Stress Illness Screening (1)

One of the most frequent questions I get after my talks to medical clinicians is about rapid ways to screen for sources of stress.  A validated questionnaire that revealed stress issues prior to the patient being seen would, theoretically, enable more accurate diagnosis in less time.

Brief, well researched instruments for all the major sources of stress capable of causing physical symptoms don’t exist.  However, a recent paper (1) describes a screen for anxiety and depression that consists of just four questions.  I will list the questions here and discuss some of the validation work in the next post.

Over the last 2 weeks, how often have you been bothered by the following problems?

Feeling nervous, anxious or on edge

Not being able to stop or control worrying

Feeling down, depressed or hopeless

Little interest or pleasure in doing things

Responders check off one of the following for each question and score the number of points indicated.

0. Not at All     1. Several Days     2. More Than Half the Days     3. Nearly Every Day

The reference group was composed of those scoring 0-2.  Mild, moderate and severe categories were set at scores of 3-5, 6-8 and 9-12 respectively.  More on the PHQ-4 in the next post.

1. Kroenke K et al.  An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ-4.  Psychosomatics 50:6.  Nov-Dec 2009.

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