Part of the screening is an initial assessment through specific questioning as to whether the problem could be related to the area of emotional function. Should the screening raise any such suspicion, a psychologist will be brought into the team for the subsequent diagnostics. The questioning follows internationally validated and standardised survey instruments.
Procedure: In the screening the patient answers the following questions:
“How often in the past two weeks (since your accident) have you felt affected by the following problems:”
1) Little interest in or enjoyment of activities
2) Despondency, depression or hopelessness
3) Nervousness, anxiety or tension
4) Not being in a position to stop or control your worries
The patient may choose from the following reply options: (1) never, (2) on a few days, (3) on more than half the days, (4) almost every day.
Patients with hand injuries are also asked the following questions, which may be answered with a ‘yes‘ or ‘no‘:
5) “Do you feel so severely burdened by dealing with your accident and its resulting injuries, that your general state of health is noticeably affected?”
Questions (1) and (2) target the identification of a possible disturbance of a depressive nature, questions (3) and (4) seek the suggestion of an anxiety disorder and (5) probes to identify any possible post-traumatic stress disorder. Since question (5) only targets possible post injury problems the question would not be asked of patients with hand diseases. The patient responds to the presence of a possible disorder for each area using the established answer options. The doctor documents the patient’s replies.
Should the interview result in a point score of at least 3 in questions (1) and (2) and/ or (3) and (4), and/ or if question (5) is answered with ‘yes’, a psychologist will be added to the testing team to carry out further supplementary tests to clarify the situation.
The following three surveys can be adopted for supplementary testing:
The “PHQ-9” module can be implemented for the diagnosis of a depressive disorder, the “GAD-7” module is used for the diagnosis of anxiety disorders. Both modules are components of the Patient Health Questionnaire (PHQ) [1,2]. The diagnosis of a post-traumatic stress disorder is helped by the use of the revised version of the Impact of Event Scale (IES-R) [3,4]. Should any of these questionnaires be adopted, the psychologist asks the patient to fill it out.
The results from the questionnaire serve as a basis for the assessment of the presence of a diagnosis and the severity of the disorder.
1. Gräfe K, Zipfel S, Herzog W, Löwe B. Screening psychischer Störungen mit dem „Gesundheitsfragebogen für Patienten (PHQ-D). Ergebnisse der deutschen Validierungsstudie. Diagnostica; 2004;50:171-181.
2. Löwe B, Spitzer RL, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen. 2. Auflage. Karlsruhe: Pfizer, 2002.
3.Weiss DS & Marmar CR (1996) The Impact of Event Scale – Revised. In JP Wilson & TM Keane (eds) Assessing psychological trauma and PTSD (pp 399-411). New York: Guilford
4. Maercker, A. & Schützwohl, M. (1998). Erfassung von psychischen Belastungsfolgen: Die Impact of Event Skala-revidierte Version (IES-R). Diagnostica, 44(3), 130-141.