Consent Form for Participation in a Research Study

Assessing the Severity or lack of Depression or Anxiety in patients in a 24-hour supervised chemical dependency housing treatment program using Hamilton-Depression rating scale (HAM-D) and Hamilton-Anxiety rating scale (Ham-A).

Description of the research and your participation

You are invited to participate in a research study conducted by Student. The purpose of this research is Assessing the severity of Depression and Anxiety in patients in a 24-hour supervised chemical dependency housing treatment program.

If you decide to participate, you will be taken to a confidential room where specific questions will be asked on depression and anxiety. A score will be totaled at the end, which will help determine any level of depression and or anxiety. Depending on your score you may be referred to a mental health counselor, psychiatric nurse practitioner, psychiatrist, or a hospital for mental health treatment

Risks and discomforts

There are minimal anticipated risks to the patient except for the possibility of boredom secondary to an extended interview and testing process. Additionally, as patients discuss their past trauma and depression and anxiety history they might experience acute anxiety and depression.

Potential benefits

The indirect benefit could be a source of patient satisfaction that this research could benefit future patients. The direct benefit could be the initiation of mental health treatment if mental health issues are identified and if the patient is receptive and consents to mental health treatment, mental health treatment can then be initiated.

Protection of confidentiality

We will do everything we can to protect your privacy. Your identity will not be revealed in any publication resulting from this study Your Ham-D, Ham-A, Demographics and consent forms will be placed in a locked safe for three years and only this researcher will have access to this safe.

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