Mental health scales
scale characteristics and quality framework scores
Mental health problems are very common among people with substance misuse disorders. Dependence is itself best thought of as a mental health problem which is often difficult to distinguish from other mental health disorders. The distinction between mental illness and symptoms of psychological distress is an important one because treatment and outcomes for each are very different. Both are commonly intertwined with addiction problems, with the addiction and mental health stresses feeding off each other. Diagnosis of mental illness is difficult in these situations and should only be made by a qualified addiction mental health practitioner. Questionnaires are helpful pointers to possible mental health problems but ideally are reserved for monitoring symptom severity. Often a diagnosis only becomes clear over time.
The collection of scales here have been selected for relevance to substance misuse and common usage.
PHQ9 :: Patient Health Questionnaire designed for routine monitoring of depressive symptoms
Licence: Copyright Pfizer (free to use)
The PHQ-9, the depression module of the self-administered Patient Health Questionnaire, has nine items that represent the nine DSM-IV depression criteria. The scale can be used to suggest a diagnosis of depression or to monitor the severity of depression once diagnosed. The nine aspects of depression measured are: Q1: loss of pleasure Q2: hopelessness Q3: insomnia Q4: tiredness Q5: appetite Q6: failure Q7: concentration Q8: slowness or agitation Q9: suicidal. Timeframe :: The last 14 days. Scoring :: Each item is scored on a four point scale: 0= 'not at all' 1= 'several days' 2= 'more than half the days' 3= 'nearly everyday'. PHQ9 total scores range from 0 to 27. Completion time :: Brief. Cut-off score :: Higher scores reflect a greater symptom severity: 0 to 9 minimal symptoms; 10 to 14 minor depressive symptoms; 15 to 19 moderate severity; 20 to 27 severe depression. Scoring for a tentative diagnosis is more complicated and various methods have been suggested of which a requirement for at least five items to score ≥2 is the simplest.
GAD7 :: Generalised Anxiety Disorder designed for routine monitoring anxiety symptoms
Licence: Copyright Pfizer (free to use)
The GAD7 has seven items that represent DSM-IV anxiety criteria. GAD7 can be used to suggest a diagnosis of anxiety or to monitor the severity of anxiety once diagnosed. Using the cutoff score of 10, the GAD-7 is moderately good at screening generalised anxiety, panic disorder, social anxiety, and post-traumatic stress disorder. The seven aspects of anxiety measures are: Q1: anxiety Q2: constant worry Q3: worry about all sorts Q4: tension Q5: restlessness Q6: irritabilityQ7: fearfulness. Timeframe :: The last 14 days. Scoring :: Each item is scored on a four point scale: 0= 'not at all' 1= 'several days' 2= 'more than half the days' 3= 'nearly everyday'. GAD-7 total scores range from 0 to 21. Completion time :: <2minutes. Cut-off score :: Higher scores reflect a greater symptom severity: 0 to 5 minimal symptoms; 6 to 10 mild severity; 11 to 15 moderately severe anxiety; 15 to 21 severe anxiety
PCL :: Post Traumatic Stress Disorder designed for screening for post traumatic stress disorder
Licence: Public Domain
As with most other mental health problems traumatic experiences can be both a cause and effect of addiction. People respond differently to traumatic events even those truly life threatening events. One way of coping with persistent and distressing consequences of trauma is to take a psychoactive drug, commonly alcohol. An addiction problem is likely to be a barrier to treatment.Three versions of the PCL are available with minor differences. The PCL-M is a military version; the PCL-S can be referenced to any specific traumatic event; the PCL-C is a general civilian version that is not linked to a specific event and is used in RESULT. The 17 items correspond to DSM-IV PTSD symptoms. There are four subscales: Q1 to Q5 reminders or re-experiencing the trauma; Q6 & Q7 avoidance of reminders; Q8 to Q12 numbness; Q13 to Q17 arousal. Timeframe :: The last month. Scoring :: Respondents are asked to rate the degree to which they were bothered by symptoms of stressful life events: 1= "not at all' 2= 'a little bit' 3= 'moderately' 4= 'quite a bit' 5= 'extremely'. Scores range from 17 to 85. Completion time :: Not stated. Cut-off score :: A cutoff score of 50 gives the best balance of sensitivity, the ability to detect people with PTSD, and specificity, the ability to detect people who do not have PTSD
LTE :: List of Traumatic Experiences designed for identification of threatening events
The LTE is 12-item questionnaire which enquires about the experience of major categories of stressful life events selected for their established long-term consequences. As the name suggests this is more of a list than it is a scale though the experience of multiple trauma can be expected to be associated with more severe mental health consequences. The twelve categories are: Q1: serious illness or assault to self Q2: serious illness or assault to important other Q3: family death Q4: important other death Q5: separation Q6: loss of relationship Q7: serious problem with important other Q8: unemployment Q9: dismissal Q10: financial crisis Q11: involvement with legal system Q12: loss. The items have also been grouped: Relationship Q5 & Q6, Livelihood Q8 Q9 Q10, Personal Q1 Q7 Q11 Q12, Loss Q2 Q3 Q4. Timeframe :: The last 6 months. Scoring :: All items are scored 1= Yes 0= No. Completion time :: Brief. Cut-off score :: A number of ways of interpreting the scores have been advocated: list the presence or absence of each individual life event item, sum of the number of life events experienced, group events into categories.
RESULT does not have permission to reproduce the LTE
PQ-B ::: Prodromal Questionnaire - Brief designed for monitoring psychotic symptoms
Psychosis, best thought of as a loss of touch with reality, has many causes of which one is substance use, notably of stimulant and hallucinogenic drugs. People who suffer from psychotic illness, such as schizophrenia, may choose psychoactive drugs in preference to their medication to alleviate distressing symptoms. Importantly psychoactive drugs may adversely affect the course of a pre-existing mental illness.The PQ-B is designed to function as the first step in a two-stage screening process that relies on clinician interview to obtain a diagnosis. It is best given to help seeking populations and can be used to monitor symptom severity once a diagnosis of psychosis or at least psychotic symptomatology is established. There are 21 items each of which is ticked if that symptom has been experienced; if the item is ticked then respondents additionally rate the distress caused by that symptom. The 21 items represent common, positive symptoms of psychosis. Instructions state not to include experiences that occur only while under the influence of alcohol, drugs or medications that were not prescribed. Timeframe :: The last month. Scoring :: The score is the total number of positive symptom items endorsed 1= Yes 0= No giving a maximum score of 21. The supplementary distress scores for each symptom item endorsed are 0= 'no' 1= "strongly disagree' 2= 'disagree' 3= 'neutral' 4= 'agree' 5= 'strongly agree' giving a range of 0 to 105. Completion time :: Not stated. Cut-off score :: Cutoff scores ≥3 symptoms and ≥6 on symptom distress are recommended as indicating a likelihood of psychosis.