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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

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Required format:

vICDMuRz2JicUctHHoCjuAfS6BuGWP88NaFH8XBnWnhFRXv4rnGvKyu5VgyxInF7FvkzXbckzNwov6G8YxuW4Q3KjM7DJIvdICZRovIMZ5x7sGdi6Te

Screening Questionnaire

Please complete the survey below.

Thank you!

What is your age?

* must provide value

What is your gender?

* must provide value

Male

Female

Non-binary/Other

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Do you consider yourself Hispanic or Latino?

* must provide value

Yes

Not sure

I'd rather not say

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Which best describes your ethnic background (check all that apply)?

* must provide value

American Indian or Alaska Native

Asian

African/Black

Native Hawaiian or Pacific Islander

European/White

Not sure

I'd rather not say

Do you currently live in the United States and have a US address where you can receive checks?

* must provide value

Yes

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Do you currently have a diagnosis of a neurological disorder? (e.g. Alzheimer's or other
dementia, Parkinson's)

* must provide value

Yes

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Do you have any physical disability that affects your ability to respond to pictures and words on
your computer screen?

* must provide value

Yes

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Have you suffered any accident or head injury in the last year that resulted in a loss of
consciousness lasting more than one minute?

* must provide value

Yes

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Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself?

* must provide value

Not at all

Several days

More than half the days

Nearly every day

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In the past 3 months, how often have you used the following substances without prescriptions?

Stimulants: amphetamines, "speed", crystal meth, "crank", Dexedrine, Ritalin, diet pills
Cocaine: snorting, IV, freebase, crack, "speedball"
Opiates: heroin, morphine, Dilaudid, opium, Demerol, methadone, Darvon, codeine, Percodan, Vicodin, OxyContin
Hallucinogens: LSD ("acid"), mescaline, peyote, psilocybin, STP, "mushrooms", "ecstasy", MDA, MDMA
Dissociative Drugs: PCP (Phencyclidine ,"Angel Dust", "Peace Pill", "Hog"), or ketamine ("Special K")
Inhalants: "glue", ethyl chloride, "rush", nitrous oxide ("laughing gas"), amyl or butyl nitrate ("poppers")
Sedatives, Hypnotics or Anxiolytics: Quaalude, Seconal ("reds"), Valium, Xanax, Librium, Ativan, Dalmane, Halcion, barbiturates, Miltown, GHB, Roofinol, "Roofies"

* must provide value

Never

Once or twice

Monthly

Weekly

Almost daily

Daily

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In the past 3 months, how often have you used the following substances without prescriptions?

Cannabis: marijuana, hashish ("hash"), THC, "pot", "grass", "weed", "reefer"

* must provide value

Never

Once or twice

Monthly

Weekly

Almost daily

Daily

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Have there been at least 6 different periods of time (at least 2 weeks) when you felt deeply depressed?

* must provide value

Yes

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Did you have problems with depression before the age of 18?

* must provide value

Yes

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Have you ever had to stop or change your antidepressant because it made you highly irritable or hyper?

* must provide value

Yes

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Over the past 7 days including today, have you been more talkative than normal with thoughts racing in your head?

* must provide value

Yes

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Over the past 7 days including today, have you been you feeling any of the following: unusually happy; unusually outgoing; or unusually energetic?

* must provide value

Yes

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Over the past 7 days including today, have you been needing much less sleep than usual?

* must provide value

Yes

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Do you ever hear the voice of someone talking that other people cannot hear?

* must provide value

Yes

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Do you see things that others can't or don't see?

* must provide value

Yes

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Do you have regular or daily access to a smartphone over the next three weeks?

* must provide value

Yes

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Does the smartphone have reliable Internet access?

* must provide value

Yes

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Was the smartphone purchased in the last 5 years?

* must provide value

Yes

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Are you awake by 9am (or soon after) most days?

* must provide value

Yes

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Do you go to sleep before 9pm most days?

* must provide value

Yes

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Will you be able to complete 5-10 minute assessments, three times a day for the next three weeks?
(between 9am and 9pm)

* must provide value

Yes

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What time zone do you live in?

* must provide value

In the next 25 days, do you plan to stay in the same time zone?

* must provide value

Yes

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Do you live in a place that observes daylight savings time?

* must provide value

Yes

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How did you hear about this study?

* must provide value

Saw a post on Mass General Brigham Rally website

Saw a post on TestMyBrain.org

Saw a physical flyer in local communities

Recommended by a friend

Other

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Please specify how you found out about this study

* must provide value

In the past 7 days including today, how much were you distressed by faintness or dizziness?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling no interest in things?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by nervousness or shakiness inside?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by pains in heart or chest?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling lonley?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling tense or keyed up?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by nausea or upset stomach?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling blue?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by suddenly feeling scared for no reason?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by trouble getting your breath?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by the feeling of worthlessness?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by spells of terror or panic?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by numbness or tingling in parts of your body?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling hopeless about the future?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling so restless you couldn't sit still?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling weak in parts of your body?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by thoughts of ending your life?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

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In the past 7 days including today, how much were you distressed by feeling fearful?

* must provide value

Not at all

A little bit

Moderately

Quite a bit

Extremely

reset

What is your email address?

* must provide value

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