From the Guidelines
Nurses should use a comprehensive, systematic approach to screen and manage mental health disorders in patients, starting with routine screening using validated tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression, as recommended by the most recent guideline update from the American Society of Clinical Oncology 1. The recommended approach begins with routine screening using validated tools such as the Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorder-7 (GAD-7) for anxiety, or the CAGE-AID for substance use disorders. These brief screenings should be incorporated into regular patient assessments across all healthcare settings. When positive screens occur, nurses should conduct more detailed assessments, including suicide risk evaluation using tools like the Columbia-Suicide Severity Rating Scale. Management involves a collaborative care model where nurses coordinate with mental health specialists, primary care providers, and social workers. Nurses should provide patient education about mental health conditions, treatment options, and self-management strategies. They should also monitor medication adherence and side effects for patients prescribed psychotropics such as SSRIs (e.g., sertraline 50-200mg daily), SNRIs (e.g., venlafaxine 75-225mg daily), or other psychiatric medications. Regular follow-up is essential to track symptom improvement using the same screening tools for consistency, as supported by the American Psychosocial Oncology Society and the Association of Oncology Social Work 1. This approach is effective because it enables early identification of mental health issues, reduces stigma through routine screening, ensures appropriate referrals, and provides continuity of care through ongoing monitoring and support. Some key considerations for implementing this approach include selecting a screening tool that can be completed quickly and incorporating screening into existing procedures, such as registration or clinic check-in procedures, to reduce disruption to clinic flow 1. Additionally, electronic screening can be helpful in getting screening data to relevant clinicians in a timely manner, and tablet-based screening can be particularly useful with a system that automatically sends results to the relevant clinicians 1. Overall, a comprehensive and systematic approach to screening and managing mental health disorders is essential for providing high-quality care to patients, as emphasized by the American Society of Clinical Oncology 1 and the American Psychosocial Oncology Society and the Association of Oncology Social Work 1.
From the Research
Recommended Approach for Nurses to Screen and Manage Mental Health Disorders
The recommended approach for nurses to screen and manage mental health disorders in patients involves the use of validated screening tools. Some of the key points to consider are:
- The use of brief mental health disorder screening questionnaires, such as the Patient Health Questionnaire-4, can provide an efficient method to guide clinicians to query symptom areas requiring further assessment 2.
- Screening tools that take a multiple-mental disorder or transdiagnostic approach can be useful in primary care settings, as they can help identify patients with a wide range of mental health problems 3.
- The selection of screening tools should be based on their psychometric properties, applicability in primary care, and characteristics such as number of items and mode of administration 4.
- Nurses should be aware of the importance of early recognition and treatment of behavioral health disorders, as it can prevent complications, improve quality of life, and help reduce health care costs 4.
Screening Tools for Mental Health Disorders
Some of the screening tools that can be used by nurses to screen for mental health disorders include:
- Patient Health Questionnaire (PHQ) 4, 2
- Brief Panic Disorder Symptom Screen-Self-Report 2
- Short-Form Posttraumatic Checklist-5 2
- Alcohol Use Disorders Identification Test-Consumption 2
- Brøset Violence Checklist and Violence Risk Screening-10 for violence risk assessment 5
Considerations for Implementing Screening Tools
When implementing screening tools, nurses should consider the following:
- The need for regular mental health screenings, particularly for high-risk populations such as public safety personnel 2.
- The importance of selecting screening tools that are validated and appropriate for the specific population being screened 3, 2.
- The need for further assessment and intervention for patients who screen positive for mental health disorders 4, 3, 2.