PRISM SECTION 4C - PRIOR SIMD

Transcription

1 START TIME : PRISM SECTION C - PRIOR SIMD Statement C.5: Now I'd like to ask you about moods that you might have had when you were drinking or using drugs a lot. I'm interested in times before (ONSET CODED IN Q., PAGE 5).. Before [ONSET OF DEPRESSED MOOD CODED IN SECTION A, Q., PAGE 5], have you had another time, lasting at least weeks, when you felt depressed Can you describe that feeling Was that a definite change from your usual self Could anything make you feel better For how long would you feel better Depressed mood for + weeks prior to most recent episode - must occur 0+ of days - code regardless of external circumstances or level of impairment - report must confirm sad quality of mood - frustrated, agitated, or irritable without sad mood = - SKIP TO Q., PAGE 7. Before [ONSET OF DEPRESSED MOOD CODED IN SECTION A, Q., PAGE 5], have you had another time, lasting at least weeks, when you felt uninterested in things most of the time What did you lose interest in Was that a definite change from usual Was there anything you were still interested in as much as usual Did you feel uninterested in things almost all day long for at least weeks Why did you feel uninterested in things Markedly diminished interest in all, or almost all, activities for + weeks prior to most recent episode - must occur 0+ of days - interesting activities unavailable due to living situation = - primarily due to fatigue or low energy = - interested in or more major activities as much as usual = "" - participated in activities only when pushed or forced self = "" - change in interest from complex to very simple activities = "" - only interested in substance use = - SKIP TO Q., PAGE 7. Before [ONSET OF DEPRESSED MOOD CODED IN SECTION A, Q., PAGE 5], have you had another time, lasting at least weeks, when you were unable to enjoy things most of the time What were you unable to enjoy Was that a definite change from usual Was there anything you still enjoyed as much as usual Were you unable to enjoy things almost all day long for at least weeks Markedly diminished pleasure from all, or almost all, activities for + weeks prior to most recent episode - must occur 0+ of days - enjoyable activities unavailable due to living situation = - enjoyed or more major activities as much as usual = "" - loss of interest, but still enjoyed activities when pushed = "" - change in enjoyment from complex to very simple activities = "" - SKIP TO SECTION 5, PAGE 95 7

2 . Did the (depression/anhedonia) ever start while you were drinking or using (DRUGS) a lot By a lot, I mean or more days a week or days straight. IF ONSET DURING INTOXICATION: What were you using How often did you (drink/use DRUG) How long did that go on Potential prior SIMD with onset during chronic intoxication or binge use - chronic intoxication: intoxicated + days a week for + weeks; binge use: intoxicated + days straight - drank only small amounts of alcohol (less than drinks) daily = - drank or used drugs less than days a week = - refer to substance timeline - relevant substances: ALC, COC, HER, HAL, SED, STI, OPI, MET - marijuana only = "" - if coded "," check relevant substance(s) SPECIFY USE PATTERN NO - SKIP TO CHECK ITEM C., PAGE 75 CHECK ALL THAT APPLY: ALC COC/STI HER/OPI/MET SED HAL OTHER 5. Did you ever start drinking or using (DRUGS) a lot soon after you became (depressed/anhedonic) By soon, I mean within a couple of weeks. IF INTOXICATED AFTER ONSET: What were you using How often did you (drink/use DRUG) How long did that go on Chronic intoxication or binge use began within weeks after onset of potential prior SIMD - chronic intoxication: intoxicated + days a week for + weeks; binge use: intoxicated + days straight - drank only small amounts of alcohol (less than drinks) daily = - drank or used drugs less than days a week = - refer to substance timeline - relevant substances: ALC, COC, HER, HAL, SED, STI, OPI, MET - marijuana only = "" - if coded "," check relevant substance(s) SPECIFY USE PATTERN NO - SKIP TO CHECK ITEM C., PAGE 75 CHECK ALL THAT APPLY: ALC COC/STI HER/OPI/MET SED HAL OTHER 6. Did the (depression/anhedonia) ever start within a couple of weeks after you drank alcohol or used (DRUGS) continuously for days or more IF NO: after you stopped drinking alcohol or using (DRUGS) entirely IF DID NOT STOP: after you cut down significantly on your drinking or (DRUG) use IF USED +DAYS, STOPPED OR CUT DOWN: What were you using How often did you (drink/use DRUG) before you stopped/cut down (How often did you (drink/use DRUG) after you cut down) How long did that go on Potential prior SIMD with onset during withdrawal - withdrawal: one month after end of chronic intoxication (+ days a week for + weeks) or binge use (+ days continuous use) - drank only small amounts of alcohol (less than drinks) daily = - drank or used drugs heavily for less than weeks before cutting down = - + days continuous use was a rare occurrence = - refer to substance timeline - relevant substances: ALC, COC, HER, SED, STI, OPI, MET - marijuana or hallucinogens only = "" - if coded "," check relevant substance(s) SPECIFY USE PATTERN NO CHECK ALL THAT APPLY: ALC COC/STI HER/OPI/MET SED OTHER 7

3 CHECK ITEM DID SUBJECT HAVE POTENTIAL PRIOR SIMD NO - SKIP TO SECTION 5, C. PAGE 95 (IS Q. OR Q.5 OR Q.6, PAGE 7 CODED ) 7. Have you had more than one time like that, when you felt (depressed/anhedonic) when you were drinking or using (DRUGS) a lot or when you recently cut down on alcohol or (DRUG) use More than one potential prior SIMD - episodes are separate if interrupted by + months of less than 5 symptoms - ONE EPISODE - MORE THAN ONE EPISODE IF ONE EPISODE: 8. How old were you the time you began to feel (depressed/anhedonic) IF MORE THAN ONE EPISODE: Of all those times, how old were you the time you were the most (depressed/ anhedonic) Onset of worst (or only) potential prior SIMD - if necessary, refer subject to treatment for depression reported in Overview MONTHS AGE (IF AGO MORE THAN MONTHS) 9. How long were you (depressed/ anhedonic) at that time Duration of potential prior SIMD - must last + weeks - offset: + months in which depressed mood was no longer present WEEKS OR MONTHS OR YEARS CHECK ITEM DID POTENTIAL PRIOR SIMD LAST ONE MONTH OR MORE NO - SKIP TO Q., C. PAGE 76 (IS Q.9 CODED MONTH OR MORE) 0. During that entire time were you (DRUG-) and alcohol-free for at least one full month IF WAS NOT ABSTINENT: were you drinking or using (DRUGS) only occasionally for at least one full month By occasionally, I mean less than days a week. IF USED OCCASIONALLY: What were you using How often did you (drink/use DRUGS) How long did that go on or more months of abstinence or occasional use during prior depressed mood (potential PMD) - occasional use: less than 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 drinks) daily = - marijuana only = "" NO SKIP TO Q., PAGE 76 ABSTINENCE OCCASIONAL USE CHECK ITEM DID SUBJECT HAVE MORE THAN ONE PERIOD OF POTENTIAL PRIOR SIMD NO - SKIP TO SECTION 5, C. PAGE 95 (IS Q.7 CODED ) 75

4 . Did any of the other times you were (depressed/anhedonic), happen when you were drinking or using drugs a lot By a lot, I mean days a week or more. Another period of potential prior SIMD lasting + weeks NO - SKIP TO SECTION 5, PAGE 95 - GO BACK TO Q.8, AND RE-CODE RELEVANT Q. S. Had someone close to you died around that time Who was that Bereavement co-occurring with potential prior SIMD - depressed mood after miscarriage, still birth, death of pet(s) = NO - SKIP TO Q.. Were you very depressed at that time for more than months Potential prior SIMD lasting + months - depressed + months = NO. Were you having medical problems around that time What was wrong IF HAD RELEVANT MEDICAL CONDITION: When did you start having this medical problem How long have you had it Did a doctor ever say that your (depression/ anhedonia) was caused by (MEDICAL CONDITION) Relevant medical condition co-occurring with potential prior SIMD - relevant medical condition: thyroid or adrenal (e.g., Cushing's or Addison's) disorders, post-stroke, brain tumor, pancreatic cancer, multiple sclerosis, Parkinson's disease, lupus, hepatitis, mononucleosis, AIDS = - menopause, childbirth, or stress = "" - depressed mood began during relevant medical condition and lasted less than weeks after remission from illness = "" NO MEDICAL CONDITION CODES: CHECK ITEM DID SUBJECT HAVE MORE THAN ONE EPISODE OF POTENTIAL SIMD NO - SKIP TO Q.7, C. PAGE 77 (IS Q.7, PAGE 75 CODED ) CHECK ITEM DID POTENTIAL SIMD FOLLOW BEREAVEMENT NO - SKIP TO CHECK ITEM C.5 C.7, PAGE 77 (IS Q. CODED ) CHECK ITEM DID POTENTIAL SIMD LAST MORE THAN MONTHS NO - SKIP TO Q.5, C.6 PAGE 77 (IS Q. CODED ) 76

5 CHECK ITEM IS POTENTIAL SIMD DUE TO MEDICAL CONDITION NO - SKIP TO Q.7 C.7 (IS Q., PAGE 76 CODED ) IF DEPRESSED LESS THAN MONTHS AFTER BEREAVEMENT: 5. Did you have other times when you felt (depressed/anhedonic) Another period of potential prior SIMD in the absence of bereavement and medical condition NO - SKIP TO Q.7 that were not related to the loss of someone IF NO: that lasted more than months IF MEDICAL CONDITION: Did you have other times when you felt (depressed/anhedonic) when you did not have a medical problem INTERVIEWER INSTRUCTIONS: REPEAT AND RECODE QUESTIONS - AS NEEDED TO VERIFY SUBSTANCE-INDUCED DEPRESSED MOOD. IF NONE OF THE OTHER DEPRESSED EPISODES IS SUBSTANCE-INDUCED, SKIP TO Q.7 6. How old were you when you began to feel (depressed/anhedonic) at that time Onset of potential prior SIMD in the absence of bereavement and medical condition - if necessary, refer subject to treatment for depression reported in Overview MONTHS AGE (IF AGO MORE THAN MONTHS) 7. Were there any other changes in your life around that time For example, did you lose a job, or did a relationship end Events co-occurring with potential prior SIMD - life event is of doubtful significance = "" NO SPECIFY LIFE EVENT 8a. Just before you began to feel (depressed/ anhedonic), were you taking any medications prescribed by a doctor Which ones IF USED ANY RELEVANT MEDICATION: When did you start taking [MEDICATION] How long did you take it Did a doctor ever say that your (depression/anhedonia) was caused by [MEDICATION] Potential prior depressed mood due to medications 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, Clonidine or sulfonamide) antibiotics - relapse due to cessation of antidepressants = "" - unclear etiology = "" - depression beginning during significant dosage of relevant medication and lasting less than weeks after termination of medication = "" NO ENTER DRUG CODES: SPECIFY DRUG(S) 77

6 8b. Just before you began to feel (depressed/anhedonic), were you exposed to a toxin or poisonous substance, like a chemical spill or fumes at your workplace When did that happen Did a doctor ever say that your (depression/ anhedonia) was caused by [TOXIN] Potential prior depressed mood due to exposure to toxin - toxins include gasoline or paint fumes, carbon monoxide, carbon dioxide, nerve gas, organophosphate insecticides - must be medical or public report that toxin caused symptoms - not sure or never thought about it before, but it might have happened = "" - unclear etiology = "" SPECIFY TOXIN(S) NO IF NOT KNOWN: 9. Was there any increase or decrease in your [RELEVANT SUBSTANCE(S)] use around the time you were feeling the worst When did (increase/decrease) occur Potential intoxication or withdrawal effects due to change in use - worst period of depression is within month following increase or decrease in use = - worst period of depression began + weeks before increase or decrease in use = - relevant substances: ALC, COC, HER, HAL, SED, STI, OPI, MET - if coded "," check relevant substance(s) SPECIFY CHANGE NO CHECK ALL THAT APPLY: ALC SED COC STI HER OPI HAL MET 78

7 Statement C.6: I m going to ask you a few more questions about the time you were depressed when you were. BOX C During that time were you sad, blue, depressed or down most or all of the time Can you describe that feeling Was that a definite change from your usual self Did you feel (depressed/anhedonic) almost all day long, for at least weeks Did anything make you feel better (For how long would you feel better) Depressed mood - must occur 0+ of days for at least weeks - disregard circumstances and level of impairment - if mood is normal or more hours a day = "" - forgets about depressed mood in work/other primary activity = "" = NO = SUBTHRESHOLD = 79

8 BOX C During that time did you find that you didn't care about the things you usually cared about Or that you were a lot less interested in things than usual What did you lose interest in Was that a definite change from before you felt (depressed/anhedonic) Was there anything you were still interested in as much as usual Did you feel uninterested in things almost all day long for at least weeks Markedly diminished interest in all, almost all, activities - must occur 0+ of days for at least weeks - interesting activities unavailable due to living situation = - primarily due to fatigue or low energy = - interested in or more major activities as much as usual = "" - participated in activities only when pushed or forced self = "" - change in interest from complex to very simple activities = "" - interested only in talking to friends about low mood = "" - only interested in substance use =....were you unable to enjoy the things you usually enjoy What were you unable to enjoy Was that a definite change from before you felt (depressed/anhedonic Was there anything you still enjoyed as much as usual (Anything else) Were you unable to enjoy things almost all day long for at least weeks Markedly diminished pleasure from all, or almost all, activities - must occur 0+ of days for the at least weeks - enjoyable activities unavailable due to living situation = - enjoys or more major activities as much as usual = "" - loss of interest, but still enjoys activities when pushed = "" - change in enjoyment from complex to very simple activities = "" - enjoys only talking to friends about low mood = "" = NO = SUBTHRESHOLD = 80

9 INTERVIEWER INSTRUCTIONS: USE FOLLOWING WEIGHT CHART TO SCORE Q. AND Q.6 5% of lbs. = lbs. = lbs. = lbs. = lbs. = lbs. = lbs. = lbs. = lbs. = lbs. = 5.5 BOX C During that time did you lose your appetite compared to usual Can you describe that to me Was that a definite change from before you felt (depressed/ anhedonic) Was your appetite poor most of the day, nearly every day for at least weeks Decrease in appetite - must occur 0+ of days, for at least weeks - decreased appetite due to external circumstances = "" - appetite was clearly decreased but ate usual amount = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI....did you lose any weight without dieting How much What was your weight before you became (depressed/ anhedonic) How long did it take to lose pounds Significant weight loss when not dieting - must be more than 5% of body weight in month (see chart) - probe for period of highest rate of loss - lost half the amount in chart in a -week period = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI CHECK ITEM DID SUBJECT REPORT CHANGE IN APPETITE/WEIGHT NO C.8 (IS Q. OR Q. CODED ) - SKIP TO BOX C, PAGE did you find you wanted to eat a lot more than usual Can you describe that to me Was that a definite change from before you felt (depressed/ anhedonic) Did you have a bigger appetite most of the day, nearly every day for at least weeks Increase in appetite - must occur 0+ of days, for at least weeks - increased appetite resulted from external circumstances = "" - appetite was clearly increased but ate usual amount = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI 6....did you gain any weight (without trying to) How much How much did you weigh before you became (depressed/anhedonic) How long did it take to gain pounds Significant weight gain when not trying to gain weight - more than 5% of body weight in a month - probe for period of highest rate of gain - gained half the amount in chart in a -week period = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI = NO = SUBTHRESHOLD = = INTOXICATION/WITHDRAWAL 8

10 BOX C During that time did you have trouble sleeping, nearly every day Can you describe that to me Was that a definite change from before you felt (depressed/ anhedonic) How much sleep were you actually getting How much sleep did you usually get Did you have trouble sleeping nearly every day for at least weeks Insomnia - must occur 0+ of days, for at least weeks - must have 5% decrease in sleep - examples: 7-8 hours to 5-6 hours, 6 hours to ½ hours - slept but had terrible dreams or remained exhausted = "" - wakes up for a few minutes and falls back to sleep = "" - loss of sleep due to noise or hallucinations or delusions = "" - sleeps during the day to make up for decrease in usual hours = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: ALC, SED, COC, STI, HER, OPI, MET CHECK ITEM DID SUBJECT REPORT INSOMNIA NO C.9 (IS Q.7 CODED ) - SKIP TO BOX 5C, PAGE did you sleep more than usual Can you describe that to me Was that a definite change from before you felt (depressed/ anhedonic) How much were you sleeping How much did you usually sleep Did you sleep more than usual nearly every day for at least weeks Hypersomnia - must occur 0+ of days for at least weeks - must have 5% estimated increase in sleep - examples: 7-8 hours to 9-0 hours, 6 hours to 7 ½ hours - increased sleep due to external circumstances = "" - stayed in bed all day but did not sleep = "" - code 5% increase even if making up for insomnia = "" - slept more but had terrible dreams or remained exhausted = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI = NO = SUBTHRESHOLD = = INTOXICATION/WITHDRAWAL 8

11 BOX 5C During that time were you so fidgety or restless that you couldn't sit still Can you describe that to me Were you actually moving more or faster than before you felt (depressed/ anhedonic) If others were around, would they have noticed Did that happen most of the day, nearly every day for at least weeks Psychomotor agitation - must occur 0+ of days for at least weeks - must be severe and observable - examples: pacing, wringing hands, scratching skin - one particular fidget or tick (leg, eye, cheek) = "" - kept busy to distract self but movement normal speed = "" - can't stay at a task without getting up and down repeatedly = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: ALC, SED, COC, STI 0....did you move or talk much more slowly than is normal for you Can you describe that to me Did you appear to be in slow motion Were you actually moving or talking much less, or much more slowly than before you felt (depressed/anhedonic) If others were around, would they have noticed Did that happen no matter what situation you were in Did that happen most of the day, nearly every day for at least weeks Psychomotor retardation - must 0+ of days, for at least weeks - must be severe and observable - examples: long pauses before answering questions, slow shuffle - spoke less because felt worthless = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI SKIP TO Q., PAGE 8 IF BEREAVED AND NOT KNOWN, ASK:....were you so slowed down that you hardly moved at all Was it almost impossible to have a conversation with you because you spoke so slowly or paused so long before you answered questions (Did you sit or lie in one position for hours) Marked psychomotor retardation - conversation difficult to maintain due to slow rate of speech and pauses in speech = - physical movements slowed to the point that subject hardly moves at all, may sit or lie awake in one position for hours = - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI = NO = SUBTHRESHOLD = = INTOXICATION/WITHDRAWAL 8

12 BOX 6C During that time were you tired out all the time Did even small things require a lot of effort (Did you get tired much more easily than usual) Was that a definite change from before you felt (depressed/anhedonic) Did you actually have less energy than usual or were you just uninterested in things Did you feel (tired/soe) most of the day, nearly every day for at least weeks Fatigue or loss of energy - must occur 0+ of days for at least weeks - must be physically tired, having no energy - differentiate from lack of interest - need not result in decrease in activities - tired due to unusual externally imposed work = "" - tired due to loss of sleep from depression-related insomnia = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: COC, STI = NO = SUBTHRESHOLD = = INTOXICATION/WITHDRAWAL 8

13 BOX 7C During that time did you feel useless, good for nothing, or worthless Can you tell me more about that Was that a definite change from before you felt (depressed/anhedonic) Was there anything you still felt was good about yourself (How much did that matter to you) Did you feel (worthless/soe) most of the day, nearly every day for at least weeks Feelings of worthlessness - must occur 0+ of days for at least weeks - must be marked devaluation of character, personality, accomplishments - may be delusional - any significant area still considered positive, unless positive areas are devalued (e.g., "I'm a great cook but who cares") = - feeling bad about depressive symptoms unless excessive or preoccupying = "" SKIP TO Q.5 IF BEREAVEMENT, ASK:....did you think so much about being (worthless/soe) that it was hard for you to think about other things Preoccupation with feelings of worthlessness - thoughts of worthlessness were so pervasive that concentration on other matters was difficult 5....did you feel guilty about things you had done or not done What did you feel guilty about Was that a definite change from before you felt (depressed/ anhedonic) How bad was the feeling Did you feel that you would be punished, or that you deserved to be punished When you look back on it now, do you think you felt more guilty than you should have Did anyone else think that Did you feel guilty most of the day, nearly every day for at least weeks Feelings of excessive or inappropriate guilt - must occur 0+ of days for at least weeks - must be greater than circumstances call for - must be convinced of responsibility - may be delusional - guilt about depression unless clearly exaggerated = "" - realistic guilt if only during periods of depression = "" - guilt about unknowing action (e.g., smoking during an earlier pregnancy before the harmful effects of cigarettes were known) = "" IF BEREAVED: - excessive or inappropriate guilt besides things done or not done at time of loved one s death, code "" and check box BEREAVEMENT = NO = SUBTHRESHOLD = 85

14 BOX 8C During that time did you have unusual trouble thinking, concentrating, or keeping your mind on things Can you give me some examples Was this because you weren't interested Was that a definite change from before you felt (depressed/anhedonic) Did you have trouble (concentrating/soe) most of the day, nearly every day for at least weeks Diminished ability to think or concentrate - must occur 0+ of days for at least weeks - do not confuse with lack of interest - distracted by hallucinations or mood-incongruent delusions = "" - memory difficulties and significant absentmindedness = "" - "blankness" or preoccupation with depressive thoughts = "" - change in concentration from complex to simple things = "" - obsessive thoughts that worsened with onset of depression = "" - subject attributes symptom to anxiety but symptom co-occurs with depressed mood/ anhedonia = "" - meets symptom criteria but occurs with increase or decrease in use = - relevant substances: ALC, SED, COC, STI, HER, OPI, MET CHECK ITEM DID SUBJECT REPORT DIMINISHED ABILITY TO CONCENTRATE NO C.0 (IS Q.6 CODED ) - SKIP TO BOX 9C, PAGE did you find it harder than usual to make everyday decisions, for instance, what to wear, what to eat, what to watch on TV Can you give me an example Were you really unable to decide or did you just not care Did it take longer than usual to make a decision Was that a definite change from before you felt (depressed/anhedonic) Did you have difficulty making decisions most of the day, nearly every day for at least weeks Indecisiveness - must occur 0+ of days for at least weeks - do not confuse with lack of interest - must concern small everyday decisions, not major life decisions - requires excessive reassurance from others = "" = NO = SUBTHRESHOLD = = INTOXICATION/WITHDRAWAL 86

15 BOX 9C During that time did you do anything to hurt or kill yourself Did you do anything on purpose you knew could have killed you What did you do What happened then Did you think you would die as a result Suicide attempt - must have believed that act was lethal - impulsive gesture begun but not completed = "" - impulsive attempt = CHECK ITEM DID SUBJECT ATTEMPT SUICIDE NO C. (IS Q.8 CODED ) - SKIP TO CHECK ITEM C., PAGE did you start to do something in order to kill yourself, even if you changed your mind and stopped, or if someone else stopped you What did you do What happened then What did you think would happen Suicide gesture - examples: takes a few pills and then stops, puts gun to head but does not use it, walks out onto ledge and then returns to safety - self mutilation for tension relief = "" - preparation for attempt (e.g., accumulating pills, giving away possessions) = "" - initiates attempt but changes mind and stops = "" - apparent suicide gesture even if subject claims intent was only attention-seeking = "" - SKIP TO CHECK ITEM C., PAGE did you think of any specific plan for committing suicide What did you think of doing Specific suicide plan - must think of actual method of suicide - need not be recurrent or feasible - intent to carry out plan is not required - even fleeting thoughts about method of suicide = "" - SKIP TO CHECK ITEM C., PAGE did you have any thoughts about suicide or killing yourself What did you think of How often did you have that thought Recurrent suicidal ideation - must occur at least times in a week (not necessarily all day) - may be ambivalent - can have suicidal ideation without having suicidal plan - SKIP TO CHECK ITEM C., PAGE 88 BOX 9C CONTINUED ON NEXT PAGE = NO = SUBTHRESHOLD = 87

16 BOX 9C (CONT.) During that time did you find yourself thinking about death or dying (Your own death, someone else's, or death in general) Were these thoughts/ feelings a change from before you felt (depressed/ anhedonic) How often were you thinking about these things Recurrent thoughts of death - must have spent some time thinking about death at least times in a week (not necessarily all day) - normal fear of death = "" - had recurrent thoughts that he/she would be better off dead unless following death of a loved one = "" - thoughts of death attributed to health problem or HIV status that occur without a change in health status = "" IF BEREAVED: - if thoughts of death other than feeling he/she would be better off dead or should have died with loved one, code "" and check box BEREAVEMENT = NO = SUBTHRESHOLD = CHECK ITEM DID PRIOR SIMD INCLUDE 5 OR MORE SYMPTOMS NO - SKIP TO CHECK ITEM C. OF MAJOR DEPRESSION C.8, PAGE 9 (DO 5 OR MORE BOXES, C-9C HAVE QUESTIONS CODED "") 88

17 During that time. did you avoid seeing or talking to people because you didn't want to be around them as much as usual did you depend on others to take care of your everyday responsibilities or to give you a lot of attention or comfort (Did they get upset because of this) did you get into more arguments than usual did you have more trouble with [work/school/household tasks] (Did anyone say anything about this) IF UNEMPLOYED: was the fact that you were not working at that time related to your depressed feelings Were the problems mild, moderate, or severe Impairment during prior SIMD: social withdrawal, demands for attention, dependency, interpersonal conflict, failure to fulfill usual responsibilities - behavior must be persistent and clearly related to depressed mood or other depressive symptoms - questionable or slight impairment = "" - MILD - MODERATE - SEVERE CHECK ALL THAT APPLY: WITHDRAWAL ATTENTION/ DEPENDENCY CONFLICT RESPONSIBILITIES CHECK ITEM DID SUBJECT REPORT IMPAIRMENT IN PRIOR SIMD NO C. (IS Q. CODED "" OR "") - SKIP TO CHECK ITEM C.. Were you very troubled by (SYMPTOMS CODED IN BOXES C-9C) Did you think of getting help Did you actually go for help Did you feel upset about these difficulties the whole time or just once in a while Prior SIMD caused clinically significant distress - must be persistent and pronounced distress - distress can concern impact of depression on one's family or career or about potential chronicity of depression - resigned to depressive symptoms = "" - sometimes disturbed or mildly upset by depressive symptoms = "" - sought treatment (voluntarily) or sought other help for depressive symptoms = "" - had strong persistent desire for relief of depressive symptoms, but did not actually seek help = "" CHECK ITEM DID SUBJECT REPORT IMPAIRMENT OR DISTRESS IN PRIOR SIMD NO - SKIP TO CHECK ITEM C. C.8, PAGE 9 (IS CHECK ITEM C. CODED OR IS Q. CODED ") > Prior SIMD followed death of loved one - refer to Q., p. 76 NO - SKIP TO CHECK ITEM C.7, PAGE 90 - POTENTIAL BEREAVEMENT 89

18 6. During that time, did you hear things that other people couldn t hear see things other people couldn t see Hallucinations other than thinking one hears voice of deceased person, or transiently sees image of deceased person during prior SIMD - culturally accepted phenomena = "" NO SKIP TO CHECK ITEM C.6 IF VOICE OR TRANSIENT IMAGE OF DECEASED: Did you (hear/see) anything else 7. Did your (depression/anhedonia) and (SYMPTOMS) last more than months after [LOVED ONE] died 5+ symptoms of prior SIMD were present + months after loss (death of loved one) NO SKIP TO CHECK ITEM C.6 CHECK ITEM DID SUBJECT REPORT SEVERE IMPAIRMENT IN PRIOR PMD NO C.5 (IS Q., PAGE 89 CODED "") SKIP TO CHECK ITEM C > Period of bereavement during prior SIMD included any symptoms not characteristic of normal grief reaction - excessive/inappropriate guilt about things (other than actions taken or not taken) around time of death (refer to Q.5) = "" - suicidal ideation or behavior, or thoughts of death other than feeling he or she would be better off dead, or should have died with loved one (refer to Box 9B) = "" - morbid preoccupation with feelings of worthlessness (refer to Q.) = "" - marked psychomotor retardation (refer to Q.) = "" NO CHECK ITEM DID PERIOD OF BEREAVEMENT MEET CRITERIA FOR NO C.6 MAJOR DEPRESSIVE EPISODE (ARE ANY Q. S 6-8 CODED "" OR IS CHECK ITEM C.5 CODED ) CHECK ITEM DID SUBJECT MEET CRITERIA FOR PRIOR SIMD NO SKIP TO CHECK ITEM C.7 C.8, PAGE 9 (IS Q.5, PAGE 89 CODED OR IS CHECK ITEM C.6 CODED ") 9. How old were you when you felt (depressed/anhedonic), (when you were drinking/soon after you were drinking) and you also had some of the experiences you've just told me about, such as (SYMPTOMS) and (IMPAIRMENT/ DISTRESS) Onset of prior SIMD in the past (coded in Boxes C - 9C) - onset is time when subject first had 5+ symptoms and impairment or distress that persisted without remission - episodes are separate if interrupted by months of less than 5 symptoms MONTHS AGO OR AGE (IF MORE THAN MONTHS AGO) 90

19 50. Since that time, did you feel better for at least months Full or partial remission from prior episode of SIMD - NO REMISSION = continues to have 5+ symptoms, or fewer than 5 symptoms for less than months - FULL REMISSION = symptom-free for + months - PARTIAL REMISSION = fewer than 5 symptoms for + months NO REMISSION - SKIP TO Q.5 FULL OR PARTIAL REMISSION 5. Did those feelings/ SYMPTOMS go away completely for at least months Full remission from prior episode of SIMD - FULL REMISSION = symptom-free for + months - PARTIAL REMISSION = fewer than 5 symptoms for + months PARTIAL REMISSION - SKIP TO Q.5 FULL REMISSION 5. When did those feelings/ SYMPTOMS go away completely for at least months Beginning of full remission from prior episode of SIMD - code beginning of period of no symptoms for + months MONTHS AGO OR AGE (IF MORE THAN MONTHS AGO) INTERVIEWER INSTRUCTIONS: SKIP TO Q.5 5. When did you begin to feel better (HAVE LESS THAN 5+ SYMPTOMS), for at least months Beginning of partial remission from prior episode of SIMD - code beginning of period of less than 5 symptoms for + months MONTHS AGO OR AGE (IF MORE THAN MONTHS AGO) 5. For how long did you feel (depressed/ anhedonic) and have some of the related experiences we ve been talking about 55. When was the very first time in your life that you felt (depressed/anhedonic) when you were drinking or using drugs a lot 56. In your entire life, how many separate times have there been weeks, when you felt (depressed/anhedonic) when you were drinking or using drugs a lot IF HAD BEREAVEMENT: Of those times, how many occurred after the death of someone close to you Duration of prior SIMD - duration is length of time from onset of 5+ symptoms and impairment distress to at least partial remission - partial remission: less than 5 symptoms for at least months Onset of initial SIMD in lifetime - code first time subject had + week period of 5+ symptoms and impairment/distress during substance use Number of SIMD episodes in lifetime - episodes must include 5+ symptoms and impairment distress lasting at least weeks WEEKS MONTHS YEARS MONTHS AGO OR AGE (IF MORE THAN MONTHS AGO) TOTAL # OF SIMD BEREAVEMENT 9

20 CHECK ITEM DID SUBJECT MEET CRITERIA FOR PRIOR SIMD NO C.8 (IS CHECK ITEM C., PAGE 89 AND CHECK ITEM C.7, PAGE 90 CODED ") END TIME : NOTE: PAGES 9-9 HAVE BEEN OMITTED. 9