Sars-Cov-2 Initiative MedStud HUN English version

Study Name

Sars-Cov-2 Initiative MedStud HUN

Leading institution

National Institute of Mental Health, Neurology and Neurosurgery

Name and position of the study leader

Dr. András Attila Horváth, seniorresearcher

Dear Sir / Madam,

We invite you to participate in a clinical trial. In the year 2020 the coronavirus pandemic has turned our lives upside down. Please take part in this survey to help in gaining a deeper understanding of the effects of the epidemic.

Before deciding to participate, it is important to understand what the purpose of the study is, how we use your data, what the possible advantages and inconveniences are. Please read the information below carefully.

WHAT IS THE BACKGROUND AND PURPOSE OF THE INVESTIGATION?

The aim of our study is to investigate the effects of the COVID-19 pandemic for the students lifestyle, health care, general well-being and mental and physical condition.

IS THE PARTICIPATION OBLIGATORY?

Your participation in the study is up to you. If you do not wish to participate in the survey, there are no disadvantages. If you decide to participate in the investigation, you must complete the Package Leaflet and the accompanying Consent Form, accepting their contents. Your consent is voluntary and unaffected, either orally or in writing you can withdraw it without any inconvenience to you.

WHAT HAPPENS IF YOU PARTICIPATE IN THE INVESTIGATION?

You will need to complete a questionnaire during the survey. Completion can be done online or printed, handwritten and then mailed. If you do not want to reply, you can leave this space blank.

DOES PARTICIPATION CREATE A COST FOR YOU?

We are unable to charge for the test.

HOW IS MY PERSONAL DATA MANAGED?

By accepting the “Written Declaration of Consent” you agree to your personal data listed below being collected and used by your physician and study stuff:

marital status
gender
data on your physical and mental health or illness

any other personal data that you have obtained while participating in the investigationgained during follow-up.

The study leader will provide your personal information to the study administration, will use data protection for scientific and statistical analysis taking into account the law. We are also responsible for ensuring that your information is not disclosed into the hands of unauthorized persons.

WHO CAN I TURN TO IF I NEED FURTHER INFORMATION?

If you have any questions about the investigation, please contact the study director listed on the first page of this leaflet at the following email address: andrashorvath.nicn@gmail.com

I hereby state that I have received written information about the investigation mentioned above and I have read the enclosed Package Leaflet. I agree to participate in the investigation and I declare that my participation is voluntary. I understand that any time my consent can be withdrawn without giving any reason.By completing and returning this Consent Form, I consent that my personal information, including my physical or mental health data will be used as described in the Package Leaflet.

Please state your full name in order to accept the Consent Form. *

	0 – not at all	1	2	3 - nearly every day
1. Feeling nervous, anxious, or on edge.	1. Feeling nervous, anxious, or on edge. 0 – not at all	1. Feeling nervous, anxious, or on edge. 1	1. Feeling nervous, anxious, or on edge. 2	1. Feeling nervous, anxious, or on edge. 3 - nearly every day
2. Not being able to stop or control worrying	2. Not being able to stop or control worrying 0 – not at all	2. Not being able to stop or control worrying 1	2. Not being able to stop or control worrying 2	2. Not being able to stop or control worrying 3 - nearly every day
3. Worrying too much about different things	3. Worrying too much about different things 0 – not at all	3. Worrying too much about different things 1	3. Worrying too much about different things 2	3. Worrying too much about different things 3 - nearly every day
4. Trouble relaxing	4. Trouble relaxing 0 – not at all	4. Trouble relaxing 1	4. Trouble relaxing 2	4. Trouble relaxing 3 - nearly every day
5. Being so restless that it is hard to sit still	5. Being so restless that it is hard to sit still 0 – not at all	5. Being so restless that it is hard to sit still 1	5. Being so restless that it is hard to sit still 2	5. Being so restless that it is hard to sit still 3 - nearly every day
6. Becoming easily annoyed or irritable	6. Becoming easily annoyed or irritable 0 – not at all	6. Becoming easily annoyed or irritable 1	6. Becoming easily annoyed or irritable 2	6. Becoming easily annoyed or irritable 3 - nearly every day
7. Feeling afraid, as if something awful might happen	7. Feeling afraid, as if something awful might happen 0 – not at all	7. Feeling afraid, as if something awful might happen 1	7. Feeling afraid, as if something awful might happen 2	7. Feeling afraid, as if something awful might happen 3 - nearly every day

	Not during the past month (0)	Less than once a week (1)	Once or twice a week (2)	Three or more times a week (3)
1. … cannot get to sleep within 30 minutes	1. … cannot get to sleep within 30 minutes Not during the past month (0)	1. … cannot get to sleep within 30 minutes Less than once a week (1)	1. … cannot get to sleep within 30 minutes Once or twice a week (2)	1. … cannot get to sleep within 30 minutes Three or more times a week (3)
2. … wake up in the middle of the night or early morning	2. … wake up in the middle of the night or early morning Not during the past month (0)	2. … wake up in the middle of the night or early morning Less than once a week (1)	2. … wake up in the middle of the night or early morning Once or twice a week (2)	2. … wake up in the middle of the night or early morning Three or more times a week (3)
3. … have to get up to use the bathroom	3. … have to get up to use the bathroom Not during the past month (0)	3. … have to get up to use the bathroom Less than once a week (1)	3. … have to get up to use the bathroom Once or twice a week (2)	3. … have to get up to use the bathroom Three or more times a week (3)
4. …cannot breathe comfortably	4. …cannot breathe comfortably Not during the past month (0)	4. …cannot breathe comfortably Less than once a week (1)	4. …cannot breathe comfortably Once or twice a week (2)	4. …cannot breathe comfortably Three or more times a week (3)
5. … cough or snore loudly	5. … cough or snore loudly Not during the past month (0)	5. … cough or snore loudly Less than once a week (1)	5. … cough or snore loudly Once or twice a week (2)	5. … cough or snore loudly Three or more times a week (3)
6. … feel too cold	6. … feel too cold Not during the past month (0)	6. … feel too cold Less than once a week (1)	6. … feel too cold Once or twice a week (2)	6. … feel too cold Three or more times a week (3)
7. … feel too hot	7. … feel too hot Not during the past month (0)	7. … feel too hot Less than once a week (1)	7. … feel too hot Once or twice a week (2)	7. … feel too hot Three or more times a week (3)
8. … had bad dreams	8. … had bad dreams Not during the past month (0)	8. … had bad dreams Less than once a week (1)	8. … had bad dreams Once or twice a week (2)	8. … had bad dreams Three or more times a week (3)
9. … have pain	9. … have pain Not during the past month (0)	9. … have pain Less than once a week (1)	9. … have pain Once or twice a week (2)	9. … have pain Three or more times a week (3)

Neurokognitív Kutatási Központ

Neurokognitív Kutatási Központ

Dear Sir / Madam,