The search continues for a valid, ultra-short screening questionnaire for stresses capable of causing physical illness. Once that is in place, the next step is for primary care clinicians to learn how to further evaluate a patient with a positive screen. This should then lead to systems for follow-up care and monitoring, including the option of referral to mental health clinicians experienced with patients who have physical symptoms.
Returning to the screening questionnaire, here are a few suggestions to assess areas not covered by the PHQ-4 (which was described in the last two posts in this series). Answers to the first three questions are chosen from the following and score points as indicated:
0. None 1. Mild 2. Moderate 3. Severe
1. How much stress have you experienced in your life in the last few weeks?
2. How much of a problem is it for you to balance meeting the needs of others with meeting your own needs?
3. How much are you troubled by memories of a terrifying, horrifying or traumatic event in your life?
The fourth question is answered with one of the following:
0. Happy 1. Neutral 2. Sad or Angry 3. Very Sad or Very Angry
4. If a child you cared about was growing up exactly as you did, how would this make you feel?
Unfortunately, these questions have not been validated by comparison with longer standardized questionnaires or with structured interviews. However, I have used them with hundreds of people referred to a class for patients with medically unexplained symptoms, most of whom probably had stress illness. In that setting people comprehended the questions readily. In addition, the answers from individuals varied significantly from question to question, suggesting that each query tapped into different areas of functioning.
I invite others to use these questions in practice or in research and report their validity and usefulness. In the meantime I will keep looking at the literature in this field and post what I learn.
Tags: medical interview, screening, Stress History
