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  2. 2013
  3. October
  4. T
  5. The Effects of Exercise on Depression
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Hello:
INFORMED CONSENT FORM
You are invited to participate in a study of exercise and mood. We hope to learn about any connection between exercise and depression.

You were invited as a possible participant in this study because you agreed to follow the link on the previous web site.

Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission. Your IP address will NOT be recorded.

Your decision whether or not to participate will not prejudice your future relation with Friends University. If you decide to participate, you are free to discontinue participation at any time without prejudice.

If you have any questions, please do not hesitate to contact us. For a summary of results please contact Elizabeth Koch ([email protected]), or my research supervisor, Dr. Donna Stuber ([email protected]). This email will also be provided at the end of the survey.

By clicking I AGREE you have indicated that you have read the information provided above and have decided to participate. You may withdraw at any time without penalty or loss of benefits to which you may be entitled should you choose to discontinue participation in this study. You are making a decision whether or not to participate.

Institutional Research Review Committee approval code: 201330.01.Koch.e.a
 
 
 
 
Choose the answer that best describes you.
 
I do not feel sad.
 
I feel sad.
 
I am sad all the time and I can’t snap out of it.
 
I am so sad or unhappy that I can’t stand it.
 
 
Choose the answer that best describes you.
 
I am not particularly discouraged about the future.
 
I feel discouraged about the future.
 
I feel I have nothing to look forward to.
 
I feel that the future is hopeless and that things cannot improve.
 
 
Choose the answer that best describes you.
 
I do not feel like a failure.
 
I feel discouraged about the future.
 
As I look back on my life, all I can see is a lot of failures.
 
I feel I am a complete failure as a person.
 
 
Choose the answer that best describes you.
 
I get as much satisfaction out of things as I used to.
 
I don’t get enjoy things the way I used to.
 
I don’t get real satisfaction out of anything anymore.
 
I am dissatisfied or bored with everything.
 
 
Choose the answer that best describes you.
 
I don’t feel particularly guilty.
 
I feel guilty a good part of the time.
 
I feel quite guilty most of the time.
 
I feel guilty all of the time.
 
 
Choose the answer that best describes you.
 
I don’t feel I am being punished.
 
I feel I am being punished.
 
I expect to be punished
 
I hate myself
 
 
Choose that answer that best describes you.
 
I don’t feel disappointed in myself.
 
I am disappointed in myself.
 
I am disgusted with myself.
 
I hate myself.
 
 
Choose that answer that best describes you.
 
I don’t feel I am any worse than anybody else.
 
I am critical of myself for my weaknesses or mistakes.
 
I blame myself all the time for my faults.
 
I blame myself for everything bad that happens.
 
 
Choose that answer that best describes you.
 
I don’t have any thoughts of killing myself.
 
I have thoughts of killing myself, but I would not carry them out.
 
I would like to kill myself.
 
I would kill myself if I had the chance.
 
 
Choose that answer that best describes you.
 
I don’t cry any more than usual.
 
I cry more now than I used to.
 
I cry all the time now.
 
I used to be able to cry, but now I can’t cry even though I want to.
 
 
Choose that answer that best describes you.
 
I am no more irritated by things than I ever am.
 
I am slightly more irritated now than usual.
 
I am quite annoyed or irritated a good deal of the time.
 
I feel irritated all the time now.
 
 
Choose that answer that best describes you.
 
I have not lost interest in other people.
 
I am less interested in other people than I used to be.
 
I have lost most of my interest in other people.
 
I have lost all interest in other people
 
 
Choose that answer that best describes you.
 
I make decisions about as well as I ever could.
 
I put off making decisions more than I used to.
 
I have greater difficulty in making decisions than before.
 
I can’t make decisions at all anymore.
 
 
Choose that answer that best describes you.
 
I don’t feel that I look an worse than I used to.
 
I am worried that I am looking old or unattractive.
 
I feel that there are permanent changes in my appearance that make me look unattractive.
 
I believe that I look ugly.
 
 
Choose the answer that best describes you.
 
I can work about as well as before
 
It takes an extra effort to get started at doing something.
 
I have to push myself very hard to do anything.
 
I can’t do any work at all
 
 
Choose that answer that best describes you.
 
I can sleep as well as usual
 
I don’t sleep as well as I used to.
 
I wake up 1-2 hours earlier than usual and find it hard to get back to sleep
 
I wake up several hours earlier than I used to and cannot get back to sleep
 
 
Choose that answer that best describes you.
 
I don’t get more tired than usual.
 
I get tired more easily than I used to.
 
I get tired from doing almost anything.
 
I am too tired to do anything.
 
 
Choose that answer that best describes you.
 
My appetite is no worse than usual.
 
My appetite is not as good as it used to be.
 
My appetite is much worse now
 
I have no appetite at all anymore.
 
 
Choose that answer that best describes you.
 
I haven’t lost or gained much weight, if any, lately.
 
I have lost or gained more than five pounds.
 
I have lost or gained more than ten pounds.
 
I have lost or gained more than fifteen pounds.
 
 
Choose that answer that best describes you.
 
I am no more worried about my health than usual.
 
I am worried about physical problems such as aches and pains, or upset stomach, or constipation.
 
I am very worried about physical problems and it’s hard to think of much else.
 
I am so worried about my physical problems that I cannot think of anything else.
 
 
Choose that answer that best describes you.
 
I have not noticed any recent change in my interest in sex.
 
I am less interested in sex than I used to be.
 
I am much less interested in sex now.
 
I have lost interest in sex completely.
 
 
 
What is your gender?
 
Male
 
Female
 
 
What is your age? (Type answer)
   
 
 
Highest level of education?
 
Did not complete high school
 
High School or GED
 
Vocational/Tech School
 
Some College
 
Bachelor's Degree
 
Master’s Degree
 
Doctoral Degree
 
Professional Degree (i.e. law degree, physician, etc.)
 
 
If in school, full-time or part-time?
(Full-time school for undergraduates is described as 12 or more hours)
 
Full-time
 
Part-time
 
 
Employment?
(Full time employment is defined as 32 hours or more a week)
 
Unemployed
 
Part-time
 
Full-time
 
 
How many hours did I exercise last week?
 
0-1
 
2-4
 
5-6
 
7+
 
 
Last week I exercised
 
Less than Normal
 
Normal Amount
 
More than Normal
 
 
If I had more time, would I have exercised?
 
Yes
 
No
 
 
In terms of exercise,
 
I have always exercised regularly.
 
I used to exercise regularly, but no longer do.
 
I have never exercised regularly.
 
 
 
Do I think I am exercising enough?
 
No, not enough exercise
 
Somewhat
 
Yes, definitely exercise enough
 
 
Do I enjoy exercising?
 
I hate it
 
It’s okay
 
I love it
 
 
Do l feel better after I exercise?
 
I definitely feel worse
 
I feel somewhat better
 
I definitely feel better
 
 
Do I currently or have I ever taken antidepressants?
 
I currently do not
 
I currently do
 
I have taken them before, but I am not currently taking them now