Screening for Psychosocial Distress and Psychiatric Disorders in Medicine: From Concepts to Evidence

Abstract

A key element of supportive care is the reliable assessment and measurement of psychological health. This includes detection of frank psychiatric disorders as well as broader psychological symptoms and generalized distress. Many organizations have made recommendations for assessment of psychiatric disorders and psychological distress, but despite the potential benefits, uptake of screening has been slow, and evidence that patient outcomes improve is mixed. New evidence supports multidomain-/algorithm-based screening as well on screening online and in new smartphone apps. Psychosocial assessment can be pragmatically divided into screening, clinical assessment (case finding) and severity measurement. Screening is designed to quickly ascertain which individuals in a large population need further assessment and where necessary additional care. The target of screening may be mood disorders, anxiety, distress, cognitive decline, unmet needs or any combination (multidomain approach). For patients with complex needs, a multidimensional approach may be preferable, and a multidimensional tool can be valuable as it can serve as a roadmap to a more effective way of addressing patient concerns in a timely way with appropriate referral to the right professional. Yet some forms of screening can be an additional burden to patients and clinicians unless conducted at home, online or in the waiting room. Screening for distress and/or psychological assessment should not be considered a one-off exercise but part of routine high quality of care that involves all healthcare professionals.