Connectome Study Healthy Participant Screening Survey

Purpose of the Study

Our research study is aimed at understanding behaviors and brain circuits that relate to anxiety and depression. We are investigating the underlying brain circuits associated with these disorders, the relationship between the circuits and specific symptoms and behaviors, and how to use the brain circuit properties to predict symptom change. We will be looking at how the circuits and behaviors of healthy people compare and contrast to those of people with anxiety and depression. We hope our project will help identify ways to develop more targeted and effective treatments.

This is a screening form for people interested in participating in this research study as Healthy Controls. If you are currently experiencing symptoms of depression and/or anxiety and would like to participate in the study as a Clinical Participant, please complete the Clinical Participant Screening Form (link can be found above).

If you are eligible and choose to participate, we'll ask you to come to Stanford for an in-person visit as well as complete tasks remotely. The study involves a non-invasive brain scan, some game-like tasks on the computer, some questions about your emotional health, and a saliva sample. This in-person visit will last about 5 hours and the remote tasks will last about 2 hours. You'll receive: $99 compensation and an image of your brain. The study is observational, so it does not involve any treatments or interventions.

You will not be paid for answering questions in this survey since it is only to see whether you qualify to take part in the study.

If you have any questions, concerns, or complaints about this survey, contact Leanne Williams at (650) 723-3579. If you want to talk to someone separate from the research team about a concern or complaint or your rights as a possible research subject, please contact the Stanford Institutional Review Board (IRB) to speak to an informed person who is separate from the research team, at 650-723-5244 (for medical studies) or toll-free at 1-866-680-2906. In addition, please call the Stanford IRB at these numbers if you cannot reach the research team.

Confidentiality Statement


The screening survey you are about to begin will be used only for the purpose of determining your eligibility for our study. Before you begin, it's important to know that your participation is entirely voluntary and you have the right to refuse to answer particular questions. In addition, there is no cost or payment for participating. This survey will take approximately 10-15 minutes. In this survey, you will be asked detailed information about your medical history, psychiatric history, and current psychiatric state.

Information you provide about yourself will be kept as confidential as possible as required by law. Your information will be stored in a secure filing system in a locked office at our lab. No part of the information you share with us will be shared with anyone outside of our research team. However, if you appear to be in immediate danger of harming yourself or someone else, we may be required to contact local police to confirm your safety. It is also possible that the Food and Drug Administration, and other federal and state authorities, may inspect our records for security reasons.
The risk in taking this survey very small. The information will be kept confidential as noted, but there is a small risk that people outside of the research team could learn this information. The benefit to you is that you will find out whether you can take part in our study.

This research is covered by a Certificate of Confidentiality from the National Institutes of Health. The researchers with this Certificate may not disclose or use information, documents, or biospecimens that may identify you in any federal, state, or local civil, criminal, administrative, legislative, or other action, suit, or proceeding, or be used as evidence, for example, if there is a court subpoena, unless you have consented for this use. Information, documents, or biospecimens protected by this Certificate cannot be disclosed to anyone else who is not connected with the research except, if there is a federal, state, or local law that requires disclosure (such as to report child abuse or communicable diseases but not for federal, state, or local civil, criminal, administrative, legislative, or other proceedings, see below); if you have consented to the disclosure, including for your medical treatment; or if it is used for other scientific research, as allowed by federal regulations protecting research subjects.

The Certificate cannot be used to refuse a request for information from personnel of the United States federal or state government agency sponsoring the project that is needed for auditing or program evaluation by the agency which is funding this project or for information that must be disclosed in order to meet the requirements of the federal Food and Drug Administration (FDA). You should understand that a Certificate of Confidentiality does not prevent you from voluntarily releasing information about yourself or your involvement in this research. If you want your research information released to an insurer, medical care provider, or any other person not connected with the research, you must provide consent to allow the researchers to release it.

You should understand that a Certificate of Confidentiality does not prevent you, or a member of your family, from voluntarily releasing information about yourself, or your involvement in this study.
If an insurer or employer learns about your participation, and obtains your consent to receive research information, then we may not use the Certificate of Confidentiality to withhold this information. This means that you must also actively protect your own privacy.

You should understand that we will in all cases, take the necessary action, including reporting to authorities, to prevent serious harm to yourself, children, or others (for example, in the case of child abuse or neglect).
A Certificate of Confidentiality does not represent an endorsement of the research study by the Department of Health and Human Services or the National Institutes of Health.