Appendix I: Mental Health Screening Tools

Updated August 2007

Screening Tools for Completing Mental Health Assessments in HIV Primary Care Settings
Abbreviation (Full Name)	Screens for:	Administered by:	Items/Minutes	Notes
BAI (Beck Anxiety Inventory)	Anxiety	Patient	21 items, 5 minutes
BDI-II (Beck Depression Inventory-II)	Depression	Patient	21 items, 10 minutes	The most widely accepted measure of depressive distress. Originally developed for use as a measure of symptom severity in psychiatric patients, it has also been used in numerous studies of depression in medically ill patients.†‡
BSI 18 (Brief Symptom Inventory-18 item)	Depression, anxiety, somatization	Patient	18 items, 4 minutes	For pts >18 years
CDQ (Client Diagnostic Questionnaire)	Depression, anxiety, post-traumatic stress disorder, psychosis, alcohol and substance use, and general health worries	Trained assistant	15-20 minutes
CES-D (Center for Epidemiologic Studies Depression)	Depression	Patient	20 items	Originally designed for use in nonpsychiatric community samples. It may be the most widely used screening instrument in North America. It has also been used extensively in medically ill samples, with evidence of good psychometric properties. Studies support value of CES in the medically ill, although the positive predictive value has been relatively low in some studies, and a lack of consensus remains about the optimal cutoff score.†‡
DRS 2 (Dementia Rating Scale-2)	Measure cognitive status in adults with cognitive impairement	Patient	5 subscales (36 items total)
Duke AD (Duke Anxiety Depression Scale)	Depression, anxiety	Patient	7 items
HADS (Hospital Anxiety and Depression Scale)	Depression, anxiety	Patient	14 items	Specifically designed for use in the medically ill. A lack of consensus exists about the utility of the HADS and about the optimal cutoff scores to screen for major and minor depression.†‡
HAM-D/HDI (Hamilton Rating Scale for Depression)	Depression, anxiety, suicidal ideation, insomnia, diminished appetite, weight loss, obsessive compulsive behavior	Clinician	21 items	Widely used in psychiatric research. Has high reliability and validity for diagnosing and monitoring clinical depression.
HANDS (Harvard Dept. of Psychiatry, NDSD Scale)	Depression (other tools available)	Patient or assistant	10 items
HDS (HIV Demetia Scale)	HIV-associated dementia	Clinician	4 areas (16 points)	Timed written alphabet, recall, cube copy time, antisaccadic error task; Most users choose the shortened version (MHDS; described below), deleting the antisaccadic error task, which is difficult to administer and score.
Mental Alternation Test	HIV-associated dementia	Clinician		Patients with early dementia usually will show impairments in timed trials, such as this test.¶
MHDS (Modified HIV Dementia Scale)	HIV-associated dementia	Clinician	4 areas (12 points), 5-7 minutes	Memory-registration, psychomotor speed, memory-recall, constructional; omits the antisaccadic item in the HDS (described above).
MMSE (Mini-Mental State Exam)	Cognitive status/ability	Interviewer	11 items	This is the most widely used and tested brief battery for cortical impairment, but has lower sensitivity with signs of subcortical impairment, such as slowing and motor abnormalities.
PHQ-2	Depression	Patient or assistant	2 items	A PHQ-2 score of 3 or greater was found to have a sensitivity of 83% and specificity of 92% for major depression in a sample of primary care and OB-GYN clinic patients.†
PHQ-9 (Patient Health Questionnaire 9)	Depression	Patient or assistant	9 items	Specifically designed for the primary care setting, it has been studied in thousands of primary care and medical specialty outpatients. Spanish version has also been validated.†‡
PRIME-MD (Primary Care Evaluation of Mental Disorders)	Depression, anxiety, alcohol, eating disorders	Patient or assistant	3 pages, 5 minutes
SAMISS (Substance Abuse and Mental Illness Symptoms Screener)*	Co-occurring substance and mental health disorders	Trained assistant	13 items	Designed to detect symptoms of co-occurring substance use and mental health disorders. See Whetten K, Reif S, Swartz M, et al. A brief mental health and substance abuse screener for persons with HIV. AIDS Patient Care STDS 2005;19:89-99.
ZUNG (Zung Self-Rating Depression Scale)	Depression, insomnia, diminished appetite, weight loss, diminished self-esteem, suicidal ideation, amhedonia	Patient	20 items
* For other alcohol- and substance use-related screening tools, see the substance use clinical guidelines Screening and Ongoing Assessment for Substance Use. † From Levenson JL, ed. Textbook of Psychosomatic Medicine. American Psychiatric Publishing, Inc.; 2005:197-200. ‡ Any of these instruments (CES-D, HADS, PHQ-9, BDI-II) may be acceptable to screen for depression in the medically ill, although the evidence for the utility of the HADS is less strong than for the CES and BDI-II. The PHQ has better sensitivity and specificity than the HADS. The cutoff score used on any of these instruments should depend on the purpose of screening and resources for follow up (Levenson, 2005). ¶ From Levenson JL, ed. Textbook of Psychosomatic Medicine. American Psychiatric Publishing, Inc.; 2005:604.