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Understanding scored measures

Understanding scored measures

Scored measures are self-report assessment tools that can be used to screen for mental health conditions and evaluate treatment progress. In this guide, you can learn more about the questions each measure includes and how scores are calculated.

The following scored measures are available in SimplePractice:

Note: To learn more about scored measures, see Getting started with measurement-based care.


GAD-7

The Generalized Anxiety Disorder 7-item scale, or GAD-7, is a tool designed to measure the presence and severity of anxiety. It includes the following questions:

Over the last 2 weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
2. Not being able to stop or control worrying Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
3. Worrying too much about different things Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
4. Trouble relaxing Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
5. Being so restless that it’s hard to sit still Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
6. Becoming easily annoyed or irritable Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
7. Feeling afraid as if something awful might happen Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult

The GAD-7 is calculated by assigning a score of 0, 1, 2, or 3 to the answers to questions 1-7, and the total score ranges from 0 to 21.

Score Anxiety severity
0-4  None-minimal
5-9  Mild
10-14 Moderate
15-21 Severe

Source

  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092–1097.

PHQ-9

The Patient Health Questionnaire-9, or PHQ-9, is a tool designed to measure the presence and severity of depression. It includes the following questions:

Over the last 2 weeks, how often have you been bothered by any of the following?
1. Little interest or pleasure in doing things Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
2. Feeling down, depressed, or hopeless Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
3. Trouble falling or staying asleep, or sleeping too much Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
4. Feeling tired or having little energy Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
5. Poor appetite or overeating Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
7. Trouble concentrating on things, such as reading the newspaper or watching television Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
9. Thoughts that you would be better off dead or of hurting yourself in some way Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult

The PHQ-9 is calculated by assigning scores of 0, 1, 2, or 3 to answers for questions 1-9, and the total score ranges from 0 to 27.

Score Depression severity
0-4  None-minimal
5-9  Mild
10-14 Moderate
15-19 Moderately Severe
20-27 Severe

Source

  • Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515.

PHQ-15

The Patient Health Questionnaire Physical Symptoms, or PHQ-15, is a tool designed to assess somatic symptom severity and the potential presence of somatization and somatoform disorders. It includes the following questions:

During the past 4 weeks, how much have you been bothered by any of the following problems?
1. Stomach pain  Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
2. Back pain Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
3. Pain in your arms, legs, or joints (knees, hips, etc.) Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
4. Menstrual cramps or other problems with your periods Not bothered at all (0) Bothered a little (1) Bothered a lot (2) Not applicable (0)
5. Headaches Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
6. Chest pain Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
7. Dizziness  Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
8. Fainting spells Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
9. Feeling your heart pound or race Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
10. Shortness of breath Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
11. Pain or problems during sexual intercourse Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
12. Constipation, loose bowels, or diarrhea  Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
13. Nausea, gas, or indigestion Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
14. Feeling tired or having low energy Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  
15. Trouble sleeping Not bothered at all (0) Bothered a little (1) Bothered a lot (2)  

The PHQ-15 is calculated by assigning a score of 0, 1, or 2, to the answers to questions 1-15, and the total score ranges from 0 to 30.

Score Somatic Symptom severity
0–4 Minimal
5–9 Low
10–14 Medium
15–30 High

Source

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258–266.

PCL-5

The PTSD Checklist for DSM-5, or PCL-5, is a tool designed to measure the presence and severity of Post-Traumatic Stress Disorder (PTSD) symptoms. It includes the following questions:

In the past month, how much were you bothered by:
1. Repeated, disturbing, and unwanted memories of the stressful experience?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
2. Repeated, disturbing dreams of the stressful experience? Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
4. Feeling very upset when something reminded you of the stressful experience? Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
6. Avoiding memories, thoughts, or feelings related to the stressful experience?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
8. Trouble remembering important parts of the stressful experience? Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
10. Blaming yourself or someone else for the stressful experience or what happened after it?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
12. Loss of interest in activities that you used to enjoy?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
13. Feeling distant or cut off from other people?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
15. Irritable behavior, angry outbursts, or acting aggressively?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
16. Taking too many risks or doing things that could cause you harm?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
17. Being “superalert” or watchful or on guard?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
18. Feeling jumpy or easily startled?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
19. Having difficulty concentrating?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
20. Trouble falling or staying asleep?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)

The PCL-5 is calculated by assigning a score of 0, 1, 2, 3, or 4 to the answers to questions 1-20, and the total score ranges from 0 to 80.

Score PTSD severity
0–31 Below clinical threshold
32–80 Above clinical threshold

Source

  • Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD.

AUDIT

The Alcohol Use Disorders Identification Test: Self-Report Version, or AUDIT, is a tool designed to screen for excessive alcohol consumption, consequences of drinking, and alcohol related symptoms. It includes the following questions:

Select the option that best describes your answer to each question:
1. How often do you have a drink containing alcohol? Never (0) Monthly or less (1) 2-4 times a month (2) 2-3 times a week (3) 4 or more times a week (4)
2. How many drinks containing alcohol do you have on a typical day when you are drinking? 1 or 2 (0) 3 or 4 (1) 5 or 6 (2) 7 to 9 (3) 10 or more (4)
3. How often do you have six or more drinks on one occasion?  Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
4. How often during the last year have you found that you were not able to stop drinking once you had started? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
5. How often during the last year have you failed to do what was normally expected of you because of drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
7. How often during the last year have you had a feeling of guilt or remorse after drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
8. How often during the last year have you been unable to remember what happened the night before because of your drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
9. Have you or someone else been injured because of your drinking? No (0)   Yes, but not in the last year (2)   Yes, during the last year (4)
10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down? No (0)   Yes, but not in the last year (2)   Yes, during the last year (4)

The AUDIT is calculated by assigning a score of 0, 1, 2, 3, or 4 to the answers to questions 1-8, and a score of 0, 2, or 4 to questions 9 and 10. The total score ranges from 0 to 40.

Score Risk category Interpretation content
0–7 Zone I Low-risk drinking or abstinence
8-15 Zone II At-risk use
16-19 Zone III Harmful and hazardous use
20-40 Zone IV Possible substance use disorder

The AUDIT can be broken into 3 conceptual domains:

  • Alcohol consumption (items 1-3)
  • Alcohol-related symptoms (items 4-6)
  • Alcohol-related harm (7-10)

Sources

  • Babor, T. F. , Higgins-Biddle, J. C. , Saunders, J. B. , Monteiro, M. G. , & World Health Organization. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (2nd ed.). Geneva, Switzerland: World Health Organization.
  • Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction, 88(6), 791–804.

WSAS

The Work and Social Adjustment scale, or WSAS, is a tool designed to measure how one’s mental health affects the ability to do certain day-to-day tasks. It includes the following statements:

On a scale, rate how much your mental health impairs your ability to carry out the following activities: 
1. Because of my mental health, my ability to work is impaired. 0 (Not at all) 1 2 (Slightly) 3 4 (Definitely) 5 6 (Markedly) 7 8 (Very severely)
2. Because of my mental health, my home management (cleaning, tidying, shopping, cooking, looking after home or children, paying bills) is impaired. 0 (Not at all) 1 2 (Slightly) 3 4 (Definitely) 5 6 (Markedly) 7 8 (Very severely)
3. Because of my mental health, my social leisure activities (with other people e.g. parties, bars, clubs, outings, visits, dating, home entertaining) are impaired. 0 (Not at all) 1 2 (Slightly) 3 4 (Definitely) 5 6 (Markedly) 7 8 (Very severely)
4. Because of my mental health, my private leisure activities (done alone, such as reading, gardening, collecting, sewing, walking alone) are impaired. 0 (Not at all) 1 2 (Slightly) 3 4 (Definitely) 5 6 (Markedly) 7 8 (Very severely)
5. Because of my mental health, my ability to form and maintain close relationships with others, including those I live with, is impaired. 0 (Not at all) 1 2 (Slightly) 3 4 (Definitely) 5 6 (Markedly) 7 8 (Very severely)

The WSAS is calculated by assigning a score of 0-8 to the answers to statements 1-5,  and the total score ranges from 0 to 40. 

Score Functional impairment severity
0-9 None or subclinical
10-19 Significant
20-40 Moderately severe

Source

  • Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. H. (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. The British Journal of Psychiatry: The Journal of Mental Science, 180, 461–464.

PEG

The Pain, Enjoyment, General Activities scale, or PEG, is a tool designed to assess pain intensity and interference. It includes the following questions:

 
1. What number best describes your pain on average in the past week?  0 (No pain) 1 3 5 7 9 10 (Pain as bad as you can imagine)
2. What number best describes how, during the past week, pain has interfered with your enjoyment of life? 0 (Does not interfere) 1 3 5 7 9 10 (Completely interferes)
3. What number best describes how, during the past week, pain has interfered with your general activity? 0 (Does not interfere) 1 2 3 4 5 6 7 8 9 10 (Completely interferes)

The PEG is calculated by assigning a score of 0-10 to the answers to questions 1-3, and the total score ranges from 0 to 10. To calculate the score, first find the average by dividing the sum of points by the total number of questions (for example, 30 points divided by 3 equals 10), then round to the nearest tenth.

Score Pain severity
0-3.9 Mild pain
4-6.9 Moderate pain
7-10 Severe pain

Source

  • Krebs, E. E., Lorenz, K. A., Bair, M. J., Damush, T. M., Wu, J., Sutherland, J. M., Asch, S. M., & Kroenke, K. (2009). Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. Journal of General Internal Medicine, 24(6), 733–738.

Y-BOCS

The Yale-Brown Obsessive Compulsive Scale, or Y-BOCS, is a tool designed to measure obsessive-compulsive disorder (OCD) symptom severity and treatment response. It includes the following:

Obsessions 

Obsessions are unwanted ideas, images or impulses that intrude on thinking against your wishes and efforts to resist them. They usually involve themes of harm, risk and danger. Common obsessions are excessive fears of contamination; recurring doubts about danger, extreme concern with order, symmetry, or exactness; fear of losing important things. 

Please answer each question:

1. Time occupied by obsessive thoughts 

How much of your time is occupied by obsessive thoughts?

None (0) Less than 1 hr/day or occasional occurrence (1) 1 to 3 hrs/day or frequent (2) Greater than 3 and up to 8 hrs/day or very frequent occurrence (3) Greater than 8 hrs/day or nearly constant occurrence (4)

2. Interference due to obsessive thoughts

How much do your obsessive thoughts interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of them?

None (0) Slight interference with social or other activities, but overall performance not impaired (1) Definite interference with social or occupational performance, but still manageable (2) Causes substantial impairment in social or occupational performance (3) Incapacitating (4)

3. Distress associated with obsessive thoughts

How much distress do your obsessive thoughts cause you?

None (0) Not too disturbing (1) Disturbing, but still manageable (2) Very disturbing (3) Near constant and disabling distress (4)

4. Resistance against obsessions

How much of an effort do you make to resist the obsessive thoughts? How often do you try to disregard or turn your attention away from these thoughts as they enter your mind?

Try to resist all the time (0) Try to resist most of the time (1) Make some effort to resist (2) Yield to all obsessions without attempting to control them, but with some reluctance (3) Completely and willingly yield to all obsessions (4)

5. Degree of control over obsessive thoughts

How much control do you have over your obsessive thoughts? How successful are you in stopping or diverting your obsessive thinking? Can you dismiss them?

Complete control (0) Usually able to stop or divert obsessions with some effort and concentration (1) Sometimes able to stop or divert obsessions (2) Rarely successful in stopping or dismissing obsessions, can only divert attention with difficulty (3) Obsessions are completely involuntary, rarely able to even momentarily alter obsessive thinking (4)

Compulsive behaviors

Compulsions are urges that people have to do something to lessen feelings of anxiety or other discomfort. Often they do repetitive, purposeful, intentional behaviors called rituals. The behavior itself may seem appropriate but it becomes a ritual when done to excess. Washing, checking, repeating, straightening, hoarding and many other behaviors can be rituals. Some rituals are mental. For example, thinking or saying things over and over under your breath.

Please answer each question:

6. Time spent performing compulsive behaviors

How much time do you spend performing compulsive behaviors? How much longer than most people does it take to complete routine activities because of your rituals? How frequently do you do rituals?

None (0) Less than 1 hr/day, or occasional performance of compulsive behaviors (1) From 1 to 3 hrs/day, or frequent performance of compulsive behaviors (2) More than 3 and up to 8 hrs/day, or very frequent performance of compulsive behaviors (3) More than 8 hrs/day, or near constant performance of compulsive behaviors (too numerous to count) (4)

7. Interference due to compulsive behaviors

How much do your compulsive behaviors interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of the compulsions?

None (0) Slight interference with social or other activities, but overall performance not impaired (1) Definite interference with social or occupational performance, but still manageable (2) Causes substantial impairment in social or occupational performance (3) Incapacitating (4)

8. Distress associated with compulsive behavior

How would you feel if prevented from performing your compulsion(s)? How anxious would you become?

None (0) Only slightly anxious if compulsions prevented (1) Anxiety would mount but remain manageable if compulsions prevented (2) Prominent and very disturbing increase in anxiety if compulsions interrupted (3) Incapacitating anxiety from any intervention aimed at modifying activity (4)

9. Resistance against compulsions

How much of an effort do you make to resist the compulsions?

Always try to resist (0) Try to resist most of the time (1) Make some effort to resist (2) Yield to all compulsions without attempting to control them, but with some reluctance (3) Completely and willingly yield to all compulsions (4)

10. Degree of control over compulsive behavior

How strong is the drive to perform the compulsive behavior? How much control do you have over the compulsions?

Complete control (0) Pressure to perform the behavior but usually able to exercise voluntary control over it (1) Strong pressure to perform behavior, can control it only with difficulty (2) Very strong drive to perform behavior, must be carried to completion, can only delay with difficulty (3) Drive to perform behavior experienced as completely involuntary and over-powering, rarely able to even momentarily delay activity (4)

The Y-BOCS is calculated by assigning a score of 0, 1, 2, 3, or 4 to the answers to questions 1-10, and the total score ranges from 0 to 40.

Score Obsessive-compulsive disorder
0–7 No or sub-clinical
8–15 Mild
16–23 Moderate
24–31 Severe
34–40 Extreme

Source

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, H. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.

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