Screening

Brief, self-report questionnaires (e.g., Clinically Useful Social Anxiety Disorder Outcome Scale [CUSADOS], Liebowitz Social Anxiety Scale [LSAS], Mini-Social Phobia Inventory [Mini-SPIN], and Generalised Anxiety Disorder 7 [GAD-7]) can be used to screen for the presence of significant anxiety symptoms in primary care.[46][47][48][49] For children, developmentally appropriate assessments of anxiety (e.g., Screen for Child Anxiety Related Emotional Disorders [SCARED]) are indicated.[50]

More specific self-report measures of social anxiety disorder have been developed, although their administration may take longer than the aforementioned general anxiety screening instruments.

Self-report measures should serve as an indicator for additional follow-up interview questions to assess the key features of the social anxiety disorder (e.g., excessive fears of being negatively evaluated by others or rejected, and the pervasiveness of avoidance due to the anxiety). They can also be used repeatedly across time to serve as a response indicator to treatment.

Social anxiety is highly comorbid with depression; therefore, a brief screening measure for depression, such as the Patient Health Questionnaire-9 (PHQ-9), should also be considered.[1]

The US Preventive Services Task Force (USPSTF) recommends universal screening in primary care for anxiety in children and adolescents aged 8-18 years; this applies to children and adolescents who do not have a diagnosed anxiety disorder or are not showing recognised signs or symptoms of anxiety.[51] Likewise, the USPSTF recommends universal screening for anxiety disorders for adults aged 19-64 years; evidence is insufficient on the net benefit of screening for older adults aged ≥65 years.[52] The Women's Preventive Services Initiative in the US recommends that clinicians screen women and adolescent girls aged 13 years and over for anxiety (including those without a diagnosis of anxiety disorder and those who are pregnant or postnatal). Optimal screening intervals are unknown and clinical judgement is required to determine frequency.[51][52][53]

Clinically Useful Social Anxiety Disorder Outcome Scale (CUSADOS)

CUSADOS is a 12-item self-report measure assessing affective, cognitive, and behavioural symptoms of social anxiety across a variety of social situations.[46] Respondents rate on a 5-point scale (0 = not at all true, 4 = almost always true) on how true each item is over the last week. Scores ranging between 13-16 demonstrated the maximum level of sensitivity and specificity, although the authors note that a cut-off score as low as 4 could prompt additional assessment.

Liebowitz Social Anxiety Scale (LSAS)

LSAS is a 24-item self-report measure of social anxiety symptoms.[48] Respondents rate their degree of anxiety and the extent to which they avoid performance-related and social interaction situations. An LSAS score of 80-120 indicates severe illness, 60-80 indicates moderate illness, and 40-60 indicates mild illness.

Mini-Social Phobia Inventory (Mini-SPIN)

Mini-SPIN is a brief, 3-item screening measure for generalised social anxiety symptoms. Its brevity and specificity makes it suitable for administration in primary care.[49] A cut-off score of 6 or above indicates a positive screen for social anxiety disorder.

Screen for Child Anxiety Related Emotional Disorders (SCARED)

The SCARED is a measure of various anxiety symptoms experienced by children and adolescents.[50] Child and parent versions of this measure are available. A number of versions of the SCARED exist that vary in terms of the total number of items. For the 41-item version, each item is rated on a 3-point scale ranging from 0 (not true or hardly ever true) to 2 (very true or often true) over the past 3 months. A total score of 25 or greater is indicative of a likely anxiety disorder. However, this measure is also helpful in identifying the presence of more specific anxiety-related conditions, such as panic disorder, generalised anxiety disorder, separation anxiety disorder, social anxiety disorder, and school avoidance. Obtaining a score of 8 or higher on items 3, 10, 26, 32, 39, 40, and 41 suggests likely social anxiety disorder.[50][54]

Generalised Anxiety Disorder 7 (GAD-7)

GAD-7 is a brief screening measure for assessing anxiety disorders in primary care. Seven items are scored on a 0 to 3 scale, with a total score of 8 or more indicative of a likely anxiety disorder.[47][55] GAD-7 may be used as a general screening tool for anxiety, but it is most specific for generalised anxiety disorder; specificity for detecting social anxiety is modest.[6]

It can be used to assess for the presence of comorbid generalised anxiety disorder that may need to be addressed in treatment planning.

  • 0-4: Normal; re-administer in future for monitoring.

  • 5-9: Mild anxiety symptoms; continue to monitor at follow-up.

  • 10-14: Moderate anxiety symptoms; presence of comorbid anxiety disorder possible.

  • 15-21: Severe anxiety symptoms; presence of comorbid anxiety disorder likely.

Patient Health Questionnaire-9 (PHQ-9)

May be used to screen for comorbid depression. PHQ-9 is a 9-item measure that can be used as a diagnostic and disease management tool for depression.[56] It classifies current symptoms on a scale of 0 (no symptoms) to 3 (daily symptoms). PHQ-9 scores of 0-4 are in the normal range; scores 5-9 indicate mild-range depressive symptoms; scores 10-14 indicate moderate-range depressive symptoms; scores 15-19 indicate moderate-severe-range depressive symptoms; scores 20+ indicate severe-range depressive symptoms. PHQ-9 has been validated for use in primary care settings.

Hospital Anxiety and Depression Scale (HADS)

Non-specific to social anxiety disorder. HADS is a self-report screening tool for generalised anxiety and depression made up of a questionnaire comprising 14 statements, 7 related to generalised anxiety and 7 to depression. Each statement is scored on a 4-point (0-3) response scale, allowing a range of scores from 0-21 for generalised anxiety and 0-21 for depression. Depending on the precise score obtained, each mood state can be divided into 4 categories: normal, mild, moderate, and severe.[57][58]

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