Why is this important? In 2016 the U.S. The Preventive Services Task Force encouraged primary care providers to screen every adolescent and adult patient for anxiety and depression symptoms. Screenings like this not only help capture patients who may not speak up about their mental health concerns during a routine visit, but can also help improve their overall health outcomes. For example, patients struggling with untreated depression may not maintain healthy habits, such as taking medication or exercising consistently, and may be more likely to become physically ill as a result. Offering a questionnaire is one way to determine if mental health may be contributing to a patients’ overall well being. If you do find your patient is struggling with mental health, you can improve their health outcomes and reduce stigma by offering alternative professional supports such as referring them to a licensed therapist or support group.
One commonly used depression questionnaire is the Patient Health Questionnaire 9 (PHQ-9). It is a nine-item questionnaire that is one of the most validated tools in mental health. The questions are designed to address levels of symptoms that could be related to depression. This self-administered survey reviews loss of interest, changes to energy or sleep, feelings of hopelessness or worthlessness and decreased levels of pleasure. At the end of this article, we’ve included a link to the PHQ-9 and a short guide on how to interpret scores, as well as what to do if a patient reports elevated levels of depression on the PHQ-9.
The Generalized Anxiety Disorder 7 (GAD-7) is a tool to screen for symptoms of anxiety. It is a 7-item questionnaire that is one of the most validated tools in mental health. This survey assesses symptom categories associated with stress or anxiety and is helpful in understanding intensity and frequency of overall anxiety. You can also use it as a way to baseline your patient in order to assess changes in each visit. A short guide on how to interpret scores and what to do if a patient reports elevated levels of anxiety on the GAD-7 is included below.
If your patient does indicate that they are experiencing suicidal thoughts, completing a suicide risk assessment is the next step to ensuring their safety. The Columbia Suicide Severity Rating Scale measures the severity and immediacy of an individuals risk as well as what support is needed as follow up. It can help determine if the patient requires emergency services to intervene. A short guide on how to interpret scores and what to do if a patient reports elevated risk levels for suicide on the C-SSRS is included below.
While these questionnaires are some of the more commonly used assessments available for screening depression and anxiety, there are several other well-validated questionnaires that may be more specific to your patient population. For example, there are assessments that are pediatric or geriatric specific. The American Psychological Association has compiled a comprehensive guide for depression measures and can be found here. The association of clinical psychologists created a similar resource for anxiety symptoms that can be found here.
PHQ9 overview
Scoring
1. 0-3 item rating assessing presence of symptoms over the past 2 weeks
a. 0= not at all
b. 1= several days
c. 2= more than half the days
d. 3= nearly everyday
2. Total score- 0-27 point scale
a. 0-4= no notable depressive symptoms
b. 5-9= mild
c. 10-14= moderate
d. 15-19= moderately severe
e. 20+= severe
Positive risk score (question 9)
Treatment considerations based on score
Resources:
PHQ-9 adapted from PRIME MD TODAY, developed by Dr. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, made possible by Pfizer, Inc. Used with permission from Pfizer, Inc. PRIME MD TODAY is a trademark of Pfizer, Inc
Instruction Manual: Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. Available here. Published December 2014
GAD7 overview
Scoring
1. 0-3 item rating
a. 0= not at all
b. 1= several days
c. 2= more than half the days
d. 3= nearly everyday
2. Total score- 0-21 point scale
a. 0-4= no notable anxiety symptoms
b. 5-9= mild
c. 10-14= moderate
d. 15+ = severe
Treatment considerations based on score
Resources: Source: Spitzer RL, Kroenke K, Williams JB, et al; A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. GAD-7
C-SSRS overview
Scoring
Positive risk score (question 4, 5, 6)
Treatment considerations based on Answer
Resources: https://cssrs.columbia.edu/