Screening for Anxiety and Depression

When to call it a disorder?

Characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour.
Usually associated with distress or impairment in important areas of functioning (functional impairment).
Duration also have to be taken into consideration.

🔍Screening tools

DASS score

Used for screening of depression, anxiety and stress.

Once patient is suspected to have symptoms of depression or anxiety, further assessment can be done via more specific questionnaire e.g. GAD-7, PHQ-9

Anxiety disorders

Common physical symptoms:

Chest discomfort
Palpitations
SOB
Stomach upset
Cold and clammy skin

Cognitive symptoms:

Feeling worried
Fear
Think of impending doom

GAD diagnostic and severity measures

Source: PAR Staff (2020). Administration and Scoring of the Generalized Anxiety Disorder-7 (GAD-7) [technical supplement]. PAR.

It is important also to assess:

Any underlying organic cause for the symptoms, e.g. ACS, asthma, hyperthyroid, etc.
Substance misuse (either as a comorbid or complication of anxiety)

Major Depressive Disorder

DSM-5 Diagnostic Criteria:

5 or more of the following symptoms must be present nearly every day during a 2 week period:

Core symptoms (≥1 required for diagnosis)

Depressed mood most of the day
Anhedonia or markedly decreased interest or pleasure in almost all activities

Additional symptoms

Clinically significant weight loss or increase or decrease in appetite.
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death or suicidal ideation

Fast screening tools for MDD

Consist of 2 questions to screen for depression

Depression diagnostic and severity measure (PHQ-9)

Remember to assess:

Manic symptoms – TRO bipolar
Suicidal thoughts/ideation/attempt
Psychosis
Substance abuse/usage
Underlying medical illness that may contribute to the symptoms

Manic symptoms

Mania vs Hypomania (Difference in symptoms duration)
3 or more of manic symptoms
Mania: at least 1 week or more
Hypomania: at least 4 days but less than 1 week.

🚑 Indications for referral

Unsure of diagnosis
Attempted suicide
Active suicidal ideas
Failure of treatment
Advice on further treatment
Clinical deterioration
Recurrent episode within one year
Psychotic symptoms
Severe agitation
Self neglect

References

Ministry of Health Malaysia. DASS self-assessment. https://mits.moh.gov.my/Modules/Patient/public-dass/
PAR Staff (2020). Administration and Scoring of the Generalized Anxiety Disorder-7 (GAD-7) [technical supplement]. PAR.
Ministry of Health Malaysia. (2019). Clinical practice guidelines: Management of major depressive disorder (2nd ed.). Malaysia Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia.