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.