoms lasting 2(+) years - SKIP TO SECTION 6, 8. Think about the first 2 years of your low mood, beginning at age [SEE Q.3, PAGE 95]. During those 2 years, did your low mood and all the other experiences we just talked about go away for at least 2 months? Remission from low mood and symptoms within the first 2 years of low mood - must be a clear indication that low mood and symptom remitted for at least 2 months - SKIP TO SECTION 6, 9. During that period of low mood that began at age [SEE Q.3, PAGE 95], did you often... have trouble getting along or dealing with people? have trouble completing your (work/school/ household) tasks or doing them as well as you used to? have trouble fulfilling other responsibilities? Was the problem mild, moderate, or severe? Impairment: social impairment, failure to fulfill usual responsibilities - impairment must represent a change from usual behavior - questionable or slight impairment = "2" 1 2 MILD 3 MODERATE 4 SEVERE CHECK ALL THAT APPLY: SOCIAL WORK/SCHOOL/HOUSEHOLD OTHER RESPONSIBILITIES CHECK ITEM DID SUBJECT REPORT SIGNIFICANT IMPAIRMENT? NO 5.5 (IS Q.9 CODED "3" OR "4?) - SKIP TO CHECK ITEM Were you very troubled by (SYMPTOMS CODED IN Q. S 6a-6f, PAGE 97)? Did you often wish you could feel better? Did you often think of getting help in order to feel better? Did you actually go for help? Low mood/symptoms caused clinically significant distress - distress can concern impact of low mood on one's family or career - resigned to low mood/ symptoms = "1" - mildly upset by symptoms = "2" - sought treatment (voluntarily) or sought other help = "3" - had strong persistent desire for relief of symptoms, but did not actually seek help = "3"? CHECK ITEM DID SUBJECT REPORT SIGNIFICANT IMPAIRMENT OR DISTRESS? NO - SKIP TO SECTION 6, 5.6 (IS CHECK ITEM 5.5 CODE OR IS Q.10 CODED 3"?) 98

5 11. Were you alcohol- and drug-free for most of time during that period of low mood? IF WAS NOT ABSTINENT: Were you drinking or using drugs only occasionally for most of time during that time? By occasionally, I mean less than 4 days a week. Abstinence or occasional use for most of the time during episode of low mood - occasional use: less than 4 days a week - refer to substance timeline - relevant substances: ALC, COC, HER, HAL, SED, STI, OPI, MET - drank only small amounts of alcohol (less than 4 drinks) daily = 3 - marijuana only = "3" - SKIP TO Q.13 ABSTINENCE OCCASIONAL USE 12. What were you using at that time? How often did you use [alcohol /DRUGS]? Substance used during episode of low mood - check relevant substance(s) used 4+ days a week SPECIFY PATTERN OF USE CHECK ALL THAT APPLY: ALC COC/STI HER/OPI/MET SED HAL 13. Were you taking any medicines prescribed by a doctor during the whole time you felt (low/ SOE)? What were you taking? How long were you taking that? Were you taking it the whole time you were in a low mood? Did a doctor ever say that the medicine caused your low mood? Most recent/only potential dysthymia due to medication taken as prescribed - relevant medications: antihypertensives (especially reserpine), cortico steroids (e.g. prednisone), anabolic steroids, anti-convulsants, anti-parkinsonian and anti-ulcer medications, oral contraceptives, cardiac medications (e.g. Digitalis, Clonodine), sulfonamide antibiotics - low mood began and remitted entirely during use of relevant medication = "3" - unclear etiology = "1" ENTER SUBSTANCE CODES: SPECIFY DRUG(S) 14. Were you exposed to a toxin or poisonous substance such as a chemical spill, paint fumes or insecticides during the whole time you felt (low/ SOE)? What were you exposed to? When did that happen? Did a doctor ever say that your low mood was caused by (TOXIN)? Most recent/only potential dysthymia due to exposure to toxin - relevant toxins: gasoline, paint fumes, carbon monoxide, carbon dioxide, nerve gas, organophosphate insecticides - must be medical or public report that toxin caused low mood - not sure or never thought about it before, but it might have happened = "1" - unclear etiology = "1" ENTER SUBSTANCE CODES: SPECIFY TOXIN(S) CHECK ITEM IS EPISODE OF LOW MOOD SUBSTANCE-INDUCED? NO 5.7 (IS Q.11 CODED 1 OR IS Q.13 OR Q.14 CODED 3?) 99

6 15. Were you having medical problems during the whole time you felt (low/soe)? What was wrong? When did it start? Did a doctor ever say that your low mood was caused by your medical problems? Relevant medical condition co-occurring with low mood - relevant medical conditions: Parkinson's, Huntington s, multiple sclerosis, stroke, head trauma, seizures, brain tumor, coronary artery disease, renal failure, B-12 deficiency, hypothyroidism, Addison s, Cushing s, diabetes, hepatitis, tuberculosis, mononucleosis, AIDS - base rating on chronology and medical likelihood that low mood was part of a medical condition - menopause, childbirth, or stress = "1" - low mood present for 2+ years prior to illness = "1" - SKIP TO Q.16 MEDICAL CONDITION CODES: SPECIFY MEDICAL CONDITION CHECK ITEM DID SUBJECT MEET CRITERIA FOR A PRIMARY DYSTHYMIC DISORDER? NO 5.8 (IS Q.5 PAGE 96 CODED NO AND IS CHECK ITEM 5.7, PAGE 99 CODED NO?) - SKIP TO Q.16 CHECK ITEM 5.9 DID SUBJECT MEET CRITERIA FOR A SUBSTANCE-INDUCED DYSTHYMIC DISORDER? NO (IS Q.5, PAGE 96 CODED NO AND IS CHECK ITEM 5.7, PAGE 99 CODED?) 16. Since you began to feel (low/ SOE) at age [SEE Q.3, PAGE 95], (did you feel/have you felt) good or okay most of the time for at least 2 months? Remission from low mood for 2+ months - low mood remitted for 2+ months = "3" - SKIP TO SECTION 6, 17. Have (ALL SYMPTOMS) gone away? Remission from all symptoms for 2+ months - all symptoms remitted for 2+ months = "3" - SKIP TO SECTION 6, 18. When did your low mood and (ALL SYMPTOMS) go away completely? Offset of episode of low mood - code time subject became and remained symptom-free for 2+ months MONTHS AGO OR AGE (IF MORE THAN 12 MONTHS AGO ) END TIME : NOTE: PAGES HAVE BEEN OMITTED 100