Why mental health?
What are the best measures?
Mental health problems are classed as a ‘specific condition’ outcome measure and are very common among people with substance misuse disorders. Questionnaires are helpful pointers to comorbidity and useful for monitoring symptom severity. It is, therefore, suggested that mental health measures are used to supplement the core addiction outcome measures.
RESULT recommends four scales.
the measurement scales…
Patient Health Questionnaire - PHQ9 and Generalised Anxiety Disorder - GAD7
Depression and anxiety are commonly associated with addiction problems and they so often go together that it is convenient to have companion scales. Caution interpreting scores with substance dependence. Popular measures in both primary care and specialist services. The diagnosis of depression or anxiety must be confirmed by qualified mental health professional.
Timeframe :: The last 14 days
Completion time :: Brief.
PHQ9 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
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 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
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
Licence: free to use
User guide
References (psychometrics)
Delgadillo J. (2012) Depression and anxiety symptoms: measuring reliable change in alcohol and drug users. Advances in Dual Diagnosis 5: 2-14
Delgadillo J, Payne S, Gilbody S, Godfrey C, Gore S, Jessop D, Dale V. (2011) How reliable is depression screening in alcohol and drug users? A validation of brief and ultra-brief questionnaires. Journal of Affective Disorders 134: 266-71
Dum M, Pickren J, Sobell LC, Sobell MB. (2008) Comparing the BDI-II and the PHQ-9 with outpatient substance abusers. Addictive Behaviors 33: 381-7
Delgadillo J, McMillan D, Leach C, Lucock M, Gilbody S & Wood N. (2012) Benchmarking Routine Psychological Services: A Discussion of Challenges and Methods. Behavioural and Cognitive Psychotherapy 42: 16-30
Delgadillo J, Payne S, Gilbody S, Godfrey C, Gore S, Jessop D, Dale V. (2012) Brief case finding tools for anxiety disorders: validation of GAD-7 and GAD-2 in addictions treatment. Drug and Alcohol Dependence 125: 37-42
Spitzer RL, Kroenke K, Williams JBW, Löwe B. (2006) A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Archives of Internal Medicine 166: 1092-7
Kroenke K, Spitzer RL, Williams JB. (2001) The PHQ-9: The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16: 606-13
Post Traumatic Stress - PCL
Trauma of one kind or another is often associated with developing an addiction problem. This is an important measure to have available. The diagnosis of PTSD must be confirmed by qualified mental health professional.
Timeframe :: The last month
Completion time :: 5-10 minutes
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
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
License: public domain
User guide
References (psychometrics)
Bollinger AR, Cuevas CA, Vielhauer MJ, Morgan EE, Keane TM. (2008) The Operating Characteristics of the PTSD Checklist in Detecting PTSD in HIV+ Substance Abusers. Journal of Psychological Trauma 7: 213-34 Journal article not found
Wilkins KC, Lang AJ, Norman SB. (2011) Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety 28: 596-606
Asmundson GJG, Frombach I, McQuaid J, Pedrelli P, Lenox R, Stein MB. (2000) Dimensionality of posttraumatic stress symptoms: a confirmatory factor analysis of DSM-IV symptom clusters and other symptom models. Behaviour Research and Therapy 38: 203-14
Prodromal Questionnaire - PQ16
Psychosis is uncommon but naturally the possibility of having psychotic illness is worrying. This is an important measure to have available. The diagnosis of psychosis must be confirmed by qualified mental health professional.
Timeframe :: Current
Completion time :: 16 item ‘symptom’ list each with possible secondary ‘distress’ rating
Scoring :: The score is the total number of positive symptom items endorsed 1= Yes 0= No giving a maximum score of 16. The supplementary distress scores for each symptom item endorsed are 0= 'none' 1= "mild' 2= 'moderate' 3= 'severe' giving a range of 0 to 48
Cut-off score :: Cutoff scores ≥6 symptoms as indicating a likelihood of psychosis.
Licence: copyright
User guide
References (psychometrics)
Loewy RL, Pearson R, Vinogradov S, Bearden CE, Cannon TD. (2011) Psychosis risk screening with the Prodromal Questionnaire — Brief Version (PQ-B). Schizophrenia Research 129: 42-6
Ising HK, Veling W, Loewy RL, Rietveld MW, Rietdijk J, Dragt S, Klaassen RMC, Nieman DH, Wunderink L, Linszen DH, and van der Gaag M (2012) The Validity of the 16-Item Version of the Prodromal Questionnaire (PQ-16) to Screen for Ultra High Risk of Developing Psychosis in the General Help-Seeking Population. Schizophrenia Bulletin 38: 1288–1296
Borderline Personality Checklist - BPC
Emotionally unstable personality disorder is commonly associated with an addiction problem. This is an important measure to have available and it is a compact scale for a complex screening problem . The diagnosis of personality disorder must be confirmed by qualified mental health professional.
Timeframe :: Current
Completion time :: 9 item ‘symptom’ checklist
Scoring :: The score is the total number of positive symptom items endorsed 1= Yes 0= No giving a maximum score of 9.
Cut-off score :: Cutoff scores ≥5 symptoms as indicating an emotionally unstable personality disorder.
Licence: available by NHS
References (psychometrics)
No references given - see NHS website for the checklist