Although mental health disorders such as anxiety and depression are common, affecting more than 20% of US adults, many people experience significant delays (sometimes years) in seeking and receiving diagnosis and treatment.Screening for mental health disorders can help promote early detection and treatment, thus improving patients’ quality of life and reducing health care costs.
The United States Preventive Services Task Force recommends that all adults be screened for depression and alcohol and drug abuse. To be most effective, tools to assess a patient’s mental health should be validated, brief, reliable, and easy administer. This article reviews some tools that clinicians to screen their patients for depression, anxiety, and substance/alcohol use disorders. Many of these tools are in the public domain and freely available for clinicians to incorporate in their practice.
SCID-5 for Assessing Major Mental Disorders
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides the diagnostic criteria psychiatric clinicians use when assessing patients for a mental disorder. The Structured Clinical Interview for DSM-5, Clinician Version (SCID-5-CV) provides a semi-structured interview guide to assist in making the major DSM-5 diagnoses. This tool helps ensure that the major DSM-5 diagnoses are systematically evaluated. It is designed to be used by clinicians who are familiar with the DSM-5. A separate version of the SCID-5 is available for evaluating patients who may have a personality disorder.
The SCID-5-CV is available for purchase here.
Depression Rating Scales
Patient Health Questionnaire-9
The Patient Health Questionnaire (PHQ) is a self-administered, criteria-based screening tool for depression and other common mental disorders.Several screening tools have been derived from the PHQ. The most common used is the 9-item PHQ-9, which represents the depression module from the full PHQ. The PHQ-9 takes 1 to 5 minutes to complete, and approximately the same amount of time for a clinician to review the responses.
The PHQ-9 asks patients to rate how often during the past 2 weeks they have experienced each of 9 depressive symptoms, from 0 (not at all) to 3 (nearly every day), with a total score ranging from 0 to 27. Scores of 5, 10, 15 and 20 correlate with the lower limits of mild, moderate, moderately severe, and severe depression, respectively. Individuals with major depressive disorder (MDD) seldom score 10 or lower, while a score of 15 or higher usually signifies MDD.
The PHQ-9 is available here.
Beck Depression Inventory
The Beck Depression Inventory (BDI) is a 21-question self-report inventory that asks about characteristic attitudes and symptoms of depression. The BDI takes approximately 10 minutes to complete, and patients need to have at least a fifth-grade reading level to be able to understand the questions in this tool. Each of the 21 questions contains a group of statements about symptom severity that are scored from 0 to 3, with a possible total score ranging from 0 to 63. A score of 29 or higher signifies severe depression.
The BDI is available for purchase here.
Hamilton Depression Rating Scale
The Hamilton Depression Rating Scale (HDRS; also sometimes referred to as HAM-D) is an older, widely used 17-item tool designed for clinicians to use in an unstructured interview.The HDRS was originally developed in 1960 for use with inpatients. It takes approximately 15 minutes to complete. This rating scale does not evaluate atypical symptoms of depression, such as hypersomnia or hyperphagia. Patients with a score of 20 or higher are considered to have at least moderately severe depression.
The HDRS is available here.
Montgomery-Åsberg Depression Rating Scale
The Montgomery-Åsberg Depression Rating Scale (MADRS) is a 10-question, clinician-rated tool designed to assess depression severity in adults age 18 and older. Each question is rated on a 7-point scale from 0 (minimal or no symptoms) to 6 (severe symptoms). The MADRS can be completed in 20 to 30 minutes. It is often used to monitor changes in depressive symptoms during treatment.
The MADRS is available here.
Anxiety Disorders
Generalized Anxiety Disorder 7-item
The 7-item Generalized Anxiety Disorder scale (GAD-7) is a self-administered tool that can be used to screen for and assess the severity of GAD. The GAD-7 asks patients about the presence of symptoms of anxiety over the past 2 weeks. It is scored from 0 to 21. Scores of 0 to 4, 5 to 9, 10 to 14, and 15 and higher correspond with minimal, mild, moderate, and severe anxiety, respectively. Most patients diagnosed with GAD have a score of 10 or higher.
The GAD-7 is available here.
Hamilton Anxiety Rating Scale
The Hamilton Anxiety Rating Scale (HAM-A) is an older, 14-item, clinician-administered tool for assessing the severity of anxiety symptoms.14,15 The questions on the HAM-A are designed to detect both psychological and somatic symptoms of anxiety. The HAM-A takes 12 to 15 minutes to administer. Each question is scored from 0 (not present) to 4 (severe), with a total possible score of 56. A score of 25 or higher correlates with moderate to severe anxiety.
The HAM-A is available here.
Alcohol and Substance Use Disorders
CAGE Questions Adapted to Include Drugs (CAGE-AID)
CAGE is a brief tool originally designed to screen for alcohol abuse and dependence in adults.16, 17 Its name is a mnemonic based on the 4 questions it asks. The CAGE Adapted to Include Drugs (CAGE-AID) modified the original CAGE to include language about drug use as follows16,17:
Have you ever felt you ought to Cut down on your drinking or drug use?
Have people Annoyed you by criticizing your drinking or drug use?
Have you ever felt bad or Guilty about your drinking or drug use?
Have you ever had a drink or used drugs first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Each question is scored 0 (no) or 1 (yes). A score of 2 or more should prompt a full assessment for an alcohol or substance abuse disorder.
The CAGE-AID is available here.
Alcohol Use Disorders Identification Test
The Alcohol Use Disorders Identification Test (AUDIT) is widely used instrument for screening for alcohol abuse.19 It is a 10-question test that can be administered by health care professionals or self-administered by patients. The responses to questions 1 through 8 are scored 0, 1, 2, 3, or 4, while questions 9 and 10 are scored 0, 2, or 4. The possible total score ranges from 0 to 40, with scores of 8 to 14 suggesting hazardous or harmful alcohol consumption and scores of 15 or higher indicating likely alcohol dependence (moderate-severe alcohol use disorder).
An interactive version of the AUDIT is available here.
Note: This article originally appeared on Psychiatry Advisor
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