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Thank you for your interest in the Mood Disorders Registry! The purpose of this registry is two-fold:
To gather and maintain information from people diagnosed with mood and affective disorders who have an interest in participating in research. To gather and maintain information from from people without mood and affective disorders who have an interest in participating as control subjects in research. This study is being created and maintained by members of the Magnotta Lab Research Team, University of Iowa College of Medicine. When a study is planned that appears to be appropriate for you based on the information you provide in the Registry, a member of the Research Team will contact you by your preferred contact method: letter, email, or phone. The purpose of the contact will be to explain the study and to see if you are interested and eligible to participate. The number and type of study volunteers needed varies by study. There is no guarantee that you will be contacted or enrolled in a study. Participation in any study is voluntary. Submitting your name to the Registry does not obligate you to respond to any requests for study volunteers. If you would like to enroll, please read the following Consent Summary .
CONSENT SUMMARY
============================================================================================= If you agree to participate in the Mood Disorders Registry, we will ask you to provide information about yourself including your birth date, gender, race, and contact information. In order to determine the research studies for which you may be eligible, we will ask you to provide information pertaining to your medical and psychiatric history. If you do not wish to participate in the Registry, do not provide your information. We will keep information you provide confidential . However, federal government regulatory agencies, auditing departments of the University of Iowa, and the University of Iowa Institutional Review Board (a committee that reviews and approves research studies) may inspect and copy records pertaining to this research. Only the Magnotta Research Team has access to the data in the Registry. Registry information is kept in a password-protected database. The information you provide to us will only be used for the purpose of contacting you for a possible future research study. If you are a participant in a research study, your data may be stored for future use in other research projects. Your contact information will not be sold or distributed to any outside party or institution. There is no compensation for enrolling in the Registry, and there are no costs for enrollment. There are no known risks from being in this Registry. There is no direct benefit to you for being in this Registry. However, we hope that others may benefit in the future from studies that are conducted. Taking part in this Registry is completely voluntary. If you decide not to be in this Registry, or if you decide, at any time, to stop participating in this Registry, you will not be penalized or lose any benefits for which you otherwise qualify. If you have any questions about the Registry itself, contact the Magnotta lab at (319) 849-8218 . If you experience a research-related injury, please contact: Dr Vincent Magnotta at (319) 335-5482 . If you have questions about the rights of research subjects, please contact the Human Subjects Office: 105 Hardin Library for the Health Sciences, 600 Newton Rd, The University of Iowa, Iowa City, IA, 52242-1098, 319-335-6564, or by email at irb@uiowa.edu. To offer input about your experiences as a research subject or to speak to someone outside the research staff, call the Human Subjects Office at the number above.If you would like to remove your name from this Registry, please contact Jenny Richards via email atĀ fiedo-lab@uiowa.edu or mail at 200 Hawkins Dr., W278 GH, Iowa City, IA, 52242.
Are you 18 years of age or older?
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Yes
No
First Name
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Last Name
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Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) Florida (FL) Georgia (GA) Hawai'i (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennsylvania (PA) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) American Samoa (AS) District of Columbia (DC) Federated States of Micronesia (FM) Guam (GU) Marshall Islands (MH) Northern Mariana Islands (MP) Palau (PW) Puerto Rico (PR) Virgin Islands (VI)
(Please include area code)
Email Address
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What is the best way to contact you?
Phone
Email
Letter
Have you ever been diagnosed with a mood disorder, such as bipolar disorder, schizoaffective disorder, or depression?
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Yes
No
Do you have a current diagnosis of the following?
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Bipolar I Disorder
Bipolar II Disorder
Major Depressive Disorder
Schizoaffective disorder
Other
None
If other, please specify:
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Are you interested in registering as a possible control subject?
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Yes
No
Are you currently prescribed psychiatric medications?
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Yes
No
Do you have a family history of mood disorders?
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Yes
No
Do you have any children?
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Yes, and they are under the age of 18.
Yes, and they are over the age of 18.
Yes, I have children who are under the age of 18, and I have children who are over the age of 18.
No
Think of this ladder as representing where people stand in the United States.
At theĀ top of the ladder are the people who have the most money, the most education, and the most respected jobs. At the bottom are the people who are the worst off, who have the least money, least education, and the least respected jobs or no job. The higher up you are on the ladder, the closer you are to the people at the very top; the lower you are the closer you are to the people at the bottom. Where are you on the ladder? Select the one number where you think you are at this time in your life, relative to other people in the United States.
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Date of Birth
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Today M-D-Y (Month-Day-Year)
Gender
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Female
Male
Non-Binary
Other
If other, please specify:
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Race/Ethnicity
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(Check all that apply)
Education
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Less than high school
High School / GED
Some College
2-Year College Degree (Associate)
4-Year College Degree (Bachelor)
Graduate/Masters Degree
Professional/Doctoral
Height
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(Inches)
Weight
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(Pounds)
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Do you have or have you ever had any of the following? (If you have none, check the box marked 'None ' ).
(Check all that apply)
Are there any other medical conditions for which you are now being treated?
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Yes
No
Please list those conditions:
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Have you ever smoked tobacco?
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Yes, I currently smoke.
Yes, I smoked in the past but have quit.
No, I have never smoked.
If you are a former smoker, did you quit smoking tobacco within the past 12 months?
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Yes
No
If you are currently a tobacco smoker, how many times have you attempted to quit smoking in the past year?
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Zero
One
Two
Three
Four
Five or more
Yes
Submit
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