What is the process for conducting a psychological risk assessment?

From the Guidelines

A psychological risk assessment should be conducted by a shared responsibility of the clinical team, using a phased approach that starts with the identification of pertinent history or risk factors, followed by the use of a valid and reliable measure such as the PHQ-9 to assess depressive symptoms. The assessment process involves several key steps, including:

• Identifying signs and symptoms of depression, anxiety, and other psychological hazards
• Evaluating the severity of cancer symptoms, possible stressors, risk factors, and times of vulnerability
• Using standardized tools or matrices to prioritize risks and develop targeted interventions
• Implementing interventions systematically with clear timelines and responsibilities
• Monitoring and reviewing the effectiveness of interventions regularly, making adjustments as needed 1. The assessment should also consider special circumstances, such as culturally sensitive assessments and treatments, tailoring assessment or treatment for those with learning disabilities or cognitive impairments, and being aware of the difficulty of detecting depression in older adults 1. The PHQ-9 is a recommended tool for assessing depressive symptoms, with a cutoff score of 8 or higher indicating moderate to severe depression. If moderate to severe or severe symptomatology is detected, individuals should have further diagnostic assessment to identify the nature and extent of the depressive symptoms and the presence or absence of a mood disorder 1. The clinical team must decide when referral to a psychiatrist, psychologist, or equivalently trained professional is needed, based on measures with established reliability, validity, and utility, such as the PHQ-9 score or standardized diagnostic interviews 1. Key considerations in the assessment process include:
• The importance of a shared responsibility among the clinical team
• The need for a phased approach to assessment
• The use of valid and reliable measures, such as the PHQ-9
• The consideration of special circumstances, such as cultural sensitivity and cognitive impairments
• The importance of monitoring and reviewing the effectiveness of interventions regularly.

From the Research

Psychological Risk Assessment Process

The process for conducting a psychological risk assessment involves several steps, including:

• Identifying individuals at risk of psychological disorders, such as anxiety and depression, particularly in populations with substance use disorders 2, 3, 4
• Using standardized screening tools, such as the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7), to detect probable mood and anxiety disorders 2, 3
• Evaluating the severity of mental health problems and developing care plans that incorporate counseling and referrals to other services 4
• Considering the comorbidity of substance use disorders and mental health issues, and using assessment information to inform treatment planning 5, 6

Screening Tools and Methods

Some commonly used screening tools for psychological risk assessment include:

• PHQ-9 and GAD-7, which have been validated for use in substance use disorder treatment settings 2, 3
• Brief screening measures, such as the PHQ-2 and GAD-2, which may have similar clinical utility to the full measures 3
• Semi-structured diagnostic clinical interviews, which can be used to establish mood and anxiety disorder diagnoses 2

Implementation and Evaluation

The implementation and evaluation of psychological risk assessment in practice involves:

• Training staff to use screening tools and interpret results 4
• Evaluating the effectiveness of screening and its impact on service delivery 4
• Considering the resource requirements and potential barriers to implementing screening in practice 4
• Continuously monitoring and improving the assessment process to ensure it is effective and efficient 6