Behavioral Health Toolkit: Depression & Anxiety

Domain: Anxiety - All Types

Number of Items: 41 child/parent

Time to Administer: 10 minutes

Age Range: 8 to 18

Cost/Copyright/Permission: $0/freely available/no permissions required

Informant: Parent report; child self-report

Exclusions (e.g. low-functioning, literacy level): Must be able to read (no picture version)

Format (e.g. paper, online, keyed into EHR): Paper

Availability in Other Languages: Yes

Scoring: Templates available

Cutoffs Established: >25 for children (see blue box below)

Use in Epilepsy Populations: Yes

Use in Medical Populations: Yes

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: n/a

Other Useful Information: The child and parent versions of the SCARED have moderate parent-child agreement and good internal consistency, test-retest reliability, and discriminant validity, and it is sensitive to treatment response.

References:

• Stefanovic, Dejan, Jasna Jancic, and Aneta Lakic. "The impact of depression and anxiety disorder symptoms on the health‐related quality of life of children and adolescents with epilepsy." Epilepsia 52.8 (2011): e75-e78.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339086/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472098/
• Dagar A, Anand A, Pestana-Knight E, Timmons-Mitchell J, Tossone K, Zemba D, Falcone T. Screening for suicidality and its relation to undiagnosed psychiatric comorbidities in children and youth with epilepsy. Epilepsy Behav. 2020 Dec;113:107443. doi: 10.1016/j.yebeh.2020.107443. Epub 2020 Nov 3. PMID: 33152581.
  

For more information, please contact Dr. Bimaher at 412-246-5235 or via email.

Domain: Anxiety - All Types

Number of Items: 44 adult

Time to Administer: 10 minutes

Age Range: 18+

Cost/Copyright/Permission: $0/freely available/no permissions required

Informant: Adult; self

Exclusions (e.g. low-functioning, literacy level): Must be able to read (no picture version)

Format (e.g. paper, online, keyed into EHR): Paper

Availability in Other Languages: Yes

Scoring: Templates available

Cutoffs Established: >23 for adults (see blue box below)

Use in Epilepsy Populations: No

Use in Medical Populations: n/a

Use in Diverse Populations: Has been used in adults with autism

Used Longitudinally/Response to Treatment: n/a

Other Useful Information: The total and each factor scores demonstrated good internal consistency (α= 0.86 – 0.97) and good discriminant validity between anxiety and other disorders and within anxiety disorders for generalized and social anxiety. Area Under the Curve for the total and each of the factor scores ranged between 0.72 and 0.84 (p< 0.0001).

References:

• Stefanovic, Dejan, Jasna Jancic, and Aneta Lakic. "The impact of depression and anxiety disorder symptoms on the health‐related quality of life of children and adolescents with epilepsy." Epilepsia 52.8 (2011): e75-e78.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339086/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472098/
• Dagar A, Anand A, Pestana-Knight E, Timmons-Mitchell J, Tossone K, Zemba D, Falcone T. Screening for suicidality and its relation to undiagnosed psychiatric comorbidities in children and youth with epilepsy. Epilepsy Behav. 2020 Dec;113:107443. doi: 10.1016/j.yebeh.2020.107443. Epub 2020 Nov 3. PMID: 33152581.
  

For more information, please contact Dr. Bimaher at 412-246-5235 or via email.

Domain: General Behavioral Screener Across 5 Scales - Emotional Symptoms/Conduct Problems

Number of Items: 5 for the emotional scale; 25 for total measure

Time to Administer: 5 minutes

Age Range: 4 to 17; Self (11-16)

Cost/Copyright/Permission: $0/copyrighted/no permission required

Informant: Caregiver; child self; teacher

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): Paper; OK to make REDCap form

Availability in Other Languages: Yes, translated to 40 languages

Scoring: Automated scoring on website (including scoring syntax for several platforms - SPSS, SAS, R)

Cutoffs Established: 4 categories (80% ‘close to average’, 10% ‘slightly raised, 5% ‘high’, and 5% ‘very high’) 

Use in Epilepsy Populations: Yes

Use in Medical Populations: Yes

Use in Diverse Populations: Yes

Used Longitudinally/Response to Treatment: n/a

References:

• sdqinfo.com
• Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A Research Note. Journal of Child Psychology and Psychiatry, 38(5), 581-586
• Epilepsy studies (not exhaustive):
  • Tanabe T, Kashiwagi M, Shimakawa S, Fukui M, Kadobayashi K, Azumakawa K, Tamai H, Wakamiya E. Behavioral assessment of Japanese children with epilepsy using SDQ (strengths and difficulties questionnaire). Brain Dev. 2013 Jan;35(1):81-6. 
  • Salayev KA, Sanne B, Salayev R. Psychiatric and Behavioural Problems in Children and Adolescents with Epilepsy. East Asian Arch Psychiatry. 2017 Sep;27(3):106-14. 
  • Hessen E, Alfstad KÅ, Torgersen H, Lossius MI. Tested and reported executive problems in children and youth epilepsy. Brain Behav. 2018 Apr 16;8(5):e00971.
  • Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Helen Cross J, Das KB, Gillberg C, Neville BGR, Scott RC. Autism, ADHD and parent-reported behavioural difficulties in young children with epilepsy. Seizure. 2019 Oct;71:233-239. 
  •  George C, Felix SA, McLellan A, Shetty J, Middleton J, Chin RF, Poveda B, Brand C, Small M, Verity K. Pilot project of psychological services integrated into a pediatric epilepsy clinic: Psychology Adding Value - Epilepsy Screening (PAVES). Epilepsy Behav. 2021 Jul;120:107968. 

Domain: Psychosocial screener, subscales for internalizing, externalizing, and attention; time to administer/score

Number of Items: 35 item original, 17 item short versions

Time to Administer:  < 5 minutes

Age Range: 3 to 17; Self (11-17)

Cost/Copyright/Permission: $0

Informant: Caregiver; self

Exclusions (e.g. low-functioning, literacy level): Also a pictoral (picture) version available for low literacy

Format (e.g. paper, online, keyed into EHR): Paper, online - EPIC or CHADIS

Availability in Other Languages: Available in 24+ languages

Scoring: Each item on the PSC receives zero, one or two points, with the scores on all 35 items summed for the total score. The recommended cutoff to indicate a possible problem is based on a large national sample in the U.S., where a score of 28+ identifies about 12% of children as being at risk (Jellinek et al., 1999; Murphy et al., 2016). Other studies support different cut-off points for other patient populations (eg.,Ishizaki, et al., 2000).

Cutoffs Established: The recommended cutoff to indicate a possible problem is based on a large national sample in the U.S., where a score of 28+ identifies about 12% of children as being at risk (Jellinek et al., 1999; Murphy et al., 2016). Other studies support different cut-off points for other patient populations (eg.,Ishizaki, et al., 2000).

Use in Epilepsy Populations: 17 item validated in epilepsy

Use in Medical Populations:  Longer version used in neurology

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: Although PSC scores vary somewhat over a few weeks to a year (Murphy, et al. 2016), the positive/negative screening scores for most patients remain the same (Hacker et al., 2009). The statistical concepts of "reliable change" and "significant change" provide parameters for judging the importance of any changes observed over time.

Includes a Suicidality Question: No

Other Useful Information: A change score of six or greater on the total score is considered a reliable change, and changes this large that also involve a change from risk to non-risk (or vice versa) are considered to indicate clinically significant change (Murphy, et al., 2016). On the subscales, only changes of two or more points are considered to indicate reliable change (Kamin, et al., 2015; McCarthy, et al., 2016), and only those that show a change in risk status are considered to show significant change.

References:

• https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist

Domain: Anger, Anxiety, Depression, Stress experiences

Number of Items: Short versions 4, 6, 8 items per domain; Item banks 20-30 per domain; Computerized (CAT) is benchmark, variable items per response

Time to Administer:  5-10 minutes per domain

Age Range: 1 to Adult

Cost/Copyright/Permission: $0

Informant: Parent (1-5); Proxy/Self 5-17 and 18+

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): Paper; REDCap; Epic; API; iPad on NIH toolbox; others

Availability in Other Languages: English, Spanish (other langauge translations for a fee)

Scoring: Average score=50 (SD=10)

Cutoffs Established: T-score cut-offs (60/70)

Use in Epilepsy Populations: Endorsed by AAN for use in Neurology, Epilepsy

Use in Medical Populations:  Endorsed by AAN for use in Neurology, Epilepsy

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: Yes - "I felt I had no reason for living ..."

Other Useful Information: 

• Short versions have high correlation with full CAT measure
• Normed in USA: Multi-center, international collaborations
• Reliability >0.9; Internal consistency >0.9; Proxy report calibrated separately

References:

• https://www.healthmeasures.net/explore-measurement-systems/promis
• Lidia M.V.R. Moura, Brandon Magliocco, John P. Ney, Eric M. Cheng, Gregory J. Esper, Daniel B. Hoch. Implementation of quality measures and patient-reported outcomes in an epilepsy clinic. Neurology Nov 2019, 93 (22) 
• Kwon OY, Park SP. Interictal fatigue and its predictors in epilepsy patients: A case-control study. Seizure. 2016 Jan;34:48-53. doi: 10.1016/j.seizure.2015.12.003. Epub 2015 Dec 14. PMID: 26723014.
• Shulman LM, Velozo C, Romero S, Gruber-Baldini AL. Comparative study of PROMISⓇ self-efficacy for managing chronic conditions across chronic neurologic disorders. Qual Life Res. 2019 Jul;28(7):1893-1901. 
• Gruber-Baldini AL, Velozo C, Romero S, Shulman LM. Validation of the PROMIS® measures of self-efficacy for managing chronic conditions. Qual Life Res. 2017 Jul;26(7):1915-1924. doi: 10.1007/s11136-017-1527-3. Epub 2017 Feb 26. PMID: 28239781; PMCID: PMC5479750.
• Jones FJS, Ezzeddine FL, Herman ST, Buchhalter J, Fureman B, Moura LMVR. A feasibility assessment of functioning and quality-of-life patient-reported outcome measures in adult epilepsy clinics: A systematic review. Epilepsy Behav. 2020 Jan;102:106704
  

Domain: Mood/Behavior

Number of Items: 5

Time to Administer:  ~2 minutes

Age Range: 2-25 - Peds (2-12); Teen (13-18); Adult (18-25)

Cost/Copyright/Permission: Depends; cost to for-profit organization users, free to non-funded academic users and clinical users

Informant: Parent-Report, Self-Report

Exclusions (e.g. low-functioning, literacy level): reading level below 2nd – 3rd grade

Format (e.g. paper, online, keyed into EHR): Paper, can program into REDCap

Availability in Other Languages: No

Scoring: Higher Scores indicate better HRQOL. 1) Reverse score (0=100; 1=75; 2=50; 3=25; 4=0); 2) To create Scale Scores, the mean is computed as the sum of the items over the number of items answered (this accounts for missing data). 3) If more than 50% of the items in the scale are missing, the Scale Score should not be computed. Imputing the mean of the completed items in a scale when 50% or more are completed is generally the most unbiased and precise method. To do this, count the number of missing values in the scale (call it nmiss). Next, sum the item scores and divide by the number of items in the scale minus nmiss. Alternatively, use the Compute command in SPSS to compute the MEAN. 

Cutoffs Established: n/a

Use in Epilepsy Populations: Yes, designed for epilepsy

Use in Medical Populations:  Yes, epilepsy

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: No

References:

• Junger, K. W., Modi, A. C., Guilfoyle, S. M., Smith, G., Wagner, J., Mucci, G. A., ... & Mara, C. A. (2019). Establishing clinical cutoffs for the PedsQL™ Epilepsy Module. Epilepsy & Behavior, 99, 106463.
• Modi, A. C., Junger, K. F., Mara, C. A., Kellermann, T., Barrett, L., Wagner, J., ... & Varni, J. W. (2017). Validation of the Peds QL Epilepsy Module: A pediatric epilepsy‐specific health‐related quality of life measure. Epilepsia, 58(11), 1920-1930.
  

Domain: Anxiety, depression, fatigue, upper extremity function, lower extremity function, cognitive function, emotional and behavioral dyscontrol, positive affect and well-being, sleep disturbance, ability to participate in social roles and activities, satisfaction with social roles and activities, stigma, communications, end of life concerns, bowel function, urinary/bladder function, sexual function

Number of Items: 5-45 per domain (short and long forms); 5-10 in short form, 18-45 in full bank; Pediatric: 11 banks with 11-20 items per bank, 8-10 in short forms

Time to Administer:  ~2 minutes

Age Range: Peds (8-17); Adult (18+)

Cost/Copyright/Permission: $0, Neuro-QoL are publicly available for use in one’s individual research, clinical practice, educational assessment, or other application without licensing or royalty fees. Commercial users must seek permission to use, reproduce, or distribute. Integration into proprietary technology requires written permission.

Informant: Patient

Exclusions (e.g. low-functioning, literacy level): Can be completed by proxy (parent or caregiver)

Format (e.g. paper, online, keyed into EHR): Paper, computer adaptive tests; Paper; REDCap; Epic; API; iPad on NIH toolbox

Availability in Other Languages: English and Spanish

Scoring: Bank specific (17 total banks)

Cutoffs Established: Yes; Anxiety: 24, Depression: 19

Use in Epilepsy Populations: Yes

Use in Medical Populations:  Yes (can be used generally in neurology patients, but also in specific disease including epilepsy)

Use in Diverse Populations: Yes

Used Longitudinally/Response to Treatment: test–retest reliability (0.59-0.83, avg 17.3 +/- 7.6 days)

Includes a Suicidality Question: Yes - "I felt I no longer had a reason for living"

References:

• https://www.healthmeasures.net/explore-measurement-systems/neuro-qol
• Lai JS, Nowinski CJ, Zelko F, Wortman K, Burns J, Nordli DR, Cella D. Validation of the Neuro-QoL measurement system in children with epilepsy. Epilepsy Behav. 2015 May;46:209-14. doi: 10.1016/j.yebeh.2015.02.038. Epub 2015 Apr 7. PMID: 25862469; PMCID: PMC4458416.
• Victorson D, Cavazos JE, Holmes GL, Reder AT, Wojna V, Nowinski C, Miller D, Buono S, Mueller A, Moy C, Cella D. Validity of the Neurology Quality-of-Life (Neuro-QoL) measurement system in adult epilepsy. Epilepsy Behav. 2014 Feb;31:77-84. doi: 10.1016/j.yebeh.2013.11.008. Epub 2013 Dec 20. PMID: 24361767; PMCID: PMC3970783.

Domain: Depression, Anxiety, Stress

Number of Items: 21

Time to Administer:  5-10 minutes

Age Range: Teen to adult

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): Paper but can program into REDCap etc.

Availability in Other Languages: Yes

Scoring: Scores for depression, anxiety and stress are calculated by summing the scores for the relevant item

Cutoffs Established: Normal, Mild, Moderate, Severe, Extremely Severe

Use in Epilepsy Populations: Yes

Use in Medical Populations:  Yes

Use in Diverse Populations: Yes - international studies

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: No - "I felt that life was meaningless"

Other Useful Information: DAS-42 better in clinical settings

References:

• https://theranest.com/blog/the-dass-21-scale-explained
• Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety & Stress Scales. (2nd Ed.)Sydney: Psychology Foundation
• Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005 Jun;44(Pt 2):227-39. doi: 10.1348/014466505X29657. PMID: 16004657.
• Kumari S, Garg D, Sharma S, Pemde HK. Effect of counselling of parents of children with epilepsy focusing on sudden unexpected death in epilepsy. Epilepsy Res. 2022 Oct;186:106992. doi: 10.1016/j.eplepsyres.2022.106992. Epub 2022 Aug 1. PMID: 35970090.
• Sammarra I, Martino I, Caligiuri ME, Giugno A, Fortunato F, Labate A, Gambardella A. The impact of one-year COVID-19 containment measures in patients with mesial temporal lobe epilepsy: A longitudinal survey-based study. Epilepsy Behav. 2022 Mar;128:108600. doi: 10.1016/j.yebeh.2022.108600. Epub 2022 Jan 31. PMID: 35151188; PMCID: PMC8801317.
• Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Das KB, Gillberg C, Neville BGR, Scott RC. Symptoms of depression, anxiety, and stress in parents of young children with epilepsy: A case controlled population-based study. Epilepsy Behav. 2018 Mar;80:177-183. doi: 10.1016/j.yebeh.2017.12.020. Epub 2018 Feb 3. PMID: 29414549.

Domain: Depression, Anxiety, Stress

Number of Items: 21

Time to Administer:  5-10 minutes

Age Range: 8-17

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): Paper but can program into REDCap etc.

Availability in Other Languages: Yes

Scoring: Scores for depression, anxiety and stress are calculated by summing the scores for the relevant item

Cutoffs Established: Normal, Mild, Moderate, Severe, Extremely Severe

Use in Epilepsy Populations: Yes

Use in Medical Populations:  Yes

Use in Diverse Populations: Yes - international studies

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: No - "I felt that life was meaningless"

Other Useful Information: DAS-42 better in clinical settings

References:

• https://theranest.com/blog/the-dass-21-scale-explained
• Lovibond, S.H. & Lovibond, P.F. (1995). Manual for the Depression Anxiety & Stress Scales. (2nd Ed.)Sydney: Psychology Foundation
• Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005 Jun;44(Pt 2):227-39. doi: 10.1348/014466505X29657. PMID: 16004657.
• Kumari S, Garg D, Sharma S, Pemde HK. Effect of counselling of parents of children with epilepsy focusing on sudden unexpected death in epilepsy. Epilepsy Res. 2022 Oct;186:106992. doi: 10.1016/j.eplepsyres.2022.106992. Epub 2022 Aug 1. PMID: 35970090.
• Sammarra I, Martino I, Caligiuri ME, Giugno A, Fortunato F, Labate A, Gambardella A. The impact of one-year COVID-19 containment measures in patients with mesial temporal lobe epilepsy: A longitudinal survey-based study. Epilepsy Behav. 2022 Mar;128:108600. doi: 10.1016/j.yebeh.2022.108600. Epub 2022 Jan 31. PMID: 35151188; PMCID: PMC8801317.
• Reilly C, Atkinson P, Memon A, Jones C, Dabydeen L, Das KB, Gillberg C, Neville BGR, Scott RC. Symptoms of depression, anxiety, and stress in parents of young children with epilepsy: A case controlled population-based study. Epilepsy Behav. 2018 Mar;80:177-183. doi: 10.1016/j.yebeh.2017.12.020. Epub 2018 Feb 3. PMID: 29414549.

Domain: Comprehensive tool to assess anxiety in PWE, providing clinicians with in‐depth insight into the nature and severity of an individual's anxiety

Number of Items: 18

Time to Administer:  10 minutes

Age Range: Adult

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): Paper/Word Document

Availability in Other Languages: French, German, Russian

Scoring: Cut off of >=7 consistent with probably anxiety disorder

Cutoffs Established: Cut off of >=7 consistent with probably anxiety disorder

Use in Epilepsy Populations: Yes, designed for epilepsy

Use in Medical Populations:  No

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: No

Other Useful Information: Designed to be the first epilepsy-specific measures of anxiety in PEW, superior to GAD-7 in detecting non-generalized anxiety disorder conditions, contains fewer questions that are likely to be impacted by medication adverse effects (i.e. hand tremulousness)

References:

• Website

Domain: Comprehensive tool to assess anxiety in PWE, providing clinicians with in‐depth insight into the nature and severity of an individual's anxiety

Number of Items: 8

Time to Administer:  10 minutes

Age Range: Adult

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): Paper/Word Document

Availability in Other Languages: French, German, Russian

Scoring: Cut off of >=7 consistent with probably anxiety disorder

Cutoffs Established: Cut off of >=7 consistent with probably anxiety disorder

Use in Epilepsy Populations: Yes, designed for epilepsy

Use in Medical Populations:  No

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: No

Other Useful Information: Designed to be the first epilepsy-specific measures of anxiety in PEW, superior to GAD-7 in detecting non-generalized anxiety disorder conditions, contains fewer questions that are likely to be impacted by medication adverse effects (i.e. hand tremulousness)

References:

• Website

^{Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc.}

Domain: Comprehensive tool to assess anxiety in PWE, providing clinicians with in‐depth insight into the nature and severity of an individual's anxiety

Number of Items: 9 or 2

Time to Administer:  <5 min

Age Range: 12-Adult

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): None

Format (e.g. paper, online, keyed into EHR): paper or can program

Availability in Other Languages: French, German, Russian

Scoring: Scoring Calculator

Cutoffs Established: Cut off of >=7 consistent with probably anxiety disorder

Use in Epilepsy Populations: Yes

Use in Medical Populations:  n/a

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: Yes on PHQ-9 - Thoughts that you would be better off dead or of hurting yourself

References:

• https://onlinelibrary.wiley.com/doi/abs/10.1002/da.21971
• https://www.sciencedirect.com/science/article/abs/pii/S0163834314002540
• https://jamanetwork.com/journals/jama/article-abstract/2766865
• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x. PMID: 11556941; PMCID: PMC1495268.
• Meta-analysis: conclusion low sensitivity for detecting MDD. 
• Epilepsy studies:
  • Rathore JS, Jehi LE, Fan Y, Patel SI, Foldvary-Schaefer N, Ramirez MJ, Busch RM, Obuchowski NA, Tesar GE. Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adults with epilepsy. Epilepsy Behav. 2014 Aug;37:215-20. 
  • Kim HJ, Jeon JY, Kim HW, Lee SA. Comparison between the Neurological Disorders Depression Inventory for Epilepsy and the Patient Health Questionnaire-9 in patients with epilepsy according to antiepileptic drug load. Seizure. 2020 Jan;74:14-19. 

Domain: Depression

Number of Items: 6

Time to Administer:  5 min

Age Range: 18+

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): must be able to complete independently

Format (e.g. paper, online, keyed into EHR): paper; some use electronically

Availability in Other Languages: Spanish, English, French, Chinese, Italian, Russian

Scoring: n/a

Cutoffs Established: Cut off of >13

Use in Epilepsy Populations: Yes

Use in Medical Populations:  No - only epilepsy

Use in Diverse Populations: Yes, NDDI-E has been used around the globe

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: Yes - "I think about dying or killing myself"

References:

• Kim DH, Kim YS, Yang TW, Kwon OY. Optimal cutoff score of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) for detecting major depressive disorder: A meta-analysis. Epilepsy Behav. 2019 Mar;92:61-70. 
• Wagner JL, Kellermann T, Mueller M, Smith G, Brooks B, Arnett A, Modi AC. Development and validation of the NDDI-E-Y: a screening tool for depressive symptoms in pediatric epilepsy. Epilepsia. 2016 Aug;57(8):1265-70. Erratum in: Epilepsia. 2018 Oct;59(10):2004. 
• Kellermann TS, Mueller M, Carter EG, Brooks B, Smith G, Kopp OJ, Wagner JL. Prediction of specific depressive symptom clusters in youth with epilepsy: The NDDI-E-Y versus Neuro-QOL SF. Epilepsia. 2017 Aug;58(8):1370-1379. doi: 10.1111/epi.13808. Epub 2017 Jun 9. Erratum in: Epilepsia. 2018 Oct;59(10):2004

Domain: Depression

Number of Items: 12

Time to Administer:  5 min

Age Range: 12-17

Cost/Copyright/Permission: $0

Informant: Self-report

Exclusions (e.g. low-functioning, literacy level): must be able to complete independently

Format (e.g. paper, online, keyed into EHR): paper; some use electronically

Availability in Other Languages: No

Scoring: n/a

Cutoffs Established: Cut off of >32

Use in Epilepsy Populations: Yes

Use in Medical Populations:  No - only epilepsy

Use in Diverse Populations: Yes

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: Yes - "I think about dying or killing myself"

References:

• Kim DH, Kim YS, Yang TW, Kwon OY. Optimal cutoff score of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) for detecting major depressive disorder: A meta-analysis. Epilepsy Behav. 2019 Mar;92:61-70. 
• Wagner JL, Kellermann T, Mueller M, Smith G, Brooks B, Arnett A, Modi AC. Development and validation of the NDDI-E-Y: a screening tool for depressive symptoms in pediatric epilepsy. Epilepsia. 2016 Aug;57(8):1265-70. Erratum in: Epilepsia. 2018 Oct;59(10):2004. 
• Kellermann TS, Mueller M, Carter EG, Brooks B, Smith G, Kopp OJ, Wagner JL. Prediction of specific depressive symptom clusters in youth with epilepsy: The NDDI-E-Y versus Neuro-QOL SF. Epilepsia. 2017 Aug;58(8):1370-1379. doi: 10.1111/epi.13808. Epub 2017 Jun 9. Erratum in: Epilepsia. 2018 Oct;59(10):2004

^{For inquiries and training information contact: Kelly Posner, PhD | New York State Psychiatric Institute, 1051 Riverside Drive, New York, New York, 10032; posnerk@nyspi.columbia.edu} 

Domain: Suicidality (four subscales: severity, intensity, behavior, lethality) 

Number of Items: 6 (2 ideation, 4 behavior; 19 items max)

Time to Administer:  2-15 minutes

Age Range: Children (6+), adolescents, adults

Cost/Copyright/Permission: $0

Informant: Self (but clinician-administered)

Exclusions (e.g. low-functioning, literacy level): n/a

Format (e.g. paper, online, keyed into EHR): Paper/Keyed into Cerner

Availability in Other Languages:  available in 114 languages

Scoring: Risk Stratification - Ranges from no wish to be dead/non-specific suidical Ideation to Active suicidal ideation with specific plan and intent

Cutoffs Established: Yes

Use in Epilepsy Populations: used in most ASM trials since 2011

Use in Medical Populations:  n/a

Use in Diverse Populations: n/a

Used Longitudinally/Response to Treatment: n/a

Includes a Suicidality Question: Yes - "I think about dying or killing myself"

Other Helpful Information: National agencies and programs including the CDC, FDA, and "Zero Suicide" initiative have adopted the C-SSRS as the standard for measuring suicidan ideation and behavior

References:

• More than 600 peer-reviewed studies have been published demonstrating its use in different populations and its validity
• Kanner AM, Saporta AS, Kim DH, Barry JJ, Altalib H, Omotola H, Jette N, O'Brien TJ, Nadkarni S, Winawer MR, Sperling M, French JA, Abou-Khalil B, Alldredge B, Bebin M, Cascino GD, Cole AJ, Cook MJ, Detyniecki K, Devinsky O, Dlugos D, Faught E, Ficker D, Fields M, Gidal B, Gelfand M, Glynn S, Halford JJ, Haut S, Hegde M, Holmes MG, Kalviainen R, Kang J, Klein P, Knowlton RC, Krishnamurthy K, Kuzniecky R, Kwan P, Lowenstein DH, Marcuse L, Meador KJ, Mintzer S, Pardoe HR, Park K, Penovich P, Singh RK, Somerville E, Szabo CA, Szaflarski JP, Lin Thio KL, Trinka E, Burneo JG; Human Epilepsy Project. Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity. Neurology. 2023 Mar 14;100(11):e1123-e1134. doi: 10.1212/WNL.0000000000201671. Epub 2022 Dec 20. PMID: 36539302; PMCID: PMC10074468.
• Andermann E, Biton V, Benbadis SR, Shneker B, Shah AK, Carreño M, Trinka E, Ben-Menachem E, Biraben A, Rocha F, Gama H, Cheng H, Blum D; Study 301, 302 and 304 Investigators. Psychiatric and cognitive adverse events: A pooled analysis of three phase III trials of adjunctive eslicarbazepine acetate for partial-onset seizures. Epilepsy Behav. 2018 May;82:119-127. doi: 10.1016/j.yebeh.2017.12.017. Epub 2018 Mar 28. PMID: 29604484.
• Hesdorffer DC, French JA, Posner K, DiVentura B, Pollard JR, Sperling MR, Harden CL, Krauss GL, Kanner AM. Suicidal ideation and behavior screening in intractable focal epilepsy eligible for drug trials. Epilepsia. 2013 May;54(5):879-87. doi: 10.1111/epi.12128. Epub 2013 Feb 28. PMID: 23448169.

^{PDF: https://www.nimh.nih.gov/sites/default/files/documents/research/research-conducted-at-nimh/asq-toolkit-materials/asq-tool/information_sheet_asq_nimh_toolkit.pdf}

Domain: Suicidality

Number of Items: 4

Time to Administer:  20 seconds

Age Range: 8+

Cost/Copyright/Permission: $0

Informant: Self, administered by interviewer

Exclusions (e.g. low-functioning, literacy level): no

Format (e.g. paper, online, keyed into EHR): Verbal

Availability in Other Languages:  Arabic, Catalan, Chinese, Dutch, Filipino, French, Hebrew, Italian, Japanese, Korean, Portuguese, European Portuguese, Russian, Somali, Spanish, Vietnamese

Scoring: Yes to any question = positive screen and triggers fuller evaluation, yes to question 5 triggers acute evaluation

Cutoffs Established: n/a

Use in Epilepsy Populations: Yes

Use in Medical Populations:  Yes

Use in Diverse Populations: Yes

Used Longitudinally/Response to Treatment: No

Includes a Suicidality Question: Yes

Other Helpful Information: Validated by multisite studies for both children 8+ and for adults. Can  be used in conjunction with the PHQ-2 and PHQ-9 in adolescents.

References:

• Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., ... & Pao, M. (2012). Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166(12), 1170-1176.
• Horowitz, L. M., Snyder, D. J., Boudreaux, E. D., He, J. P., Harrington, C. J., Cai, J., Claassen, C. A., Salhany, J. E., Dao, T., Chaves, J. F., Jobes, D. A., Merikangas, K. R., Bridge, J. A., Pao, M. (2020). Validation of the Ask Suicide-Screening Questions (ASQ) for adult medical inpatients: A brief tool for all ages. Psychosomatics, 61(6), 713-722.
• Horowitz, L. M., Wharff, E. A., Mournet, A. M., Ross, A. M., McBee-Strayer, S., He, J., Lanzillo, E., White, E., Bergdoll, E., Powell, D. S., Merikangas, K. R., Pao, M., & Bridge, J. A. (2020). Validation and feasibility of the Ask Suicide-Screening Questions (ASQ) among pediatric medical/surgical inpatients.  Hospital Pediatrics, 10(9), 750-757
• Aguinaldo, L. D., Sullivant, S., Lanzillo, E. C., Ross, A., He, J. P., Bradley-Ewing, A., Bridge, J. A., Horowitz, L. M., & Wharff, E. A. (2021). Validation of the Ask Suicide-Screening Questions (ASQ) with youth in outpatient specialty and primary care clinics. General Hospital Psychiatry, 68, 52–58.
• Brahmbhatt, K., Kurtz, B. P., Afzal, K. I., Giles, L. L., Kowal, E. D., Johnson, K. P., ... & Workgroup, P. (2019). Suicide risk screening in pediatric hospitals: Clinical pathways to address a global health crisis. Psychosomatics, 60(1), 1-9.
• Roaten, K., Horowitz, L. M., Bridge, J. A., Goans, C. R. R., McKintosh, C., Genzel, R., Johnson, C., & North, C. S. (2021). Universal pediatric suicide risk screening in a health care system: 90,000 patient encounters.  Journal of the Academy of Consultation-Liaison Psychiatry.
• Horowitz, L. M., Mournet, A. M., Lanzillo, E., He, J. P., Powell, D. S., Ross, A. M., Wharff, E. A., Bridge, J. A., & Pao, M. (2021). Screening pediatric medical patients for suicide risk: Is depression screening enough?  Journal of Adolescent Health, S1054-139X(21)00060-4.
• Mournet, A. M., Smith, J. T., Bridge, J. A., Boudreaux, E. D., Snyder, D. J., Claassen, C. A., Jobes, D. A, Pao, M., & Horowitz, L. M. (2021). Limitations of screening for depression as a proxy for suicide risk in adult medical inpatients.  Journal of the Academy of Consultation-Liaison Psychiatry.
• Thom, R., Hogan, C., & Hazen, E. (2020). Suicide Risk Screening in the Hospital Setting: A Review of Brief Validated Tools. Psychosomatics, 61(1), 1–7.
• Lanzillo, E. C., Horowitz, L. M., Wharff, E. A., Sheftall, A. H., Pao, M., & Bridge, J. A. (2019). The importance of screening preteens for suicide risk in the emergency department.  Hospital Pediatrics, 9(4), 305–307.
• DeVylder, J. E., Ryan, T. C., Cwik, M., Wilson, M. E., Jay, S., Nestadt, P. S., Goldstein, M., & Wilcox, H. C. (2019). Assessment of selective and universal screening for suicide risk in a pediatric emergency department. JAMA Network Open, 2(10), e1914070.
• Ballard, E. D., Cwik, M., Van Eck, K., Goldstein, M., Alfes, C., Wilson, M. E., ... & Wilcox, H. C. (2017). Identification of at-risk youth by suicide screening in a pediatric emergency department. Prevention Science, 18(2), 174-182.
• Newton, A. S., Soleimani, A., Kirkland, S. W., & Gokiert, R. J. (2017). A systematic review of instruments to identify mental health and substance use problems among children in the emergency department. Academic Emergency Medicine, 24(5), 552-568.
• Ross, A. M., White, E., Powell, D., Nelson, S., Horowitz, L., & Wharff, E. (2016). To ask or not to ask? Opinions of pediatric medical inpatients about suicide risk screening in the hospital. The Journal of Pediatrics, 170, 295-300.
• Horowitz, L. M., Bridge, J. A., Pao, M., & Boudreaux, E. D. (2014). Screening youth for suicide risk in medical settings: time to ask questions. American Journal of Preventive Medicine, 47(3), S170-S175.
• Ballard, E. D., Bosk, A., Pao, M., Snyder, D., Bridge, J. A., Wharff, E. A., Teach, S. J., & Horowitz, L. (2012). Patients’ opinions about suicide screening in a pediatric emergency department. Pediatric Emergency Care, 28(1), 34.