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The table represents the items from the C-SSRS BASELINE instrument.

Dataset wrap
Nameqs
Rows 5-6:Represent the conditional branching on data entry where Suicidal Ideation-No Intent is "No" and the associated description is missing.
Rows 9-10:Represent the conditional branching on data entry where Ideation With Plan/Intent is "No" and the associated description is missing.
Rows 28-29:Represent the conditional branching on data entry where Preparatory Acts/Behavior is "No" and the associated description is missing.
Rows 40-41:Represent the conditional branching on data entry where Wish to be Dead is "No" and the associated description is missing.
Rows 42-43:Represent the conditional branching on data entry where Non-Specific Suicidal Thought is "No" and the associated description is missing.
Rows 44-56:Represents items missing due to conditional branching from the items Wish to be Dead and Non-Specific Suicidal Thought being "No".
Rows 57-59:Represent the conditional branching on data entry where Actual Attempt is "No". The Number of Actual Attempts and the associated description are missing.
Rows 61-63:Represent the conditional branching on data entry where Interrupted Attempt is "No". The Number of Interrupted Attempts and the associated description are missing.
Rows 64-66:Represents items missing due to conditional branching from Aborted Attempt is "No". The Number of Aborted Attempts and the associated description are missing.
Rows 70-78:Represents items missing due to conditional branching from Actual Attempt being "No".
Rows 79-117:

Show the subject was not evaluated on this instrument at visit 2. A record for each item on the instrument is created with a status of 'NOT DONE'. Since the reason for not completing the visit was not collected, no date is assumed for when the visit would have occurred. 

Dataset2
RowSTUDYIDDOMAINUSUBJIDQSSEQQSTESTCDQSTESTQSCATQSSCATQSORRESQSSTRESCQSSTRESNQSSTATQSREASNDQSLOBXFLQSDRVFLVISITNUMQSDTCQSEVINTX
1STUDYXQS2324-P00011CSS0101CSS01-Wish to be DeadC-SSRS BASELINESUICIDAL IDEATIONYesY


Y
108/19/2022BASELINE
2STUDYXQS2324-P00012CSS0101ACSS01-Wish to be Dead, DescribeC-SSRS BASELINESUICIDAL IDEATIONFall asleep and not wake upFall asleep and not wake up


Y
108/19/2022BASELINE
3STUDYXQS2324-P00013CSS0102CSS01-Non-Specific Suicidal ThoughtC-SSRS BASELINESUICIDAL IDEATIONYesY


Y
108/19/2022BASELINE
4STUDYXQS2324-P00014CSS0102ACSS01-Non-Specific Suicid Thought, DescrC-SSRS BASELINESUICIDAL IDEATIONI thought about taking an overdose but I never made a specific plan as to whenI thought about taking an overdose but I never made a specific plan as to when


Y
108/19/2022BASELINE
5STUDYXQS2324-P00015CSS0103CSS01-Suicidal Ideation-No IntentC-SSRS BASELINESUICIDAL IDEATIONNoN


Y
108/19/2022BASELINE
6STUDYXQS2324-P00016CSS0103ACSS01-Suicidal Ideation-No Intent, DescrC-SSRS BASELINESUICIDAL IDEATION


NOT DONE
YY108/19/2022BASELINE
7STUDYXQS2324-P00017CSS0104CSS01-Ideation With Intent, No PlanC-SSRS BASELINESUICIDAL IDEATIONYesY


Y
108/19/2022BASELINE
8STUDYXQS2324-P00018CSS0104ACSS01-Ideation With Intent No Plan DescrC-SSRS BASELINESUICIDAL IDEATIONI’ve thought about killing myself and howI’ve thought about killing myself and how


Y
108/19/2022BASELINE
9STUDYXQS2324-P00019CSS0105CSS01-Ideation With Plan/IntentC-SSRS BASELINESUICIDAL IDEATIONNoN


Y
108/19/2022BASELINE
10STUDYXQS2324-P000110CSS0105ACSS01-Ideation With Plan/Intent, DescrC-SSRS BASELINESUICIDAL IDEATION


NOT DONE
YY108/19/2022BASELINE
11STUDYXQS2324-P000111CSS0106CSS01-Most Severe IdeationC-SSRS BASELINEINTENSITY OF IDEATION111

Y
108/19/2022BASELINE
12STUDYXQS2324-P000112CSS0106ACSS01-Most Severe Ideation, DescriptionC-SSRS BASELINEINTENSITY OF IDEATIONWish to be DeadWish to be Dead


Y
108/19/2022BASELINE
13STUDYXQS2324-P000113CSS0107CSS01-Most Severe Ideation, FrequencyC-SSRS BASELINEINTENSITY OF IDEATIONOnce a week22

Y
108/19/2022BASELINE
14STUDYXQS2324-P000114CSS0108CSS01-Most Severe Ideation, DurationC-SSRS BASELINEINTENSITY OF IDEATION4-8 hours/most of day44

Y
108/19/2022BASELINE
15STUDYXQS2324-P000115CSS0109CSS01-Most Severe Ideation, ControlC-SSRS BASELINEINTENSITY OF IDEATIONDoes not attempt to control thoughts00

Y
108/19/2022BASELINE
16STUDYXQS2324-P000116CSS0110CSS01-Most Severe Ideation, DeterrentsC-SSRS BASELINEINTENSITY OF IDEATIONDoes not apply00

Y
108/19/2022BASELINE
17STUDYXQS2324-P000117CSS0111CSS01-Most Severe Ideation, ReasonsC-SSRS BASELINEINTENSITY OF IDEATIONMostly to get attention, revenge or a reaction from others22

Y
108/19/2022BASELINE
18STUDYXQS2324-P000118CSS0112CSS01-Actual AttemptC-SSRS BASELINESUICIDAL BEHAVIORYesY


Y
108/19/2022BASELINE
19STUDYXQS2324-P000119CSS0113CSS01-Number of Actual AttemptsC-SSRS BASELINESUICIDAL BEHAVIOR555

Y
108/19/2022BASELINE
20STUDYXQS2324-P000120CSS0113ACSS01-Actual Attempt, DescribeC-SSRS BASELINESUICIDAL BEHAVIORTo feel betterTo feel better


Y
108/19/2022BASELINE
21STUDYXQS2324-P000121CSS0114CSS01-Non-suicidal Self-injurious BehavC-SSRS BASELINESUICIDAL BEHAVIORNoN


Y
108/19/2022BASELINE
22STUDYXQS2324-P000122CSS0115CSS01-Interrupted AttemptC-SSRS BASELINESUICIDAL BEHAVIORYesY


Y
108/19/2022BASELINE
23STUDYXQS2324-P000123CSS0116CSS01-Number of Interrupted AttemptsC-SSRS BASELINESUICIDAL BEHAVIOR111

Y
108/19/2022BASELINE
24STUDYXQS2324-P000124CSS0116ACSS01-Interrupted Attempt, DescribeC-SSRS BASELINESUICIDAL BEHAVIORStopped from overdoseStopped from overdose


Y
108/19/2022BASELINE
25STUDYXQS2324-P000125CSS0117CSS01-Aborted AttemptC-SSRS BASELINESUICIDAL BEHAVIORYesY


Y
108/19/2022BASELINE
26STUDYXQS2324-P000126CSS0118CSS01-Number of Aborted AttemptsC-SSRS BASELINESUICIDAL BEHAVIOR333

Y
108/19/2022BASELINE
27STUDYXQS2324-P000127CSS0118ACSS01-Aborted Attempt, DescribeC-SSRS BASELINESUICIDAL BEHAVIORParent found my lettersParent found my letters


Y
108/19/2022BASELINE
28STUDYXQS2324-P000128CSS0119CSS01-Preparatory Acts/BehaviorC-SSRS BASELINESUICIDAL BEHAVIORNoN


Y
108/19/2022BASELINE
29STUDYXQS2324-P000129CSS0119ACSS01-Preparatory Acts/Behavior, DescrC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY108/19/2022BASELINE
30STUDYXQS2324-P000130CSS0120CSS01-Suicidal BehaviorC-SSRS BASELINESUICIDAL BEHAVIORYesY


Y
108/19/2022BASELINE
31STUDYXQS2324-P000131CSS0121ACSS01-Most Recent Attempt DateC-SSRS BASELINESUICIDAL BEHAVIOR2/14/2016



Y
108/19/2022BASELINE
32STUDYXQS2324-P000132CSS0121BCSS01-Most Recent Attempt DamageC-SSRS BASELINESUICIDAL BEHAVIORModerately severe physical damage; medical hospitalization and likely intensive care required33

Y

08/19/2022BASELINE
33STUDYXQS2324-P000133CSS0121CCSS01-Most Recent Attempt PotentialC-SSRS BASELINESUICIDAL BEHAVIORBehavior likely to result in death despite available medical care22

Y

08/19/2022BASELINE
34STUDYXQS2324-P000134CSS0122ACSS01-Most Lethal Attempt DateC-SSRS BASELINESUICIDAL BEHAVIOR12/31/2013



Y
108/19/2022BASELINE
35STUDYXQS2324-P000135CSS0122BCSS01-Most Lethal Attempt DamageC-SSRS BASELINESUICIDAL BEHAVIORSevere physical damage; medical hospitalization with intensive care required44

Y

08/19/2022BASELINE
36STUDYXQS2324-P000136CSS0122CCSS01-Most Lethal Attempt PotentialC-SSRS BASELINESUICIDAL BEHAVIORBehavior likely to result in death despite available medical care22

Y

08/19/2022BASELINE
37STUDYXQS2324-P000137CSS0123ACSS01-First Attempt DateC-SSRS BASELINESUICIDAL BEHAVIOR3/27/2009



Y
108/19/2022BASELINE
38STUDYXQS2324-P000138CSS0123BCSS01-First Attempt DamageC-SSRS BASELINESUICIDAL BEHAVIORNo physical damage or very minor physical damage00

Y

08/19/2022BASELINE
39STUDYXQS2324-P000139CSS0123CCSS01-First Attempt PotentialC-SSRS BASELINESUICIDAL BEHAVIORBehavior not likely to result in injury00

Y

08/19/2022BASELINE
40STUDYXQS2324-P00021CSS0101CSS01-Wish to be DeadC-SSRS BASELINESUICIDAL IDEATIONNoN


Y
107/13/2022BASELINE
41STUDYXQS2324-P00022CSS0201ACSS01-Wish to be Dead, DescribeC-SSRS BASELINESUICIDAL IDEATION


NOT DONE
YY107/13/2022BASELINE
42STUDYXQS2324-P00023CSS0102CSS01-Non-Specific Suicidal ThoughtC-SSRS BASELINESUICIDAL IDEATIONNoN


Y
107/13/2022BASELINE
43STUDYXQS2324-P00024CSS0102ACSS01-Non-Specific Suicid Thought, DescrC-SSRS BASELINESUICIDAL IDEATION


NOT DONE
YY107/13/2022BASELINE
44STUDYXQS2324-P00025CSS0103CSS01-Suicidal Ideation-No IntentC-SSRS BASELINESUICIDAL IDEATION


NOT DONE
YY107/13/2022BASELINE

……………………………………
………
56STUDYXQS2324-P000217CSS0111CSS01-Most Severe Ideation, ReasonsC-SSRS BASELINEINTENSITY OF IDEATION


NOT DONE
YY107/13/2022BASELINE
57STUDYXQS2324-P000218CSS0112CSS01-Actual AttemptC-SSRS BASELINESUICIDAL BEHAVIORNoN


Y
107/13/2022BASELINE
58STUDYXQS2324-P000219CSS0113CSS01-Number of Actual AttemptsC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
59STUDYXQS2324-P000220CSS0113ACSS01-Actual Attempt, DescribeC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
60STUDYXQS2324-P000221CSS0114CSS01-Non-suicidal Self-injurious BehavC-SSRS BASELINESUICIDAL BEHAVIORNoN


Y
107/13/2022BASELINE
61STUDYXQS2324-P000222CSS0115CSS01-Interrupted AttemptC-SSRS BASELINESUICIDAL BEHAVIORNoN


Y
107/13/2022BASELINE
62STUDYXQS2324-P000223CSS0116CSS01-Number of Interrupted AttemptsC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
63STUDYXQS2324-P000224CSS0116ACSS01-Interrupted Attempt, DescribeC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
64STUDYXQS2324-P000225CSS0117CSS01-Aborted AttemptC-SSRS BASELINESUICIDAL BEHAVIORNoN


Y
107/13/2022BASELINE
65STUDYXQS2324-P000226CSS0118CSS01-Number of Aborted AttemptsC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
66STUDYXQS2324-P000227CSS0118ACSS01-Aborted Attempt, DescribeC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
67STUDYXQS2324-P000228CSS0119CSS01-Preparatory Acts/BehaviorC-SSRS BASELINESUICIDAL BEHAVIORYesY


Y
107/13/2022BASELINE
68STUDYXQS2324-P000229CSS0119ACSS01-Preparatory Acts/Behavior, DescrC-SSRS BASELINESUICIDAL BEHAVIORBought pills, Bought a gun, suicide noteBought pills, Bought a gun, suicide note


Y
107/13/2022BASELINE
69STUDYXQS2324-P000230CSS0120CSS01-Suicidal BehaviorC-SSRS BASELINESUICIDAL BEHAVIORYesY


Y
107/13/2022BASELINE
70STUDYXQS2324-P000231CSS0121ACSS01-Most Recent Attempt DateC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
71STUDYXQS2324-P000232CSS0121BCSS01-Most Recent Attempt DamageC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
72STUDYXQS2324-P000233CSS0121CCSS01-Most Recent Attempt PotentialC-SSRS BASELINESUICIDAL IDEATION


NOT DONE
YY107/13/2022BASELINE

……………………………………
………
78STUDYXQS2324-P000239CSS0123CCSS01-First Attempt PotentialC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE
YY107/13/2022BASELINE
79STUDYXQS2324-P000240CSS0101CSS01-Wish to be DeadC-SSRS BASELINESUICIDAL IDEATION


NOT DONE


2

80STUDYXQS2324-P000241CSS0201ACSS01-Wish to be Dead, DescribeC-SSRS BASELINESUICIDAL IDEATION


NOT DONE


2

81STUDYXQS2324-P000242CSS0102CSS01-Non-Specific Suicidal ThoughtC-SSRS BASELINESUICIDAL IDEATION


NOT DONE


2

82STUDYXQS2324-P000243CSS0102ACSS01-Non-Specific Suicid Thought, DescrC-SSRS BASELINESUICIDAL IDEATION


NOT DONE


2

83STUDYXQS2324-P000244CSS0103CSS01-Suicidal Ideation-No IntentC-SSRS BASELINESUICIDAL IDEATION


NOT DONE


2


……………………………………
…
…
117STUDYXQS2324-P000278CSS0123CCSS01-First Attempt PotentialC-SSRS BASELINESUICIDAL BEHAVIOR


NOT DONE


2

...

Info

The evaluation interval text value for data collection needs to be populated in SUPPQS as follows. The standard terminology for QNAM and QLABEL are listed below.

STUDYIDRDOMAINUSUBJIDIDVARIDVARVALQNAMQLABELQVALQORIG
STUDYXQS2324-P0001QSSEQ6QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0001QSSEQ10QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0001QSSEQ29QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ2QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ4QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ5QSCBRFLConditional Branching Item IndicatorYASSIGNED
…………
…………
STUDYXQS2324-P0002QSSEQ17QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ19QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ20QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ23QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ24QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ26QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ27QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ31QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ32QSCBRFLConditional Branching Item IndicatorYASSIGNED
STUDYXQS2324-P0002QSSEQ33QSCBRFLConditional Branching Item IndicatorYASSIGNED
…………
…………
STUDYXQS2324-P0002QSSEQ39QSCBRFLConditional Branching Item IndicatorY

ASSIGNED

4 SDTM Mapping Strategy

This section is used for reference regarding the CRF data capture and to understand the alignment of the instrument to the SDTM QS domain. It also provides guidance on how the result variables (QSORRES, QSSTRESC, and QSSTRESN) should be populated.

...

5 Supplemental Qualifier Name Codes

Info

The instrument used as an example in this template did not require supplemental qualifiers, but this section has been included to provide guidance on those instruments which do require supplemental qualifiers. (Many instruments do not require it.) Text that always will be in the section when it is included has been left black.

Additional rows will be required in the suppqs.xpt dataset for each supplemental qualifier needed.

Remove Section 5 if it does not apply to the new instrument.

The following table contains additional standard name codes for use in the Supplement Qualifiers for Questionnaires (SUPPQS) special purpose dataset.

Dataset wrap
Namesuppqs
QNAMQLABELQVAL
QSCBRFLConditional Branching Item IndicatorY


End of Document