The APA is offering a number of “emerging measures” for further research and
clinical evaluation. These patient assessment measures were developed to be
administered at the initial patient interview and to monitor treatment progress. They should be used in research and evaluation as potentially useful tools to enhance clinical decision-making and not as the sole basis for making a clinical diagnosis. Instructions, scoring information, and interpretation guidelines are provided; further background information can be found in DSM-5. The APA requests that clinicians and researchers provide further data on the instruments’ usefulness in characterizing patient status and improving patient care at http://www.dsm5.org/Pages/Feedback-Form.aspx.
Short Form) Rights granted: This material can be reproduced without permission by clinicians for use with their patients. Any other use, including electronic use, requires written permission of the PROMIS Health Organization (PHO). Rights holder: PROMIS Health Organization (PHO) and PROMIS Cooperative Group To request permission for any other use beyond what is stipulated above, contact: PROMIS Health Organization (PHO) LEVEL 2—Sleep Disturbance—Adult* *PROMIS—Sleep Disturbance—Short Form
Name: ________________________________ Age: ____ Sex: Male Female Date:________________
If the measure is being completed by an informant, what is your relationship with the individual receiving care? __________________
In a typical week, approximately how much time do you spend with the individual receiving care? __________________ hours/week
Instructions to patient: On the DSM-5 Level 1 cross-cutting questionnaire that you just completed, you indicated that during the past 2 weeks you (the individual receiving care) have been bothered by “problems with sleep that affected your sleep quality over all” at a mild or greater level of severity. The questions below ask about these feelings in more detail and especially how often you (the individual receiving care) have been bothered by a list of symptoms during the past 7 days. Please respond to each item by marking ( or x) one box per row.
Clinician Use In the past SEVEN (7) DAYS.... Not at all A little bit Somewhat Quite a bit Very much 1. My sleep was restless. 1 2 3 4 5
2. I was satisfied with my sleep. 5 4 3 2 1
3. My sleep was refreshing. 5 4 3 2 1
4. I had difficulty falling asleep. 1 2 3 4 5
In the past SEVEN (7) DAYS....
Never Rarely Sometimes Often Always 5. I had trouble staying asleep. 1 2 3 4 5
Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 8 to 40 with higher scores indicating greater severity of sleep disturbance. The clinician is asked to review the score on each item on the measure during the clinical interview and indicate the raw score for each item in the section provided for “Clinician Use.” The raw scores on the 8 items should be summed to obtain a total raw score. Next, the T-score table should be used to identify the T-score associated with the individual’s total raw score and the information entered in the T-score row on the measure.
Note: This look-up table works only if all items on the form are answered. If 75% or more of the questions have been answered; you are asked to prorate the raw score and then look up the conversion to T-Score. The formula to prorate the partial raw score to Total Raw Score is:
(Raw sum x number of items on the short form)
Number of items that were actually answered
If the result is a fraction, round to the nearest whole number. For example, if 6 of 8 items were answered and the sum of those 6 responses was 20, the prorated raw score would be 20 X 8/6 = 26.67. The T-score in this example would be that T-score associated with the rounded whole number raw score (in this case 27, for a T-score of 57.3).
The T-scores are interpreted as follows:
Less than 55 = None to slight 55.0—59.9 = Mild 60.0—69.9 = Moderate 70 and over = Severe
Note: If more than 25% of the total items on the measure are missing the scores should not be used. Therefore, the individual receiving care (or informant) should be encouraged to complete all of the items on the measure.
Frequency of Use To track change in the severity of the individual’s sleep disturbance over time, the measure may be completed at regular intervals as clinically indicated, depending on the stability of the individual’s symptoms and treatment status. For individuals with impaired capacity, it is preferred that completion of the measures at follow-up appointments is by the same knowledgeable informant. Consistently high scores on a particular domain may indicate significant and problematic areas for the individual that might warrant further assessment, treatment, and follow-up. Your clinical judgment should guide your decision.
