Beck Anxiety Inventory (BAI)

Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you have been bothered by that symptom during the past month OR since your last infusion, if you have started the ketamine infusion therapy. Circle one number in the corresponding space in the row next to each symptom.

The total score is calculated by finding the sum of the 21 items.

Beck Anxiety Score _______________

Score of 0 – 21 = low anxiety

Score of 22 – 35 = moderate anxiety

Score of 36 and above = potentially concerning levels of anxiety

Beck's Depression Inventory

This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.

INTERPRETING THE BECK DEPRESSION INVENTORY

Now that you have completed the questionnaire, add up the score for each of the twenty-one

questions by counting the number to the right of each question you marked. The highest possible

total for the whole test would be sixty-three. This would mean you circled number three on all

twenty-one questions. Since the lowest possible score for each question is zero, the lowest

possible score for the test would be zero. This would mean you circles zero on each question.

You can evaluate your depression according to the Table below.

Total Score____________________Levels of Depression

1-10____________________These ups and downs are considered normal

11-16___________________ Mild mood disturbance

17-20___________________Borderline clinical depression

21-30___________________Moderate depression

31-40___________________Severe depression

over 40__________________Extreme depression

GAD-7 Anxiety

Over the last two weeks, how often have you

been bothered by the following problems?

Not at all = 0

Several days =1

More than half the days=2

Nearly every day=3

Source: Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD-PHQ). The PHQ was

developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues. For research information, contact Dr.

Spitzer at ris8@columbia.edu. PRIME-MD® is a trademark of Pfizer Inc. Copyright© 1999 Pfizer Inc. All rights reserved.

Reproduced with permission

Scoring GAD-7 Anxiety Severity

This is calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of “not at all,” “several days,” “more than half the days,” and “nearly every day.”

GAD-7 total score for the seven items ranges from 0 to 21.

0–4: minimal anxiety

5–9: mild anxiety

10–14: moderate anxiety

15–21: severe anxiety

PATIENT HEALTH QUESTIONNAIRE (PHQ-9)

Over the last 2 weeks, how often have you been

bothered by any of the following problems?

Not at all = 0

Several days =1

More than half the days=2

Nearly every day=3

(Healthcare professional: For interpretation of TOTAL, please refer to accompanying scoring card).

Add columns

PHQ-9 Patient Depression Questionnaire

For initial diagnosis:

1. Patient completes PHQ-9 Quick Depression Assessment.

2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive disorder. Add score to determine severity.

Consider Major Depressive Disorder

- if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2)

Consider Other Depressive Disorder

- if there are 2-4 3s in the shaded section (one of which corresponds to Question #1 or #2)

Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood

the questionnaire, as well as other relevant information from the patient.

Diagnoses of Major Depressive Disorder or Other Depressive Disorder also rquire impairment of social, occupational, or other important areas of functioning (Question #10) and ruling out normal bereavement, a

history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms.

To monitor severity over time for newly diagnosed patients or patients In current treatment for depression:

1. Patients may complete questionnaires at baseline and at regular intervals (eg, every 2 weeks) at home and bring them in at their next appointment for scoring or they may complete the questionnaire during each scheduled appointment.

2. Add up 3s by column. For every 3: Several days = 1 More than half the days = 2 Nearly every day = 3

3. Add together column scores to get a TOTAL score.

4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score.

5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention.

Scoring: add up all checked boxes on PHQ-9

For every 3 Not at all = 0; Several days = 1;

More than half the days = 2; Nearly every day = 3