Standardizing the Use of Mental Health Screening Instruments in Patients With Pain
Conclusion
The economic burden of major depressive disorder in the US has risen 21.5% from 2005 to 2010.16 Unfortunately, only 35% of those with symptoms of severe depression had contact with a mental health professional in the past year.8 Avoiding missing opportunities to screen for mental health conditions can decrease the disease burden. The GAD-7 and PHQ-9 are relatively cost free and are deemed reliable and valid for screening for, and determining the severity of, symptoms of anxiety and depression.12 The evidence suggests that screening for, and early recognition of, mental illness, are critical parts of evidence-based practice and provide the most cost-effective care.16
This PI project demonstrated that the standardized use of the GAD-7 and PHQ-9 during patient visits for pain did improve adherence to guidelines and resulted in a significant increase in the rate of mental health referrals from 10% to 23.1%. This information is valuable because a score of ≥ 10 on either screening instrument is considered the optimal cutoff for diagnosing and determining severity of anxiety and depression symptoms.12 The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) have jointly developed clinical practice guidelines, which recommend that interventions, such as behavioral therapies or first-line pharmacologic treatment, be offered to patients with mild to moderate symptoms of depression.17 The VA/DoD guidelines for low back pain suggest screening for mental health disorders.2 For these reasons, the standardized use of the screening instruments remains in place within the pain management clinic at NMCCL.
