From time to time, I end up entering into a conversation with clinicians around the value of using standardized assessments for depression and anxiety. I have heard people comment on the relative quality of these tools and if they are really all that effective in assessing a new client’s level of depression or anxiety.
As you might imagine, I’m on the side of valid standardized assessments are generally a good thing. They can sometimes be used too much, and they don’t necessarily lead you directly to a diagnosis, but they still have their place in the world of behavioral health treatment.
We all know there is currently a high prevalence of depression and anxiety in the United States. In a pulse survey conducted by the US Census Bureau, it was reported that around half (50%) of adults aged 18 to 24 years of age reported experiencing symptoms of anxiety and depression in 2023. Given the unique circumstances of the two preceding years, which impacted education and social interactions, this number may be striking but not surprising. Far-reaching social events have the capacity to have significant mental health impacts.
The vast majority of individuals receiving psychotherapy services experience anxiety or depression. Around 19.1% of the US population have an anxiety disorder and 8.4% have had at least one major depressive episode in a given year. Because of the prevalence of these two disorders, and the risks associated with both, there is an expectation in the community, and especially from third-party payers, that these will be assessed for at the outset of treatment.
While most payers do not dictate whether a standardized assessment tool is utilized versus the clinician utilizing their own process using the current diagnostic definitions to ascertain current symptoms and the level of severity, there is a benefit to utilizing a standardized assessment tool for both.
While they’ve existed for a while, the value of the standardized assessment tools is that they are peer-reviewed and continuously evaluated to continue to ensure validity, which provides some level of assurance of the value of the outcome of the review.
And there is a range of tools available.
For depression, multiple studies have found the Patient Health Questionnaire (PHQ) 9 questions to be a highly validated instrument and found to be more effective than semi-structured assessments using diagnostic criteria. For clients aged 11 to 17, the PHQ-A has been adapted to provide effective assessment in this age group. One of the key benefits of the PHQ-9 is that has been developed to be self-administered, and while highly validated takes only around 5 minutes to complete.
As an alternative, we have the availability of the Beck Depression Inventory (BDI- II), which has also been found to have validity for individuals ages 13 through 80 and has been evaluated worldwide. In at least one study, when the BDI was compared to the PHQ-9, it found that the BDI identified a higher frequency of severe levels of depression.
The notion of standardized assessment versus semi-structured approach also holds true for the assessment of anxiety. The two assessment surveys that are typically used, though other validated tools exist, are the Generalized Anxiety Disorder (GAD) – 7 (questions) and the Beck Anxiety Inventory (BAI). Both are highly validated and internally consistent, and they correlated well with one another. They are also both written to be self-administered. So, either can be an effective tool for identifying the existence and severity of anxiety symptoms.
Part of our job as clinicians, particularly if we accept health insurance reimbursements, is to identify their symptoms at the outset of treatment and monitor those symptoms over time. Structured tools are a straightforward way to accomplish this that allows for a standard approach to the measure as well as a way to compare improvement or decline over time.
Most, if not all, of the EHR systems allow you to automatically send these assessments to your clients, collect the information, and store it electronically in the treatment record, so this is not a difficult thing to utilize. So, my encouragement is, if you’re not using these assessments currently, or you’re only using it part of the time, I would be assessing for depression and anxiety with every client you have that is within the age range of these tools.
They work!