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

Case identification and formal assessmentfor depression has emerged since this approach was endorsed and incentivised under theNHS primary care QOF (British Medical Association & NHS Employers, 2006).Recently, the updated edition of the Depression: the Treatment and Managementof Depression in Adults guideline (NCCMH, 2010b) and the guideline on Depressionin Adults with a Chronic Physical Health Problem (NCCMH, 2010a) reviewed availablecase identification instruments for depression. These guidelines recommendedthat healthcare professionals should be alert to possible depression (particularly inpeople with a past history of depression or a chronic physical health problem withassociated functional impairment) and consider asking people who may have depressiontwo questions, known as the ‘Whooley questions’:1. During the last month, have you often been bothered by feeling down, depressedor hopeless?2. During the last month, have you often been bothered by having little interest orpleasure in doing things?If a person answers ‘yes’ to either of these questions, then the guidelines recommendthat a practitioner who is competent to perform a mental health assessment shouldreview the person’s mental state and associated functional, interpersonal and socialdifficulties. Furthermore, when assessing a person with suspected depression, the guidelinesrecommend that practitioners should consider using a validated measure (forexample, for symptoms, functions and/or disability) to inform and evaluate treatment.Compared with depression, the case for the routine identification of anxiety hasreceived less attention. Nevertheless, the epidemiology and unmet needs attributable toanxiety are similar to that of depression. There has been less experience to draw uponrelating to the use of routine case identification measures in primary care in the UK,since their use has not previously been endorsed by the UK QOF. A decision was takenwhen formulating the scope of this guideline that the use of brief anxiety questionnairesshould be considered alongside depression questionnaires. The classification of anxietydisorders is more complex compared with depressive disorders; however, the view ofthe GDG was that the development of separate case identification questions for eachtype of anxiety disorder would very likely be impractical and have no utility for routineuse in primary care. The GDG’s preference was to explore the possibility that a smallnumber of case identification questions with general applicability to a range of anxietydisorders should be the starting point for a review in this area. As with depressive disorders,a potentially positive response would then prompt a further assessment.Given that case identification instruments were recently reviewed for the twoguidelines on depression, the present review will focus on case identification instrumentsfor anxiety or GAD.DefinitionCase identification instruments were defined, for the purposes of this review, as validatedpsychometric measures that were used to identify people with anxiety. The reviewwas limited to instruments likely to be used in UK clinical practice, that is, ‘ultra-briefinstruments’ (defined as those with one to three items) or ‘longer instruments’ (defined asthose with four to 12 items). The identification instruments were assessed in consultationsamples (which included primary care and general medical services) and community93