University of Nevada, Las Vegas
Department of Psychology
Informed Consent Form
Phase 2: Perinatal Mood Assessment Scale

1. Introduction: You are invited to participate in a research study conducted by Dr. Chandler Marrs Ph.D of the Psychology Department at the University of Nevada Las Vegas. The purpose of this study is to examine the mood changes and psychiatric symptoms associated with postpartum.

2. Participants: You are being asked to participate in the study because you have given birth within the last year.

3. Procedure: If you volunteer to participate in this study, you will be asked to answer questions regarding your mood, physical health and psychiatric distress within the first 30 days following childbirth. Some of these questions are on very sensitive topics and may cause disturbing recollections.

4. Benefits of Participation: There may not be direct benefits to you as a participant in this study. However, we hope to learn more about the mood changes, psychiatric distress, and physical status associated with postpartum. The aim of the study is to develop an assessment scale to identify signs and symptoms and assist in the early diagnosis and treatment of serious postpartum complications.

5. Risks of Participation: There are minimal risks involved in participation of this study. These risks include anxiety and discomfort associated with answering sensitive questions. For this reason, the survey is completely anonymous and no identifying information will be collected. You may also quit the survey at any time and/or choose not to answer specific questions.

6. Cost/Compensation: There will not be a financial cost to you to participate in this study. The study will take approximately 30 minutes of your time. You will not be compensated for your time.

7. Contact Information: If you have any questions or concerns about the study, you may contact Dr. Chandler Marrs at 702-895-0547.For questions regarding the rights of research subjects, any complaints or comments regarding the manner in which the study is being conducted you may contact the UNLV Office for the Protection of Research Subjects at 702-895-2794.

8. Voluntary Participation: Your participation in this study is voluntary. You may refuse to participate in this study or in any part of this study. You may withdraw at any time without prejudice to your relations with the university.

9. Confidentiality: All material gathered in this study will be kept private and confidential. No reference will be made in written or oral materials that could link you personally to this study at any time. All paper records will be stored in a locked facility at UNLV for at least 3 years after completion of this study. After 3 years, all records will be destroyed.

Participant Consent:
I have read or have had read to me all of the above information. I agree to participate in the study. I am at least 18 years of age.

Yes, I am at least 18 years old and consent to participate in this study.
No, I do not wish to consent at this time.