Screening Questionnaires

Screening Questionaires

WebQ™ – an internet-based questionnaire assessing illness features and psychological function. Can be used for assessing inclusion/exclusion criteria and specific aspects of well-being. Includes symptom measures, and assessment of substance dependence.

BRISC – Brain Resource Inventory of Social Cognitions, including mesures of emotional intelligence and regulation.

Data Available:

Demographics

Disposition: Personal Details

  • Demographics (10 questions on DOB, sex, country of birth, marital status, height, weight, occupation, education x 2, ethnic origins

Disposition: Handedness/Laterality

  • Handedness (15 questions)

Medical history and psychological measures

Disposition: Medical

  • Vision, hearing, mobility/dexterity, mobile phone use learning/dyslexia, psychiatric/psychological, neurological, sleep x 2, eating, tobacco, alcohol, marijuana, recreational drugs, surgery, physical trauma) (16 trigger questions for optional sections 1 to 15)
  • Axis-I symptoms (SPHERES, draws on PHQ; 34 questions
  • Caffeine, Alcohol, Addictive Drugs (3 questions for harmful use)
  • Prescription medications (5 questions x max. of 3 medications)
  • Feeling and Self Regulation: Wellbeing and Personality Profile questions
  • Depression Anxiety and Stress Scale-21 (DASS-21; 21 questions)
  • BRIEF (Brain Resource Inventory of Emotional intelligence Factors; 14 questions)
  • NEO-FFI (NEO-Five Factor Inventory, 60 item)
  • BRISC (Brain Resource Inventory of Social Cognitions; 45 questions)
  • Environment: Stressors
  • Early Life Stress (19 questions)
  • Traumatic life events (11 trigger questions for optional sectional 16 on DSM trauma criteria)

Additional section (based on trigger questions)

Disposition: Medical (expanded from 16 trigger questions)

  • Vision (2 questions)
  • Hearing (2 questions)
  • Mobility/Dexterity (2 questions)
  • Mobile phone (4 questions)
  • Learning (difficulties/dyslexia; 5 questions)
  • Psychiatric/Psychological (8 questions)
  • Neurological (8 questions)
  • Sleep (A survey screen for prediction of Apnea, plus 16 questions on sleep disturbances)
  • Eating (disordered eating, Patient Health Questionnaire, 7 questions)
  • Tobacco-Smoking (Fagerstrom Test for Nicotine Dependence, 6 questions)
  • Alcohol (AUDIT WHO Alcohol Use Disorders Identification Test, 10 questions)
  • Marijuana (3 questions)
  • Recreational Drugs (2 questions)
  • Surgery (3 questions)
  • Physical Trauma (7 questions)
  • Traumatic experiences (DSM-IV Criterion A trauma, 30 questions)