Psychiatric screening tools in asthma and their barriers to clinical utilization: a systematic review

BACKGROUND: Chronic airway diseases such as asthma are often associated with psychiatric disorders like anxiety, depression, and posttraumatic stress disorder (PTSD), which occur 1.5-2.4 times more frequently in individuals with asthma. Despite this, these conditions are under-recognized. Various questionnaire-based screening tools exist for identifying these psychiatric conditions. This systematic review examines existing screening tools for asthma-related psychiatric conditions, evaluating their efficacy, effectiveness, and cost, with the goal of implementing them more broadly in clinical practice. DATA SOURCES: A search was performed using the databases MEDLINE, EMBASE, SCOPUS, CINAHL, and Web of Science for all relevant studies published before July 25, 2024. Costs for clinical use and copyright/open access status were assessed through internet searches and/or direct communication. Original validation studies of the screening tools were also reviewed. STUDY SELECTION: A total of 23 studies were included for analysis. Eligible studies focused on screening anxiety disorders, depressive disorders and/or PTSD in individuals with asthma. RESULTS: Eight psychiatric screening tools were identified, each validated and effective in screening for their respective anxiety disorders, depressive disorders, and PTSD. These tools effectively screen for psychiatric disorders, including in undiagnosed populations. Three are available at no cost for clinical use, while five require a fee. CONCLUSIONS: Considering multiple factors such as ease of administration, effectiveness, and cost, we recommend a combination of PHQ-9, GAD-7, and PCL-5 as screening tools for psychiatric comorbidity in primary care and specialty clinics managing adult asthma. Two of these tools are available in EMRs within Alberta.