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1 General Considerations
This section describes the implementation of the analysis dataset for QRS instruments as based on the Basic Data Structure (BDS) described in the Analysis Data Model Implementation Guide (ADaMIG). The ADaMIG can be found on the CDISC website at https://www.cdisc.org/standards/foundational/adam. The BDS was chosen as the model for analysis datasets of QRS instruments because it supports a wide variety of analyses, including summaries of total score by timepoint as well as change from baseline by timepoint. This data structure allows the ADaM variables PARAM and PARAMCD to come directly from Study Data Tabulation Model (SDTM) variables QS.QSTEST and QS.QSTESTCD, respectively, for individually captured questions, thus ensuring traceability between SDTM and ADaM data. If other analyses are required that are not supported by the BDS, then consideration would be needed as to the appropriate structure. Analysis requirements always drive the design of the analysis datasets.
This ADaM supplement is based on the Geriatric Depression Scale Short Form Questionnaire Supplement Version 2.0 to the SDTM Implementation Guide for Human Clinical Trials (SDTMIG). The Geriatric Depression Scale Short Form is known by several names, including GDS SHORT FORM, GDS-15, GDS-SF, and Mood Scale. In this document, it will be referred to as the GDS SHORT FORM.
Note that source SDTM score values may not be suitable for analysis because the values may need to be imputed or transformed. In addition, recalculation of collected values may be needed per analysis rules. In these cases, the derivation of AVAL may not be a simple copying of QS.QSSTRESN.
These specific analysis implementation details for the GDS SHORT FORM are meant to be used in conjunction with ADaMIG. All completed questionnaires, ratings, and scales documentation can be found on the CDISC website at: https://www.cdisc.org/foundational/qrs.
1.1 Representations and Warranties, Limitations of Liability, and Disclaimers
This document is a supplement to the ADaMIG and is covered under Appendix C of that document, which describes representations, warranties, limitations of liability, and disclaimers. Please see Appendix C of the ADaMIG for a complete version of this material.
CDISC does not endorse any QRS instrument and does not specify how to conduct clinical assessments, protocols, or analyses. CDISC disclaims any liability for your use of this material.
Include this line only for supplements that the US FDA will be reviewing: Although the United States Food and Drug Administration (US FDA) has provided input with regard to this supplement, this input does not constitute US FDA endorsement of any particular instrument.
1.2 Copyright Status
(fyi, much of the text is in blue because not all instruments are public domain or copyrighted; however, please only change the name of the copyright holder and the QRS Short_Name and remove italics.)
For public domain instruments use the following text: This instrument is in the public domain. CDISC has included the QRS Short_Name in the CDISC library of QRS data standards supplements. There may be many versions of this instrument in the public domain or copyrighted. CDISC has chosen to use the version attached to the QRS supplement to the SDTMIG, and the QRS supplement to the ADaMIG is based on the same version.
For copyrighted instruments use the following text: Name of copyright holder (e.g. Board of Regents of The University of Texas System) owns the copyright for the QRS Short_Name instrument and has granted CDISC permission to include this supplement in the CDISC library of QRS data standards supplements. (For supplements that are to be distributed by the copyright holder, add: Name of copyright holder (e.g. Board of Regents of The University of Texas System) will distribute the CDISC supplement package to sponsors when they are approved to use this instrument.) There may be many versions of this instrument in the public domain or copyrighted. CDISC has chosen to use the version attached to the QRS supplement to the SDTMIG, and the QRS supplement to the ADaMIG is based on the same version.
Only include for copyrighted instruments: CDISC acknowledges name of copyright holder (e.g., Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues as developers of the GAD-7 and Pfizer) for the approval to include the QRS Short_Name in the CDISC data standards.
Only include for copyrighted instruments: CDISC has developed this documentation at no cost to the copyright holder or any additional cost to users of the instrument beyond the normal license fees charged by the copyright holder.
Include for all instruments: Note: CDISC Controlled Terminology is maintained by National Cancer Institute (NCI) Enterprise Vocabulary Services (EVS). The most recent versions of the SDTM and ADaM controlled terminologies should be accessed through the CDISC website (https://www.cdisc.org/standards/terminology).
1.3 Known Issues
(Only include this section if there are any known issues; otherwise omit this. Describe any known issues. If there is more than one known issue, use a bulleted list to describe the issues.)
2 Rules and References
The primary source used in the development of this supplement is the Geriatric Depression Scale web page[1] maintained by Dr. Jerome Yesavage, co-developer of the instrument. It contains scoring instructions and links to multiple language translations. The development of the GDS SHORT FORM is discussed in "Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version"[2] by Drs. Sheikh and Yesavage. Validation and possible interpretations of the GDS SHORT FORM are discussed in "The Short Form of the Geriatric Depression Scale: A Comparison With the 30-Item Form."[3]
All links are valid and referenced information is current as of the date of this ADaMIG QRS supplement. Only include if no imputation rules are provided in initial documentation.This supplement does not make recommendations for the handling of missing data or adoption of imputation methods.
3 Scoring Software
There is no known publicly available scoring software as of the date of this ADaMIG QRS supplement.
4 Introduction to the Instrument
(Example text. This section should be very specific to your QRS instrument)
The GDS SHORT FORM is an instrument developed to measure depression in older adults. It was modified from the original 30-item form to focus on items with the highest correlation to depressive symptoms in validation studies, and consists of 15 items, each with possible response options of "YES" or "NO". Note that the “YES” and “NO” responses for SDTM QS.QSORRES are recorded in QS.QSSTRESN based on the instrument's scoring manual, so that a QSSTRESN (and AVAL) value of 0 does not always represent a QSORRES response of "NO", and a QSSTRESN (and AVAL) value of 1 does not always represent a QSORRES response of "YES". As a result, transposition or reversal of question responses is not required. The total score is computed by adding the individual standardized item responses.
Scores for the GDS SHORT FORM range from 0 to 15, inclusive.
5 Key Data Checks
Each item has a possible value of 0 or 1. The computed total score consists of integer values ranging from 0 to 15.
6 Example
6.1 Background
Analyses based on ADaM datasets may vary depending on the sponsor, therapeutic area, and the needs of regulatory authorities in their decision-making processes. This fictional example is provided for illustrative purposes only. The ADaM dataset describing the analysis results from an instrument is based on the protocol and statistical analysis plan (SAP) for the individual study.
The example dataset described here is intended to support a variety of analyses, ranging from simple univariate summary statistics on both the actual total scores and change in total score from baseline by visit to other types of by-visit and repeated-measure analyses. For that reason, standard ADaM BDS variables such as AVAL (analysis value) and CHG (change from baseline) have been included in the example. In addition, because scores can be classified into categorizations of depression severity, frequency of subjects reporting each category may also be generated.
In the example presented here, it is assumed that the final GDS SHORT FORM analysis dataset (ADGDSSF) contains all of the original records, plus a record for the computed total score for each patient and assessment timepoint. The date of the assessment—and time of the assessment, if collected—should also be included in the dataset. For traceability, raw item-level responses from the SDTM QS.QSORRES variable, stored separately from the analysis variable AVAL, are included. Derivation type (DTYPE) should be used to clearly indicate those records where missing values or other information has been imputed. If useful for analysis, a summary analysis dataset which includes only the computed total score records may also be created.
This example is based on Yesavage's short form English scoring,[1] which states that if 5 or fewer instrument items are missing, the values of the missing items are imputed as the average of the non-missing responses. If the imputation procedure results in a total score that is not a whole number (e.g., 4.5, 10.2), the total score should be rounded up to the next whole number (i.e., round up to a more severe level of depression). For example, if 3 of the 15 items are missing and the total score based on the 12 non-missing items is 4, then impute the value of each of the 3 missing items as 4/12 = 1/3, for a total score of 4 + (3 * 1/3) = 4 + 1 = 5 (see the Parameter Value Level List - ADGDSSF [AVAL] table). If more than 5 items on the GDS SHORT FORM are missing, no item-level imputation is performed and a total score is not calculated.
6.2 Example Analysis Dataset, Variable and Value-level Metadata
The ADGDSSF Dataset Metadata table shows an example of how the GDS SHORT FORM may be implemented in ADaM. The dataset metadata is a recommendation for the dataset name, label, structure, and keys. These can be modified for sponsor-specific standards and analyses.
(Use the table macros to insert these tables. they reside at the end of the document like an appendix)
ADGDSSF Dataset Metadata
Dataset | Label | Structure | Keys | Class |
---|---|---|---|---|
ADGDSSF | Geriatric Depression Scale SF Analysis | 1 record per subject per timepoint per parameter. | USUBJID, AVISITN, ADT, PARAMN | BASIC DATA STRUCTURE |
Update the below table according to the current QRS Short_Name instrument.
ADGDSSF Variable Metadata
Variable Name | Variable Label | Type | Controlled Terms | Source | Derivation | User Notes |
---|---|---|---|---|---|---|
STUDYID | Study Identifier | Char | QS.STUDYID | |||
USUBJID | Unique Subject Identifier | Char | QS.USUBJID | |||
SITEID | Site Identifier | Char | ADSL.SITEID | |||
QSSEQ | Sequence Number | Num | QS.QSSEQ | QSSEQ is included to provide traceability back to SDTM. | ||
ASEQ | Analysis Sequence Number | Num | After sorting by key variables, renumber all the records from 1 to n within a subject. | Provides a sequence number to derived rows which are not present in QSSEQ. | ||
ITTFL | Intent-to-Treat Population Flag | Char | “Y”, “N” | ADSL.ITTFL | Conditional; must include at least 1 population flag. | |
TRTP | Planned Treatment | Char | Derivation should be defined by sponsor according to analysis needs. Conditional; should include at least 1 treatment variable (e.g., TRTP, TRTA, TRTSEQP, TRT01P). | |||
PARAM | Parameter | Char | GDS02TN, GDS02PN | QS.QSTEST for responses to individual questions copied from SDTM. Set PARAM to "GDS02- Total Score - Analysis" for the derived total score. | ||
PARAMCD | Parameter Code | Char | GDS02TC, GDS02PC | QS.QSTESTCD for responses to individual questions copied from SDTM. Set PARAMCD to "GDS02TS" for the derived total score. | ||
PARAMN | Parameter Number | Num | Number of the item in the order it appears on the form; assign a higher value to the derived total score record. | |||
PARCAT1 | Parameter Category 1 | Char | "GDS SHORT FORM" | Set to QS.QSCAT for records that come directly from SDTM and "GDS SHORT FORM" for any derived records such as total scores or last observed value (LOV). | ||
VISIT | Visit Name | Char | QS.VISIT | QS.VISIT included for traceability. | ||
VISITNUM | Visit Number | Num | QS.VISITNUM | QS.VISITNUM included for traceability. | ||
AVISIT | Analysis Visit | Char | AVISIT represents the analysis visit for the record. Refer to the SAP for additional details. | |||
AVISITN | Analysis Visit (N) | Num | A numeric representation of AVISIT. | |||
QSDTC | Date/Time of Finding | Char | QS.QSDTC | QS.QSDTC included for traceability. | ||
ADT | Analysis Date | Num | Date portion of QS.QSDTC converted to numeric and displayed in a format such as DATE9. For derived total score records where PARAMCD="GDS02TS", this information will be copied from the individual records that comprise that instrument. | |||
ADY | Analysis Relative Day | Num | ADT-ADSL.TRTSDT+1 if ADT≥TRTSDT; else, ADT-ADSL.TRTSDT if ADT<TRTSDT. | This derivation is for example only. | ||
QSORRES | Finding in Original Units | Char | QS.QSORRES | |||
AVAL | Analysis Value | Num | See Parameter Value Level List - ADGDSSF table. | |||
AVALCAT1 | Analysis Value Category 1 | Char | "Normal”, "Possible Depression", "Likely Depression", | If AVAL<5, then AVALCAT1="Normal"; If 5<AVAL<10, then AVALCAT1="Possible Depression"; If AVAL>10, then AVALCAT1="Likely Depression". | Source: Yesavage[1] | |
BASE | Baseline Value | Num | BASE=AVAL where ABLFL="Y". | Only the derived total score records where PARAMCD="GDS02TS" should have BASE populated in this example. | ||
CHG | Change from Baseline | Num | CHG=AVAL-BASE | Only populate for post-baseline total score records in this example (where PARAMCD="GDS02TS" and ADY>1). | ||
DTYPE | Derivation Type | Char | “AVERAGE”, “LOV” | For PARAMCD="GDS02TS": If the scoring instructions on the GDS SHORT FORM web page are followed and 1-5 responses are missing on the instrument, then populate DTYPE with "AVERAGE". Other missing value imputations for individual questions are indicated with DTYPE="AVERAGE", and imputations for a completely missing total score and a derived endpoint record can be indicated with DTYPE="LOV" in this example. Otherwise, leave NULL. | ||
ABLFL | Baseline Record Flag | Char | “Y” | Set ABLFL="Y" on the record defined as the baseline value. This flag will only be populated on the derived total score records (PARAMCD="GDS02TS") in this example. | ||
ANL01FL | Analysis Record Flag 01 | Char | “Y” | Set ANL01FL="Y" on derived total score records (PARAMCD="GDS02TS") associated with scheduled visits in this example (VISIT is not of the form "UNSCHEDULED XXX.XX"). | Permissible and useful for selecting records that are used in SAP-specified analyses. | |
INVNAM | Investigator Name | Char | ADSL.INVNAM | Permissible if needed for analysis. |
All controlled terminology for instruments in both SDTM and ADaM is associated with a specific version of the instrument. When integrating responses from an instrument across studies, it is important to know which version of the instrument was used for each study. When multiple versions of the same instrument exist in an integration, a pooled analysis of responses across different versions can only be performed if determined to be clinically and statistically acceptable. In that case, sponsor-defined terminology, similar to CDISC Controlled Terminology but without the reference to a specific version, should be used for PARAMCD, PARAM and PARCATy.
Parameter Value List - ADGDSSF [AVAL]
Variable | Where | Type | Controlled Terms | Source | Derivation | User Notes |
---|---|---|---|---|---|---|
AVAL | PARAMCD NE "GDS02TS" (GDS02- Total Score - Analysis) | Num | Set AVAL=QS.QSSTRESN. | The analysis value is the result copied from SDTM. | ||
AVAL | PARAMCD EQ "GDS02TS" (GDS02- Total Score - Analysis) | Num | The sum of QS.QSSTRESN for QS.QSTESTCD in ("GDS0201"-"GDS0215") if no question are missing.
|
6.3 Example Analysis Dataset
The GDS SHORT FORM Summary Analysis Dataset table shows the terminology and variables for implementing the example analysis dataset for this instrument in the BDS. This specific example is taken from a multicenter, randomized, double-blind, active-controlled parallel design study conducted in elderly patients with major depressive disorder. The purpose of the analysis is to compare the effect of Drug A to Drug B on depression in elderly patients using the GDS SHORT FORM to construct an endpoint. All analyses are conducted on an intent-to-treat basis, and the planned duration of treatment is 5 months. The baseline measurement is defined as the last non-missing value collected at or prior to the start of treatment; change from the last non-missing post-baseline value to baseline is used to construct an endpoint. The SAP specifies that planned collected visits, including baseline measurements, are to be used in analyses and displays of results, whereas unscheduled visits appear only in listings. The total score records for 1 subject were collected at 3 visits, plus a derived last observed value (LOV) endpoint record for the GDS SHORT FORM. Visit 1 is remapped to AVISIT = "BASELINE". There are 2 visits at AVISIT = "VISIT 2". However, because 1 visit was unscheduled, it is not used in the analysis and the ANL01FL value is null. Visits 5 and 6 are missing because the subject discontinued early due to an adverse event unrelated to treatment.
Update the below dataset and title according to the current QRS Short_Name instrument.
GDS SHORT FORM Complete Analysis Dataset
The GDS SHORT FORM Complete Analysis Dataset table shows all of the individual question responses for this example, as well as the computed total score. This example is considered to be the final analysis dataset for submission. Computed total scores can appear after the individual item responses, with appropriate labels for identification.
GDS SHORT FORM Summary Analysis Dataset
Due to the number of items on the instrument and the fact that only the total score records are required for analysis, the separate summary dataset shown in the following example, which contains only the total score records, may also be created. QSSEQ was not included in this example because it would be null for all computed total score records. QSORRES is not shown because only derived total score records are displayed.
7 References
- Yesavage J. Geriatric depression scale. Stanford/VA/NIA Aging Clinical Research Center (ACRC) Website. Accessed May 6, 2020. http://web.stanford.edu/~yesavage/GDS.html
Sheikh JI, Yesavage JA. Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1-2):165-173. doi:10.1300/J018v05n01_09
Burke WJ, Roccaforte WH, Wengel SP. The short form of the geriatric depression scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol. 1991;4(3):173-178. doi:10.1177/089198879100400310
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