Julie M. Wood, PhD Consultant Medical Liaison, Neuroscience Lilly USA, LLC Indianapolis, Indiana
Sanjay Gupta, MD Clinical Professor Departments of Psychiatry SUNY Upstate Medical University Syracuse, New York SUNY Buffalo School of Medicine and Biomedical Sciences Buffalo, New York Member of Current Psychiatry Editorial Board
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
Psychiatry is replete with rating scales and screening tools, and the number of competing scales can make choosing a measure difficult.1 Nonetheless, not all scales are appropriate for clinical use; many are designed for research, for instance, and are lengthy and difficult to administer.
This article reviews a number of rating scales that are brief, useful, and easy to administer. A framework for the screening tools addressed in this article is available on the federally funded Center for Integrated Health Systems Web site (www.integration.samhsa.gov). This site promotes the use of tools designed to assist in screening and monitoring for depression, anxiety, bipolar disorder, substance use, and suicidality.11
Quality criteria for rating scales
The quality of a rating scale is determined by the following attributes12:
Objectivity. The ability of a scale to obtain the same results, regardless of who administers, analyzes, or interprets it.
Reliability. The ability of a scale to convey consistent and reproducible information across time, patients, and raters.
Validity. The degree to which the scale measures what it is supposed to measure (eg, depressive symptoms). Sensitivity and specificity are measures of validity and provide additional information about the rating scale; namely, whether the scale can detect the presence of a disease (sensitivity) and whether it detects only that disease or condition and not another (specificity).
Establishment of norms. Whether a scale provides reference values for different clinical groups.
Practicability. The resources required to administer the assessment instrument in terms of time, staff, and material.
In addition to meeting these quality criteria, selection of a scale can be based on whether it is self-rated or observer-rated. Advantages to self-rated scales, such as the PHQ-9, Mood Disorder Questionnaire (MDQ), and Generalized Anxiety Disorder 7-item(GAD-7) scale, are their practicability—they are easy to administer and don’t require clinician or staff time—and their use in evaluating and raising awareness of subjective states.
However, reliability may be a concern, as some patients either may lack insight or exaggerate or mask symptoms when completing such scales.13 Both observer and self-rated scales can be used together to minimize bias, identify symptoms that might have been missed/not addressed in the clinical interview, and drive clinical decision-making. Both also can help patients communicate with their providers and make them feel more involved in clinical decision-making.8
The following scales have met many of the quality criteria described here and are endorsed by the government payer system. They can easily be incorporated into clinical practice and will provide useful clinical information that can assist in diagnosis and monitoring patient outcomes.
