Routinely administered questionnaires for depression and anxiety: systematic review
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7283.406 (Published 17 February 2001) Cite this as: BMJ 2001;322:406
Data supplement
We used the following search terms in our search of Medline, Embase, Cinahl; PsycLIT, and the Cochrane Controlled Trials Register:
"Health-Status-Indicators"; "Outcome-and-Process-Assessment-(Health-Care)"/ all subheadings; "Outcome-Assessment-(Health-Care)"/ all subheadings; (outcome measure*) in ti,ab; (health outcome*) in ti,ab; (quality of life) in ti,ab; measure* in ti,ab; assess* in ti,ab; (score* or scoring) in ti,ab; index in ti,ab; "outcomes-research"/ all subheadings; health outcome* in ti,ab; scale* in ti,ab; monitor* in ti,ab; assess* in ti,ab; outcome* in ti,ab; explode "Treatment-Outcomes"; explode "Psychological-Assessment"; "Quality-of-Life"; (outcome* or process*) near3 assessment*; health status indicator*; health status; health outcome* in ti,ab; quality of life in ti,ab
Table1 Randomised controlled studies evaluating use of routine outcome measures for psychiatric disorders in primary care and general hospital settings
Author and year Design Population, setting and sample size Routine outcome measure Intervention and control conditions Length of follow up and outcomes Results Johnstone and Goldberg 19768 Patients randomised using alternate odd and even allocation* Sequential attenders to a single UK doctor (n=1093); those with psychiatric morbidity (scores on general health questionnaire >5) that had not been hitherto recognised by the doctor (hidden psychiatric morbidity) were followed up General health questionnaire (version not given) Intervention: questionnaire administered and clinician asked about likelihood of psychiatric morbidity. Results then fed back to clinician. Those with unrecognised depression and high scores at initial interview (hidden psychiatric morbidity) were followed up (n=60). Control: questionnaire administered and clinician asked about the likelihood of psychiatric morbidity. Questionnaire folded and placed in the patient note envelope. Those with unrecognised depression and high scores at initial interview (hidden psychiatric morbidity) were followed up (n=59)
For those with hidden psychiatric morbidity the following were studied: diagnosis and severity of depression during 12 months follow up (including scores on questionnaire);
length of depressive episodes; pattern of consultation over 12 months
Feedback increased the rate of detection of hidden psychiatric morbidity by 11%. Improved outcome at 12 months only for those with >severe= disorders. Feedback reduced length of illness (2.8 v 5.3 months). Feedback facilitated a more psychological, rather than somatic, pattern of consulting
Moore et al 19789 Individual patients randomised Attenders at general practice with self rated depression scores >50 (n=96) Zung self rating depression scale18 Intervention: questionnaire administered and score fed back (>mildly= or >severely depressed=) Control: questionnaire administered but no feedback to clinician
Notation of depression following index visit Selective feedback increased recognition of depression for high risk patients (22% v 56%) Linn and Yager 198014 Individual patients randomised New referrals to US medical outpatients (n=150); mean age 56 Zung self rating depression scale18 Intervention: five different interventions, which varied time of feedback of questionnaire, and the use of an interview to sensitise the clinician to the presence of depression Control: administration of questionnaire but no feedback to clinician
For all patients at initial interview the following were studied: whether depression noted in charts and initiation of any treatment for depression
Depression was generally under-recognised. Screening and feedback of questionnaire increased the frequency of notation of depression (8% v 25%) Increased notation of depression occurred irrespective of time of feedback (before or after consultation). Sensitisation to depression had no effect. Screening had a much smaller effect on initiation of treatment for depression
Hoeper et al 198410 Individual patients randomised Adult primary care patients in USA (n=2309) treated by 14 physicians General health questionnaire (version 28)4 Intervention: questionnaire administered by researcher and scores fed back to clinician, with information that a score >5 indicated mental illness Control: questionnaire administered but no feedback to clinician
Clinician diagnoses of mental illness at reference visit (information elicited as part of study) No difference in rate of detection of mental disorders (16.0% (intervention) v 16.8% (control)). No difference in rate of detection among those with high scores (30% v 29%) German et al 198715 Individual patients randomised Adult and elderly general medical outpatients in USA (n=1242); separate interventions for high (n=488) and low (n=754) scorers on general health questionnaire General health questionnaire (version 28)4; administered by a research assistant Intervention: questionnaire administered preconsultation and results fed back to clinician, together with an indication that score was high and suggested >psychiatric diagnosis= (n=165) Control: questionnaire administered but not fed back to clinician (n=323)
For all patients at initial interview the following were studied: detection of depression by clinicians; treatment initiated for depression; scores on questionnaire at 6 months
No difference in detection rate among under 65s (57% (intervention) v 58%). Greater detection of depression in over 65s with feedback (63% v 43%). No differences in management of depression in under 65s (46% v 46%), but greater proportion of over 65s receiving intervention after feedback (42% v 32%). Scores at 6 months not reported Magruder-Habib et al 199016 Individual patients randomised Male adult veterans (mean age 60) attending a US general internal medicine outpatients clinic, with Zung self rated depression scores >50 (n=100) Zung self rating for depression scale18 Intervention: questionnaire administered and fed back to physicians at first clinic assessment visit– placed at front of clinic notes (n=48) Control: questionnaire administered but not fed back to clinician (n=52)
Recognition of depression; initiation of management of depression; scores on questionnaire at 3, 6, 9, and 12 months Greater recognition of depression in feedback group (56% v 35% at 12 months). More frequent intervention in feedback group (56% v 42% at 12 months). Feedback facilitated recognition for those with a high somatic score on the subscale Dowrick and Buchan 199512 ndividual patients randomised Consecutive attenders to general practice in Liverpool (n=116), with depression score >14 on the Beck depression inventory Beck depression Inventory17 Intervention: questionnaire administered preconsultation and depression scores fed back to clinician (n=52) Control: questionnaire administered but not fed back to clinician (n=64)
Rates of recognition of depression at 6 and 12 months; rates of intervention for depression (antidepressants; outside mental health referral or discussion of depression with the subject); scores on questionnaire at 6 and 12 months Disclosure had no effect on the rate of clinician diagnosis of depression at 6 months (relative risk 0.82, 95% confidence interval 0.32 to 2.07) and at 12 months (1.71, 0.93 to 3.14). Disclosure had no significant difference on rates of intervention at 6 months (1.43, 0.75 to 2.69) and at 12 months (1.22, 0.69 to 2.11). Disclosure had no discernible effect on scores: median group difference in scores at 6 months=!1 (95% confidence interval !4 to 3) and at 12 months=0 (!3 to 11)
Mazonson 199611 RCT Primary care group practices randomised
Primary care patients with hitherto unrecognised anxiety Symptom check list-9019 (anxiety subscales only) and short form 3620 Intervention: clinicians (n=40) given an educational package that included teaching sessions on the importance and causes of anxiety problems; they received structured feedback of anxiety scores (system check list) and functional status (SF-36) scores from 357 patients. Feedback was given at consultation at two further points in the follow up (11 weeks and 5 months) Control: clinicians (n=35) received no feedback from 216 patients who had completed both questionnaires
Recognition and treatment for anxiety problems; changes in anxiety scores at 3 and 5 months; changes in SF-36 scores at 3 and 5 months; self reported global improvement in anxiety and functional status Increased recognition and treatment for anxiety symptoms (35.6% v 20.8%; P<0.001). Increased referral to mental health sector (9.5% v 3.2%; P<0.001), but no difference in the prescription of pscyhotropics. No differences in change for anxiety scores (P=0.89). No differences in change for SF-36 (total and mental health scores). Self reported global anxiety and functional status both improved in intervention group (46.3% v 37.0%) and reported improvement for anxiety Lewis 199613 RCT Individual patients randomised
Attenders at a single general practice with general health questionnaire (version 12) scores >2 (n=681) General health questionnaire (version 12) and computerised assessment of psychiatric symptomatology Intervention 1: questionnaire administered and placed in notes with no interpretation or instruction on the presence of mental disorder (n=227 patients) Intervention 2: patient asked to complete a computerised assessment; results were fed back to the clinician (n=227)
Control: no feedback given (n=227)
Consultation rates and clinician attribution of encounters as due to psychological or physical problems; prescription of a psychotropic drug; rates of outside mental health referrals to outside agencies; scores on questionnaire at 6 weeks and 3 and 6 months
No differences in consultation rates, but more identified as >psychological= for general health questionnaire group (P=0.09). No differences in the rate of prescriptions for psychotropics.
No differences in the rate of referral to outside agencies. Moderate improvement (5%, B3 to 14%) in general health questionnaire scores at 6 weeks for computerised feedback. No differences between groups over longer term
*Pseudorandomised study.
Related articles
- Editor's Choice Published: 17 February 2001; BMJ 322 doi:10.1136/bmj.322.7283.0
- Editor's Choice Published: 17 February 2001; BMJ 322 doi:10.1136/bmj.322.7283.0/a
- This Week In The BMJ Published: 17 February 2001; BMJ 322 doi:10.1136/bmj.322.7283.0/e
- Primary Care Published: 13 October 2005; BMJ 331 doi:10.1136/bmj.38607.464537.7C
- PRIMARY CARE Published: 15 September 2005; BMJ doi:10.1136/bmj.38607.464537.7C
- Letter Published: 21 July 2001; BMJ 323 doi:10.1136/bmj.323.7305.167/b
See more
- Introductory AddressProv Med Surg J October 03, 1840, s1-1 (1) 1-4; DOI: https://doi.org/10.1136/bmj.s1-1.1.1
- Report of the Meeting of the Eastern Branch of the Provincial Association at Bury St. Edmond'sProv Med Surg J October 03, 1840, s1-1 (1) 10-13; DOI: https://doi.org/10.1136/bmj.s1-1.1.10
- Mr. Warburton's Bill for the Regulation of the Medical ProfessionProv Med Surg J October 03, 1840, s1-1 (1) 13-15; DOI: https://doi.org/10.1136/bmj.s1-1.1.13
- An Atlas of Plates, illustrative of the Principles and Practice of Obstetric Medicine and Surgery, with descriptive LetterpressProv Med Surg J October 03, 1840, s1-1 (1) 4; DOI: https://doi.org/10.1136/bmj.s1-1.1.4
- A Practical Treatise on the Diseases peculiar to Women, illustrated by Cases, &cProv Med Surg J October 03, 1840, s1-1 (1) 4-5; DOI: https://doi.org/10.1136/bmj.s1-1.1.4-a
Cited by...
- Effectiveness and cost-effectiveness of a web-based routine assessment with integrated recommendations for action for depression and anxiety (RehaCAT+): protocol for a cluster randomised controlled trial for patients with elevated depressive symptoms in rehabilitation facilities
- Understanding the complexities of collecting and using PRO data in a primary care context
- Patient-reported outcome measurements in clinical routine of trauma, spine and craniomaxillofacial surgeons: between expectations and reality: a survey among 1212 surgeons
- Impact of Patient-Reported Outcomes in Oncology: A Longitudinal Analysis of Patient-Physician Communication
- Patient Benefits From Psychosocial Care: Screening for Distress and Models of Care
- Uptake of mandatory outcome measures in mental health services
- Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis
- Does a single-item measure of depression predict mortality?
- Screening for depression in high-risk groups: prospective cohort study in general practice
- Primary care management of major depression in patients aged >=55 years:: outcome of a randomised clinical trial
- Screening and case-finding instruments for depression: a meta-analysis
- Structured patient clinician communication and 1-year outcome in community mental healthcare: Cluster randomised controlled trial
- Use of standardised outcome measures in adult mental health services: Randomised controlled trial
- Mental health screening may prove effective in primary care
- Effect of the addition of a "help" question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study
- The effectiveness of case-finding for mental health problems in primary care
- Screening for depression in primary care
- Computerised patient-specific guidelines for management of common mental disorders in primary care: a randomised controlled trial
- Selecting, designing, and developing your questionnaire
- Screening for depression in primary care with two verbally asked questions: cross sectional study
- Mild depression in general practice: time for a rethink?
- Screening for depression in primary care
- Improving the detection and management of depression in primary care
- Feasibility and Compliance of Automated Measurement of Quality of Life in Oncology Practice
- Depression and Psychological Distress in Patients During the Year After Curative Resection of Non-Small-Cell Lung Cancer
- Anxiety Disorders in Cancer Patients: Their Nature, Associations, and Relation to Quality of Life
- Managing depression in physical illness
- 4 factors were predictive of extended duration in hospital in acute psychiatric admission
- Psychiatrists in the UK do not use outcomes measures: National survey
- Improving the delivery and organisation of mental health services: beyond the conventional randomised controlled trial
- Review: questionnaire feedback to clinicians improves recognition of psychiatric disorders in high risk patients but not in all patients in non-psychiatric settings
- Questionnaires for depression and anxiety