CG123 Common mental health disorders - National Institute for ...

Case identification and formal assessmentTable 21: (Continued)Where management is shared between primary and secondarycare, there should be clear agreement among individualhealthcare professionals about the responsibility for monitoringpatients with PTSD. This agreement should be inwriting (where appropriate, using the Care ProgrammeApproach) and should be shared with the patient and, whereappropriate, their family and carers.People who have lost a close friend or relative due to anunnatural or sudden death should be assessed for PTSD andtraumatic grief. In most cases, healthcare professionals shouldtreat the PTSD first without avoiding discussion of the grief.5.3.5 Summary of clinical evidence from other sourcesThe New Zealand guideline on identification of common mental health disorders(New Zealand Guidelines Group, 2008) systematically reviewed the evidence forassessment instruments that were brief (less than 5 minutes) to administer. Includedin their review was the first Depression guideline (NCCMH, 2004a), a review ofscreening for depression in adults (Pignone et al., 2002), two reviews of screening foralcohol problems (Aertgeerts et al., 2004; Fiellin et al., 2000) and 27 primary studies(some of which were included in the NICE guideline and/or the other includedsystematic reviews). The New Zealand guideline review concluded that the PHQ-9appeared to have the best clinical utility for the assessment of depression, being reliableand valid for identifying depression, and sensitive to change. In addition, it wasreported that other instruments with acceptable clinical utility were the GHQ-12 (VonKorff et al., 1987; Schmitz et al., 1999) and the Common Mental DisorderQuestionnaire (CMDQ; Christensen et al., 2005). It was also stated that other brieftools, such as the Center for Epidemiological Studies Depression scale (CES-D;Fechner-Bates et al., 1994), the World Health Organization Wellbeing Index (WHO-5;Henkel et al., 2003) and Duke-Anxiety-Depression scale (Parkerson & Broadhead,1997) are less accurate for routine use in primary care. The GAD-7 and the two-itemversion, GAD-2, (Kroenke et al., 2007; Spitzer et al., 2006) were described as valid fordetecting anxiety disorders, and the GAD-7 was included as a potentially useful assessmenttool. The Kessler-10 questionnaire was included as a potentially useful assessmenttool, but described as only validated in secondary care (Andrews & Slade, 2001).The IAPT screening prompts tool (IAPT, 2010) was developed on the basis of thediagnostic criteria contained in ICD-10 and also makes explicit links to the use offormal measures such as the PHQ-9. It sets out a stepwise approach to questionsabout the experience, duration of the symptoms and impact on functioning based on130