Mental health assessments are used for several different reasons in therapy. Assessments can provide information for diagnosis or to maintain a check on the progress or severity of symptoms. They can reassure clients that they are on the right track and help therapists keep an eye on any potential red flags or warning signs with their client’s condition.
Psychological evaluation versus mental health assessments
It is important to differentiate between a psychological evaluation and an assessment tool. A full psychological evaluation is a large battery of tests and clinical interviews which collects a plethora of information about the identified client and their situation. This is then analyzed by a trained psychology professional with a Master’s Degree or Ph.D. Depending on the level of evaluation needed, and a large report with information about the assessment results, interpretation, diagnosis, and treatment recommendations is written. This test battery is likely to include intellectual, achievement, and personality tests that require specific training and licensure to administer and interpret.
This type of evaluation is typically quite thorough, time-consuming, and costly; evaluations are typically completed over multiple days and take more days to analyze, assemble, and report on. Psychological evaluations need to be done in person as many psychological tests must be completed in person face to face.
Mental health assessments, on the other hand, tend to be more brief and specific. Many of the evaluations we will discuss have 20 or fewer questions and are related to either a specific disorder or are general questionnaires intended to guide the clinician to another assessment for a specific disorder. Assessments are typically self-report in nature and can be completed in person, however, even in person, they are often completed outside of meetings,s and completing the assessments online is commonplace.
Mental health assessment
| Assessments for Depression | Abbreviation |
|---|---|
| Patient Health Questionnaire | (PHQ-9) |
| Beck Depression Inventory | (BDI) |
| Self-Rating Depression Scale | (SDS) |
| Assessments for Anxiety | Abbreviation |
| Beck Anxiety Inventory | (BAI) |
| Generalized Anxiety Disorder-7 | (GAD-7) |
| Depression Anxiety Stress Scales | (DASS) |
| Assessments for PTSD | Abbreviation |
| PTSD Checklist for DSM-V | (PCL-5) |
| International Trauma Questionnaire | (IRAQ) |
| Clinician-Administered PTSD Scale for DSM-V | (CAP-5) |
| Assessments for Suicidality and Self-harm | Abbreviation |
| Columbia-Suicide Severity Rating Scale | C-SSRS |
| SAD person Scale | |
| Self-Harm Inventory | (SHI) |
Mental health assessments for depression
Several mental health assessments or screeners for depression exist. The three discussed here are most commonly used in practices. They are all fairly short and directly ask about typical symptoms of depression simply and understandably. While they all have specific scoring methods, it is easy enough for a clinician to look at the raw answers to the questions and see how the client is functioning that day.
Patient Health Questionnaire (PHQ-9)
The PHQ-9 is a nine-question subset focused on depression from the 3-page patient health questionnaire and was first used in 2001. Originally intended for screening of depression symptoms in a primary care setting, this questionnaire is useful for anyone assessing depression as it is based on the DSM-4 symptoms specific to major depression. Each question has answers that range from 0 (not at all) to 3 (nearly every day). The PHQ-9 also has the advantage of being free and readily available to clinicians. More information about the PHQ-9 can be found in the American Psychological Association’s article.
Beck Depression Inventory (BDI)
The BDI was originally developed in 1961 as an inventory to assess the severity of depressive symptoms. It is a 21-question screener where answers range from not at all to high intensity regarding the client’s symptoms in the past week. The BDI has been modified a few times since its inception and exists in short form and an updated BDI-II form. The BDI requires the purchase of a license for its use and like other self-report forms can be falsified if the individual chooses to be dishonest. It is important to remember that assessments like these are intended to be part of the diagnostic assessment, not used as a sole measure of diagnosis.
Self-Rating Depression Scale (SDS)
The SDS was also developed in the 1960s but is readily and freely available to individuals who wish to use it. It consists of 20 self-report questions related to symptoms of depression where answers range from “none of the time” to “most of the time.” Answers are then assigned a number to get the raw score and converted to get the total score. There is also a clinician-rated scale available.
Mental Health Assessments for Anxiety
Anxiety is another area with many assessments available. The most common assessments will be covered here, but it’s important to note that a variety of different anxiety disorders and presentations are available. The correct assessment should match the individual’s disorder and symptom presentation.
Beck Anxiety Inventory (BAI)
The BAI is a self-report mental health assessment developed to measure the severity of anxiety. It was developed by pulling information from the PDR checklist, the Anxiety checklist, and the situational anxiety checklist. Analysis was completed repeatedly to decrease from 86 questions to 21 which best represents anxiety. It utilizes a four-point scale to measure how bothered by symptoms the individual has been.
Generalized Anxiety Disorder-7 (GAD-7)
The GAD-7 was originally developed for Generalized Anxiety disorder but is increasingly used for any type of anxiety screening. It is a 7-question screener with answers ranging from not at all to nearly every day. The general nature of the questions allows them to be easily adapted to other anxiety disorders making it an easy way to maintain an accounting of symptom severity.
Depression Anxiety Stress Scales (DASS)
There are two different versions of the Depression Anxiety Stress Scale – a 21-question version, and a 42-question version. Each measures symptoms of depression, anxiety, and stress and their severity. For complex depression affected by symptoms of anxiety and stress, this measure is a great way for clinicians to keep track of symptoms and severity as a measure of how the client is doing and the progress being made. Both versions of the scale are readily available online and easy to use by any mental health professional.
Mental Health Assessments for PTSD
In the area of mental health, PTSD is an area that has rapidly evolved over the last 100 years from a place of complete ignorance and denial to a place more of acceptance and understanding. This evolution has allowed combat veterans and civilians who have experienced trauma to seek out treatment more readily which has encouraged the development of several assessments for the diagnosis and ongoing monitoring of trauma symptoms.
PTSD Checklist for DSM-V (PCL-5)
The PCL-5 is the most updated version of the PTSD checklist. It is a 20-question self-report questionnaire that can be used to screen for PTSD, monitor symptoms and progress before, during, and after treatment, and make a provisional diagnosis of PTSD. It utilizes a 5-point scale and is not time-consuming for the client to complete regularly. This is a freely accessible mental health assessment but should be limited to being interpreted by trained clinicians. More information is available on the VA website.
International Trauma Questionnaire (ITQ)
The ITQ is set up for PTSD and Complex PTSD as defined by ICD-11. It is 18 questions in all, 9 for PTSD and 9 for CPTSD. They are all simply worded and related to diagnostic criteria. The questionnaire uses a five-point Likert scale to measure how much each criteria point has bothered the individual in the past month. Again this measure can be used to screen for PTSD, monitor symptoms and progress before, during, and after treatment, and make a provisional diagnosis of PTSD. It is available along with references, resources, and more information on the ITQ website in a variety of languages.
Clinician-Administered PTSD Scale for DSM-V (CAP-5)
The CAP-5 is specifically geared towards PTSD as defined by the DSM-V. It is clinician-administered and requires specific training, which is easily available on the Veteran Affairs website. Training goes over the questions involved as well as the follow-up/clarifying responses the clinician can use. It can be used to diagnose and assess PTSD in “veteran and civilian trauma survivors.” The VA website touts this as the “gold standard” of PTSD assessment. The longest of the assessments mentioned here, this scale takes approximately 45-60 minutes to complete.
Mental Health Assessments for Suicidality and Self-Harm
Because suicide is still fairly rare and unpredictable, evaluating the threat can be complicated and some methods of assessment have been devised to assist clinicians in this process. The most useful tool in a clinician’s toolbox to assess suicidality or self-harm behaviors is the clinical interview. Most clinicians are thoroughly trained in the series of questions to ask to probe for suicidality and this remains the most effective measure to use.
Columbia-Suicide Severity Rating Scale
The Columbia scale was developed at Columbia University with the University of Pennsylvania, and the University of Pittsburgh and focuses on suicidal ideation as a predictor of suicidal action. The Columbia scale is a brief mental health assessment that can be administered in the field by individuals not trained as mental health professionals to determine the next steps to be taken. The scale consists of 6 simple yes or no style questions. The Columbia scale is even available via a free app that can walk an individual through the questionnaire and guide them based on given answers which is available in both the google play store and the Apple app store.
SAD person Scale
The SAD person scale is part pneumonic to remember risk factors in suicidality and part scale to recognize the level of risk. It is widely used especially in non-psychiatric settings.
The scale consists of:
- S: Sex: Male
- A: Age <19 or >45
- D: Depression
- P: Previous attempt
- E: Excessive alcohol or substance use
- R: Rational thinking loss
- S: Social support lacking
- O: Organized plan
- N: No partner
- S: Sickness
For each positive factor, the clinician should add one point.
3-6 points indicate a follow-up needed
7-10 indicates high risk and the potential need for admission to a hospital.
Self-Harm Inventory (SHI)
The Self-Harm Inventory is a 22-question yes/no inventory of potential self-harm behaviors. It is a self-report mental health assessment and while it is not an exhaustive list of potential behaviors, it is fairly comprehensive. As with suicidality, a clinical interview is typically the best policy for understanding the severity of behaviors, however, at times when a quick screener is needed, the SHI is a short and simple measure with benefit.
Potential Problems with mental health assessments
While mental health assessments have a variety of uses, some potential problems, and drawbacks to existing.
Dishonesty is a problem that is potentially an issue with any reported symptoms. While more advanced psychological testing has values that differentiate between honest individuals and individuals that are not honest, basic screeners and assessments have nothing to validate the honesty level of the individual. The biggest risk is individuals “faking good,” particularly with screeners for suicidality and hiding negative symptoms from clinicians. Individuals endorsing worse symptoms than they are experiencing is a risk too. However, this exaggeration can be explored in therapy if the clinician finds that the self-report doesn’t match the presentation in person. Many reasons can exist behind the exaggeration of symptoms, but each one of them provides important information to the clinician about the individual, therefore, there is a benefit in assessment.
The ambiguous nature of mental health disorders also makes assessment difficult. Many disorders have overlapping symptoms or presentations and there is no blood test for mental health disorders like physical health disorders. Assessments for depression often ask about difficulty concentrating which could come from attention disorders as one example.
Additionally, some assessments lack consistent evidence of validity. For example, most assessments of suicidality often lack consistency in predicting those individuals who follow through with suicide. Some assessments of depression and hopelessness are better at predicting suicide than suicidal assessments.
Challenges of assessing online
Many mental health assessments can easily be used online as effectively as they are in person. A majority of the assessments discussed above are self-report, when done in person may not even be completed in front of the clinician.
Additionally, many mental health assessments cannot be completed online. Intelligence tests and projective tests have to be conducted in person or through telehealth and some assessments need behavioral observations.
Benefits of using mental health assessments
While there are some negatives to using mental health assessments in treatment, there are benefits like allowing progress to be monitored and assisting in diagnosis. A significant benefit of mental health assessments is the ability to quantitatively measure treatment progress. When assessments are given at the beginning of treatment to measure the severity of symptoms and periodically throughout treatment, then both client and provider can visually see the progress being made.
Additionally, mental health assessments can give a name to what is going on. The unknown in treatment is the worst feeling that most people ever experience. Having a name and an idea of what to do about it can be a relief to the patient who has been suffering from symptoms and not knowing what to do about it. Suffering and dealing with confusion and frustration can often feel so much worse than finally having an answer.
