Looking to the Future of Comorbid Mental Health Screening
Comorbid Mental Health Screening
There are many mental health screening tools, such as the Generalized Anxiety Disorder Screener (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), but are these tools as good as they could be? In other words, are we screening for mental health disorders as efficiently and effectively as possible? The current approach during psychiatric intakes or assessments is to have patients fill out multiple, repetitive forms and questionnaires. This is exhausting not only for the patient but also for the practitioner who must score the questionnaires. This approach may be particularly ineffective in view of the fact that mental health conditions rarely occur in isolation — they are often comorbid.
Comorbid mental health conditions, such as mood and anxiety disorders, are very common. In fact, in one Swedish study, among participants with either depression or anxiety, nearly 50% had comorbid disorders.1 Depression and comorbid drug use is also common. In a meta-analysis of 22 unique epidemiological studies, the strongest associations found were between drug use and major depression. 2 However, these aren’t the only commonly comorbid conditions. Bipolar disorder is highly comorbid with anxiety. 3 Additionally, bipolar disorder also has high comorbidity with substance use disorder. 4
Comorbidity Increases Medical Utilization
Comorbidity also implies interactions between mental health conditions that can worsen the course of each condition. In one study, it was found that the presence of comorbidity significantly increased medical utilization. Furthermore, comorbidity was associated with greater chronicity, slower recovery, increased rates of recurrence, and greater psychosocial disability. 5 In other words, when multiple mental health conditions present themselves at the same time (as they often do) it makes them harder to treat. However, increasing recognition of the high prevalence and negative impact of comorbidity will lead to more effective treatment. Importantly, decreasing the time to diagnosis will shorten the window to therapeutic treatment.
Improve Screening Efficiency
How can this be achieved? As mentioned previously, the current approach to psychiatric diagnosis involves filling out many repetitive forms. Unfortunately, tools like the GAD-7 (published in 2006) and PHQ-9 (published in 2001) may miss things outside of the common conditions of depression and anxiety. Additionally, the GAD-7 has low sensitivity even for generalized anxiety disorder. In one study of oncology patients, the sensitivity of the GAD-7 was determined to be was low (<36%), which suggests that about 2 in every 3 cases are wrongly classified as not having GAD (false negatives).6 Although the sensitivity of the PHQ-9 is relatively high (76%), it is limited to detecting just depression.7 Additionally, under-diagnosis of bipolar disorder by the PHQ-9 was the primary reason for false positives.8
It is critical that physicians find an efficient and reliable way to screen patients for multiple mental health disorders at once. We also need to broaden our consideration of comorbidity in substance use and mental disorders. To these ends, Connected Mind’s new screening tool provides both patients and health providers with the opportunity for more efficient mental health care. This tool has been validated by a team of psychologists working as independent contractors out of the University of North Texas. It utilizes a branching logic engine to identify a person’s risk for multiple disorders, including depression, anxiety, attention deficit hyperactivity disorder (ADHD), bipolar disorder, substance use, and somatic symptom disorder, making it more comprehensive than existing screening practices. It also evaluates a person’s risk for suicidal behaviors. Finally, this tool can be used remotely for use with telemedicine. In the wake of COVID-19, this is more important than ever before.
Helping patients come to a diagnosis and begin treatment quickly and efficiently is a priority, and Connected Mind can shorten this window to treatment by expediting the diagnostic process. Click here to see a video on how this tool works.
1 – Johansson, Robert, et al. “Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life.” PeerJ 1 (2013): e98.
2 – Lai, Harry Man Xiong, et al. “Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: A systematic review and meta-analysis.” Drug and alcohol dependence 154 (2015): 1-13.
3 – Yapici Eser, Hale, et al. “Prevalence and associated features of anxiety disorder comorbidity in bipolar disorder: a meta-analysis and meta-regression study.” Frontiers in psychiatry 9 (2018): 229.
4 – Hunt, Glenn E., et al. “Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: systematic review and meta-analysis.” Journal of affective disorders 206 (2016): 331-349.
5 – Hirschfeld, Robert MA. “The comorbidity of major depression and anxiety disorders: recognition and management in primary care.” Primary care companion to the Journal of clinical psychiatry 3.6 (2001): 244.
6 – Clover, Kerrie, et al. “Apples to apples? Comparison of the measurement properties of hospital anxiety and depression-anxiety subscale (HADS-A), depression, anxiety and stress scale-anxiety subscale (DASS-A), and generalised anxiety disorder (GAD-7) scale in an oncology setting using Rasch analysis and diagnostic accuracy statistics.” Current Psychology (2020): 1-10.
7 – Carey, Mariko, et al. “Comparison of a single self-assessment item with the PHQ-9 for detecting depression in general practice.” Family practice 31.4 (2014): 483-489.
8 – Inoue, Takeshi, et al. “Utility and limitations of PHQ-9 in a clinic specializing in psychiatric care.” BMC psychiatry 12.1 (2012): 73.