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Beck Depression Inventory II –
The Beck Depression Inventory (BDI-II) is a 21-question, multiple-choice, self-report inventory34 one of the most widely used
instruments for measuring depression and its severity. The BDI is composed of items relating to symptoms of depression
such as hopelessness and irritability; cognitions such as guilt or feelings of being punished; as well as physical symptoms
such as fatigue, weight loss and lack of libido.35
The efficacy of the BDI-II has been validated against similar instruments and showed to positively correlate with other
respected rating scales as well high internal consistency.
Global Assessment of Functioning (GAF) –
The Global Assessment of Functioning (GAF) assigns a clinical judgment in numerical fashion to a patient’s overall
functioning level. It was created in 1962 and first published in the Diagnostic and Statistical Manual of Mental Disorders
(DSM) in 1987, by the American Psychiatric Association, to provide a common language and standard criteria for the
classification of mental disorders.
The purpose of using the GAF tool is to enable healthcare professionals to obtain information about global functioning, to
supplement information that they have received from the patient about their medical history and symptoms, and to help
predict the allocation and potential outcomes of mental health treatment. Many experts question the reliability and validity of
the GAF and its ability to predict the likelihood of future mental health episodes.36
Behavioral Risk Factor Surveillance System (CDC) –
The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, continuously conducted telephone health
survey system.37
The BRFSS uses data collected to assess risk for chronic disease, identify demographic differences and trends in health-
related behaviors, address emergent and critical health issues, formulate policy and legislation for health initiatives and to
design and monitor health interventions and services. 37
The questionnaire has three parts:
• Core component questions: This section consists of the fixed core, rotating core, and emerging core questions
that cover demographics, general health behaviors topics and “late breaking”29issues. All health departments must
ask the core component questions without modification in wording.
• Optional modules: This section is used in alternating years when the rotating core questions are not used.
• State-added questions: This section is customized based on health and wellness trends experienced by
individual states.
The BRFSS is considered the gold standard37 in behavioral surveillance and states have used BRFSS to address urgent and
emerging health issues. It was used to monitor the influenza vaccine shortage during the 2004–2005 flu season. Following
Hurricanes Katrina and Rita, four Gulf Coast states used it to assess the impact of both events. During the 2009 H1N1 flu
pandemic, modules related to influenza-like illness, and seasonal and H1N1 vaccinations were added to the survey.37
Missed Opportunities for Depression Screening
Depression screening guidelines have been endorsed for high-risk groups, such as individuals with arthritis, in an effort to be
proactive in using appropriate interventions. Although this is widely known, individuals with arthritis are often not screened.
A study, looking at data between 2006 and 2010, set out to examine national rates of depression and depression screening
for patients with arthritis. Published in 2013, the study revealed that of the 644,419,374 visits where arthritis was listed as a
health issue, 83,574,127 (13%) were associated with a comorbid diagnosis of depression. Despite the high prevalence of
depression with arthritis, screening for depression was performed at few arthritis visits, representing missed opportunities
to detect a common, serious comorbidity. In fact, in this study, depression screening occurred at 3,835,000 (1%) visits
associated with arthritis. 36