Screening Tools for Behavioral Health Conditions in Primary Care

Anxiety Disorders^1–3
Routine screening for anxiety is recommended for patients aged 8 and older*

Generalized Anxiety Disorder-7 (GAD-7) (adolescents and adults, self-report, free)
Generalized Anxiety Disorder-2 (GAD-2) (adolescents and adults, self-report, free)
Patient Health Questionnaire-4 (PHQ-4) (adults, also screens for depression, self-report, free)
Screen for Child Anxiety Related Disorders (SCARED) (pediatric, self-report, free)

Attention Deficit Hyperactivity Disorder (ADHD)^4,5
Evaluation is recommended in patients aged 4 to 18 who present with academic or behavioral problems and symptoms of inattention, hyperactivity, and/or impulsivity. Evaluation is recommended in adults for whom ADHD is suspected (self-referral, adult patient referred for assessment, re-assessment of adult patient diagnosed with ADHD in childhood).

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist (adults, self-report, free)
SNAP-IV-18-Item (ages 6–18, parent- and teacher-report, free)

Eating Disorders^1–6
There is insufficient evidence to recommend routine use of screening tools for eating disorders in primary care. For youth, screening should include weight and height monitoring, looking for signs of disordered eating, and screening for body image issues. For adults, screening should include monitoring for changes in weight and other vital signs or signs and symptoms of disordered eating. High-risk patients should be monitored for symptoms of eating disorders.

Binge Eating Disorder Screener-7 (BEDS-7) (adults, self-report, free)

Mood Disorders^1–3,7
Routine screening for depression is recommended for patients aged 12 and older, including pregnant and postpartum women. Pediatricians should screen mothers for postpartum depression at the infants 1-, 2-, and 4-month well visits.

Patient Health Questionnaire-9 (PHQ-9) (adults, self-report, free)
Patient Health Questionnaire-2 (PHQ2) (adults, screens for postpartum depression, self-report, free)
Patient Health Questionnaire-4 (PHQ-4) (adults, also screens for anxiety, self-report, free)
Patient Health Questionnaire-Adolescents (PHQ-A) (adolescents, self-report, free)
Geriatric Depression Scale (short form) (older adults, self-report, free)
Edinburgh Postnatal Depression Scale (EPDS) (adolescents and adults, self-report, free)
Bipolar Spectrum Diagnostic Scale (BSDS) (adults, self-report, free)
Rapid Mood Screener (RMS) (adults, self-report, free)

Posttraumatic Stress Disorder (PTSD)s
High-risk patients should be monitored for symptoms of PTSD.

Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) (adults, self-report, free)
Child PTSD Symptom Scale (CPSS) (ages 8–18, self-report, free)

Substance Use^1,2
Routine screening (asking questions, not biologic specimens) about unhealthy drug and alcohol use is recommended in adults. Recommendations for routine screening about unhealthy drug and alcohol use in adolescents vary by organization.

CAGE Questionnaire (adolescents and adults, for alcohol use, self-report, free)
Alcohol Use Disorders Identification Test-Concise (AUDIT-C) (adolescents and adults, self-report, free)
CRAFFT Screening Test (ages 12–21, for multiple substances, clinician- or self-report, free)
Cannabis Use Disorder Identification Test-Revised (CUDIT-R) (adolescents and adults, self-report, free)

Suicide Risk^1,2,8,9
Routine screening for suicide risk is recommended for patients aged 12 years and older.

Ask Suicide-Screening Questions (ASQ) (ages 8 and older, clinician-administered, free)
Columbia-Suicide Severity Rating Scale (C-SSRS) (ages 6 and older, self-report, free)

*The American Academy of Pediatrics and Bright Futures recommends annual screening for behavioral, social, and emotional problems (including anxiety) from birth to age 21 years.³

References
1. US Preventive Services Task Force. Recommendations for mental health conditions and substance abuse. PSTF recommendations. Published 2016–2022. Accessed May 4, 2023.
2. Mulvaney-Day N, Marshall T, Downey Piscopo K et al. Screening for behavioral health conditions in primary care settings: a systematic review of the literature. J Gen Intern Med 2018;33(3):335-46.
3. Bright Futures/American Academy of Pediatrics. Recommendations for preventive pediatric health care. Published 2022. Accessed May 4, 2023.
4. Wolraich ML, Hagan Jr JF, Allan C et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatr 2019;144(4):e20192528.
5. American Academy of Family Practitioners. Adult ADHD assessment and diagnostic approach. Published 2019. Accessed May 4, 2023.
6. Hornberger LL, Lane MA; Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics 2021;147(1)e2020040279.
7. Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): part I: practice preparation, identification, assessment, and initial management. Pediatrics 2018;141(3):e20174081.
8. American Academy of Pediatrics, American Foundation for Suicide Prevention, National Institute of Mental Health. Suicide: blueprint for youth suicide prevention. Published 2022. Accessed May 4, 2023.
9. The Joint Commission. National patient safety goal for suicide prevention. Updated November 20, 2019. Accessed May 4, 2023.