Evaluated need is accounted for in a portion of prior help-seeking studies. Evaluated need is measured using clinician-administered interviews (e.g., Structured Clinical Interview for DMS-5) or self-report survey measures. It may also be measured via coding of medical records (e.g., mental illness diagnosis data from electronic medical records). There are a wide array of measures that can be used to assess individuals’ self-reported perceptions of the severity, frequency, duration, and nature of their symptoms, as well as their self-reported subjective well-being and functioning.

When these measures are scored and interpreted by mental health professionals for the purpose of determining whether a respondent is sufficiently distressed/impaired to warrant treatment, these measures are considered assessments of evaluated need. However, when these measures are used for the purpose of understanding the subjective illness perceptions of respondents, these measures are considered assessments of constructs such as illness perceptions or perceived need. According to the IBM-HS, these latter constructs fall within the mental health perceptions, knowledge, and skills help-seeking determinant construct category. In summary, the distinction between evaluated need and mental health perceptions, knowledge, and skills can be fuzzy as it is not dictated by the wording of the measures themselves but instead how they are interpreted and used by investigators. The rationale for the IBM-HS maintaining these as two separate (yet admittedly overlapping and fuzzy) categories is because the help-seeking literature often talks about these measures in one of these two ways, and certain measures are typically used primarily for determining evaluated need whereas other measures are used primarily for exploring mental health perceptions. Therefore, this evaluated need measures page will focus on measures typically used by investigators to assess evaluated need. Consequently, readers should visit the mental health perceptions, knowledge, and skills measures page for measures used primarily for exploring mental health perceptions.

Sareen and colleagues (2005) note that a significant portion of individuals seek help without meeting criteria for a mental disorder, hence the value in evaluating need more broadly. They noted that Shapiro et al., (1985) “have suggested assessing need for treatment according to the following 3 measures: 1) presence of a DSM disorder, 2) dysfunction in usual activities, and 3) increased distress on a continuous measure of distress.” (p. 644).

This webpage is designed to introduce readers to some of the many public-domain (free to use) measures used to assess evaluated need that exist, which professionals may leverage to answer questions about how evaluated need shapes people’s perceptions and behaviors related to seeking mental healthcare.

The below lists of measures will be expanded and revised over time to maximize value for those looking for measures with published evidence of reliability and validity.

This first list highlights Dr. Hammer’s favorite symptom-focused evaluated need instruments for use in help-seeking research.

  • Kessler-6 (K-6) (Kessler et al., 20023) (Kessler-6 informational webpage) – measures nonspecific psychological distress by asking how how frequently they experienced symptoms of psychological distress during the past 30 days. A cut point of 13+ is used to indicate the presence of “serious mental illness”. Prochaska et al., (2012) also found that the K6 cut point of 5+ can be used to identify individuals struggling with moderate (or greater) mental health distress that warrants mental health intervention. We highly recommend use of this moderate distress cutoff for use in help-seeking investigations because it helps identify the subset of a sample for whom the option of seeking mental health help is relevant – focusing analyses on this segment of the sample can allow professionals to avoid issues with floor effects related to sampling from people who are unlikely to need treatment (and thus have little reason to intend to seek help). However, please note that optimal distress cutoffs vary by population, so populations beyond U.S. adult populations required psychometric testing in order to determine what K6 cutoff is the most accurate marker of moderate distress. For example, this has been tested in Chinese residents of Hong Kong by Lee and colleagues (2011).
  • Patient Health Questionnaire-9 (PHQ-9) and the Patient Health Questionnaire–2 (PHQ-2) and Patient Health Questionnaire-8 (PHQ-8) – depression screening measures.
    • The PHQ-9 (Kroenke et al., 2001) is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. Depression should not be diagnosed or excluded solely on the basis of a PHQ-9 score. PHQ-9 total scores of 5, 10, 15, and 20 represent cutpoints for mild, moderate, moderately severe and severe depression, respectively.
    • The PHQ-2 (Kroenke et al., 2003), which consists of the first 2 items (depressed mood and anhedonia) of the PHQ-9, inquires about the frequency of depressed mood, with a score of 3 being optimal cut point for screening purposes per the original validation study. Levis and colleagues (2020) recommended that the PHQ-2 be administered first and those who score a 2+ on the PHQ-2 should then complete the remainder of the PHQ-9. When there is not room to include the full PHQ-9, Dr. Hammer likes using the PHQ-2 alone, treating a cut score of 3+ as an indicator that the respondent may need to seek help for depression-related concerns. Manea and colleagues (2016) reported that a PHQ-2 cut point of 2+ may also be appropriate, as it increases sensitivity at the cost of increased false-positives.
    • The PHQ-8 (Kroenke & Spitzer, 2002), which consists of the first 8 items (excludes the item about suicidality) of the PHQ-9 is scored in the same exact way as the PHQ-9. Kroenke and colleagues (2009) explain that the “PHQ-8 may be useful in some types of research, particularly epidemiological/population-based studies, postal or web-based surveys, and clinical studies in which depression is a secondary outcome. In such instances, depression prevalence and severity are expected to be low, the 9th item of the PHQ-9 is infrequently endorsed and even then usually represents passive thoughts of death rather than suicidal ideation, and immediate mental health back-up to interview all the false–positive endorsements of the 9th item is not feasible.” In certain settings, institutional review boards may be uncomfortable with researchers assessing for suicidal ideation but not having a plan in place to follow up with people who screen positive for suicidal ideation, which has led some researchers to prefer using the PHQ-8, especially for internet-based self-report surveys.
  • Generalized Anxiety Disorder scale-7 (GAD-7) and Generalized Anxiety Disorder scale-2 (GAD-2) – anxiety screening measures.
    • The GAD-7 (Spitzer et al., 2006) is based on Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for identifying likely cases of Generalized Anxiety Disorder. It investigates how often the patient has been bothered by seven different symptoms of anxiety during the last two weeks. The scores of 5, 10, and 15 are taken as cut off points for mild, moderate, and severe anxiety, respectively (Sapra et al., 2020).
    • The GAD-2 (Kroenke et al., 2007) is an brief version of the GAD-7 that incorporates the first two questions of the GAD-7, which are also critical components of any anxiety disorder. The GAD-2 questionnaire has been validated in multiple studies and shown to retain the excellent psychometric properties of the GAD-7 (Sapra et al., 2020). A cutpoint of 3+ has been recommended for identifying generalized anxiety. Dr. Hammer likes using the GAD-2 alone, treating a cut score of 3+ as an indicator that the respondent may need to seek help for anxiety-related concerns. O’Connor and colleagues’ (2023) systematic review regarding anxiety screening is a good resource.
  • The combined GAD-2 and PHQ-2 are known as the PHQ-4 (Kroenke et al., 2009; Löwe et al., 2010; Khubchandani et al., 2016) and can be used in combination to identify people who may benefit from seeking mental health care. Cutoffs for the PHQ-4 for various populations continue to be published for consideration. Here is a useful scoring manual for the PHQ and GAD measures.
  • Other respected measures of nonspecific psychological distress include the Distress Questionnaire-5 (DQ-5), Mental Health Inventory-5 (MHI-5), Self-Reporting Questionnaire-20 (SRQ-20), General Health Questionnaire-12 (GHQ-12), and Distress Thermometer (DT). Batterham (2017) provides a helpful crosswalk comparison of eight measures of psychological distress.
  • Other respected measures of depression include the Center for Epidemiologic Studies Depression Scale (CES-D) and Hamilton Rating Scale for Depression (HDRS, HRSD or HAM-D). Santor and colleagues (2009) provide a helpful review of depression measures.
  • Other respected measures of anxiety include the anxiety subscale of the Hamilton Anxiety Rating Scale (HARS) and the Penn State Worry Questionnaire (PSWQ).

Here is a list of respected subjective well-being measures that may be useful in help-seeking research:

Here is a list of respected functioning measures that may be useful in help-seeking research:

Here is a list of respected psychological well-being measures that may be useful in help-seeking research:

  • Psychological Well-Being Scale-18 (PWBS-18; Ryff & Keyes, 1995) – eighteen item version of the PWB scale that measures six aspects of wellbeing and happiness: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Contact Dr. Carol Ryff for permission to use the scale.
  • Cooke and colleagues (2016) (full-text download) provide a helpful review of well-being measures, including Table 1 with an exhaustive list of such measures. You will note that the concepts of functioning, well-being, and mental health have a lot of overlap and their uniqueness is entirely dependent on how one chooses to define and operationalize them. McDowell (2010)‘s review of well-being measures complements the review of Cooke and colleagues.

Some studies have asked respondents to self-report whether or not they have been diagnosed with a mental disorder by a professional. There are a few limitations to keep in mind regarding such questions. First, in order to receive a diagnosis, one must have “received help” in some sort of fashion, whether the person chose/intended to or not (e.g., a person could visit their primary care physician/general practitioner for help with stomach discomfort and subsequently be told that their provider is diagnosing them with an anxiety disorder). Second, people do not necessarily know whether a give provider has diagnosed them with a disorder or not (e.g., providers do not always disclose this to the patient, a person may forget that a past provider told them about a suspected or confirmed diagnosis). With these limitations in mind, here are two examples of different formats of this question reported in the published literature, which vary by time-period and structure:

  • Do et al., (2023) used this binary checklist:  “Within the last 12 months, have you been diagnosed or treated by a professional for any of the following?” The mental health illness categories included: anorexia, anxiety, ADHD, bipolar disorder, bulimia, depression, insomnia, other sleep disorder, obsessive compulsive disorder (OCD), panic attacks, phobia, schizophrenia, substance abuse or addiction (alcohol or other drugs), other addiction (e.g., gambling, internet, sexual), or other mental health condition.”
  • Zhang et al., (2021) used this binary yes/no item: ““Have you been diagnosed with emotional, nervous, or psychiatric problem by a doctor?”

Lastly, the USA National Institute of Health (NIH) has promoted the use of PROMIS (Patient-Reported Outcomes Measurement Information System) measures of “mental health” (e.g., anxiety, depression, alcohol, anger, cognitive function, life satisfaction, meaning & purpose, medication adherence, positive affect, psychosocial illness impact, self-efficacy for managing chronic conditions, smoking, substance use) and NIH Toolbox measures of cognitive, emotional (e.g., psychological well-being, stress and self-efficacy, social relationships, negative affect), sensory, and motor functions. These measures cut across all of the evaluated need measure categories described on this webpage.