The primary care anxiety and depression (PCAD) scale: a culture-oriented screening scale

The construction of a screening scale for states of anxiety and depression among primary health care (PHC) patients is described. Most of the scale items were selected from a pool of items chosen from two international screening scales which were validated locally, namely the Self-Reporting Questionnaire (SRQ-20) and the Hospital Anxiety and Depression (HAD) Scale. A validity study of a new sample of PHC patients indicated that the scale provided a valid measure of anxiety and depressive states, and was closely correlated with the psychiatrist's clinical judgement. The scale correlated more strongly with the psychiatrist's clinical judgement than the general practitioners' assessments. Two cut-off points were established, one of which is more appropriate for clinical use and the other for prevalence estimation. The former threshold of the scale could be used to alert the busy general practitioner to the possibility that clinically significant anxiety or depression may be present.