Mood Assessment and Management

Initial Screening and Assessment

• The American College of Oncology recommends that mood assessment should begin with the Patient Health Questionnaire-9 (PHQ-9) as the primary screening tool, followed by structured evaluation of anxiety symptoms, risk assessment for self-harm, and identification of medical or substance-induced causes 1, 2, 3
• The PHQ-9 should be administered first to all patients requiring mood assessment, using a cutoff score of ≥8 for detecting depression in medical populations 3
• Patients with PHQ-9 scores ≥15 require referral to psychiatry or psychology 4

Anxiety Assessment and Management

• Following depression screening, assess anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7) scale 1, 2
• The GAD-7 total score ranges from 0 to 21, with interpretation as follows: 0-4 (minimal anxiety), 5-9 (mild anxiety), 10-14 (moderate anxiety), and 15-21 (severe anxiety) 1, 5

Critical Safety Assessment and Referral

• Before proceeding with further assessment, evaluate for risk of harm to self or others, severe depression or agitation, psychosis, or confusion (delirium), all of which require immediate referral to a psychiatrist, psychologist, physician, or equivalently trained professional 1, 2, 5, 3
• Systematically evaluate for both active and passive suicidal ideation, including thoughts of suicide or death 3

Diagnostic Clarification and Medical Rule-Out

• If moderate to severe or severe symptomatology is detected through screening, individuals must have further diagnostic assessment to identify the nature and extent of the depressive symptoms and the presence or absence of a mood disorder 1, 2, 5
• Medical or substance-induced causes of significant depressive symptoms must be determined and treated 1, 2, 5

Alternative and Supplementary Assessment Tools

• Alternative validated instruments for depression assessment include the Beck Depression Inventory-II (BDI-II), Center for Epidemiological Studies–Depression Scale (CES-D), and Geriatric Depression Scale (GDS) 1, 2
• The Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV) are recommended for anxiety assessment 1, 2

Team-Based Assessment and Referral

• Assessments should be a shared responsibility of the clinical team, with designation of those expected to conduct assessments as per scope of practice 1, 2, 5
• The clinical team must decide when referral to a psychiatrist, psychologist, or equivalently trained professional is necessary 1, 2, 5