Routinely administered questionnaires for depression and anxiety: systematic review

Abstract

Objectives To examine the effect of routinely administered psychiatric questionnaires on the recognition, management, and outcome of psychiatric disorders in non-psychiatric settings. Data sources Embase, Medline, PsycLIT, Cinahl, Cochrane Controlled Trials Register, and hand searches of key journals. Methods A systematic review of randomised controlled trials of the administration and routine feedback of psychiatric screening and outcome questionnaires to clinicians in non-psychiatric settings. Narrative overview of key design features and end points, together with a random effects quantitative synthesis of comparable studies. Main outcome measures Recognition of psychiatric disorders after feedback of questionnaire results; interventions for psychiatric disorders; and outcome of psychiatric disorders. Results Nine randomised studies were identified that examined the use of common psychiatric instruments in primary care and general hospital settings. Studies compared the effect of the administration of these instruments followed by the feedback of the results to clinicians, with administration with no feedback. Meta-analytic pooling was possible for four of these studies (2457 participants), which measured the effect of feedback on the recognition of depressive disorders. Routine administration and feedback of scores for all patients (irrespective of score) did not increase the overall rate of recognition of mental disorders such as anxiety and depression (relative risk of detection of depression by clinician after feedback 0.95, 95% confidence interval 0.83 to 1.09). Two studies showed that routine administration followed by selective feedback for only high scorers increased the rate of recognition of depression (relative risk of detection of depression after feedback 2.64, 1.62 to 4.31). This increased recognition, however, did not translate into an increased rate of intervention. Overall, studies of routine administration of psychiatric measures did not show an effect on patient outcome. Conclusions The routine measurement of outcome is a costly exercise. Little evidence shows that it is of benefit in improving psychosocial outcomes of those with psychiatric disorder managed in non-psychiatric settings.

The factor structure of the GHQ-12: the interaction between item phrasing, variance and levels of distress

“…The utility of using brief measures such as the GHQ-12 as screening tools has been questioned [32] given the relatively low positive predictive value of these measures (largely due to the low prevalence of conditions severe enough to warrant intervention). Nevertheless some authors have recommended continuing to use a summary index of the GHQ-12 despite the presence of multiple factors [12].…”

Validating automated screening for psychological distress by means of computer touchscreens for use in routine oncology practice

“…Data collection by touchscreen computer in routine oncology practice offers the opportunity to improve the identification of patients with clinically significant levels of distress. A recent systematic review (Gilbody et al, 2001) examining evidence of the effect of routine screening on the recognition, management and outcome of psychiatric disorders in non-psychiatric settings, confirmed the value of providing clinicians with feedback only about those who screen positive. Computer-administered screening is a promising platform from which to develop a rational strategy for offering a range of psychosocial interventions appropriately to patients most in need of them.…”

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

“…There are, however, important caveats. First, there is, little point in screening unless it is associated with an intervention programme (Gilbody et al, 2001). We report on such a programme in a companion paper .…”