Screening
Brief, self-report questionnaires can be used effectively to screen for the presence of significant depressive symptoms. More specific self-report measures of SAD have been developed. However, their administration may take longer than general depression screening instruments, such as the Patient Health Questionnaire-9 (PHQ-9). Self-report measures should serve as an indicator for additional follow-up interview questions to assess the seasonality of mood changes. They can also be used repeatedly across time to serve as a response indicator to treatment. Patients displaying an autumn or winter pattern of depressive symptoms should be additionally assessed in the spring or summer for symptom remission and/or the onset of manic or hypomanic symptoms.
Patient Health Questionnaire-9 (PHQ-9)
A brief, self-report inventory suitable for delivery in the primary care setting.[45] Nine items are scored on a 0 to 3 scale, with a total score of ≥5 suggesting depressive symptoms. Follow-up interview questions should assess for a seasonal onset and remission pattern commensurate with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) diagnostic criteria.[39] PHQ-9 does not assess for atypical depressive symptoms, which are common among autumn- or winter-onset SAD patients. Scoring is as follows:
0 to 4: normal, re-administered in future for monitoring
5 to 9: mild depressive symptoms
10 to 14: moderate depressive symptoms
15 to 19: moderately severe symptoms
20 to 27: severe symptoms.
Seasonal Health Questionnaire (SHQ)
A self-report instrument divided into 6 sections to assess depressive symptoms and their temporal association, helping to establish the ratio of seasonal to non-seasonal episodes.[50] SHQ has greater sensitivity and specificity than the Seasonal Pattern Assessment Questionnaire (another screening tool), and is more consistent with DSM-5-TR diagnostic standards.[42]
Seasonal Pattern Assessment Questionnaire (SPAQ)
A 6-item self-report measure appropriate for screening seasonal changes across a variety of atypical and vegetative symptoms, including mood, eating habits, weight, sleep, energy, and levels of social activity. Seasonal Pattern Assessment Questionnaire Opens in new window[47][48] The low specificity and poor test-retest reliability of the SPAQ may limit its utility.[51] However, the SPAQ may be beneficial in clinical settings as a brief, general index of severity and functional impairment.
Generalised Anxiety Disorder 7 (GAD-7)
A brief self-report measure for assessing anxiety severity in primary care. Seven total items are scored on a 0 to 3 scale, with a cut score of 10 or greater indicative of a likely anxiety disorder.[52][53] GAD-7 can be used to assess for the presence of comorbid anxiety conditions that may need to be addressed in treatment planning. Scoring is as follows:
0 to 4: normal, re-administered in future for monitoring
5 to 9: mild anxiety symptoms, monitoring continued at follow-up
10 to 14: moderate anxiety symptoms, presence of comorbid anxiety disorder possible
15 to 21: severe anxiety symptoms, presence of comorbid anxiety disorder likely.
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