Screening tools for ruling out mood and anxiety disorders in adults in primary care: a rapid systematic review.

Abstract

Patients with mood and anxiety disorders commonly visit primary care providers in Canada. Screening tools can support providers in identifying patients who need further mental health care. Identify screening tools that are valid and reliable for ruling out mood and anxiety disorders in adults in primary care settings. Our rapid review searched MEDLINE, Embase and PsycInfo from January 1, 2006, to May 27, 2025. A single reviewer conducted screening, critical appraisal and data extraction. Low risk-of-bias studies were included. Sensitivity, specificity, and negative likelihood ratios (NLRs) with 95% confidence intervals were extracted or calculated. A threshold of NLR < 0.1 was used to interpret strong rule-out performance. We included 11 low risk-of-bias studies evaluating validity in 13 tools. No reliability studies were included due to high risk-of-bias. The Patient Health Questionnaire (PHQ)-2 (≥ 1/7), PHQ-9 (≥ 10/17), Generalised Anxiety Disorder (GAD)-2 (≥ 2/6), and GAD-7 (≥ 5/21) demonstrated the strongest evidence for ruling out depression and anxiety (NLR < 0.1). The PHQ-2, PHQ-9, HADS-D, 15-item GDS, QIDS-SR16, GAD-2, and GAD-7 are brief, valid tools with strong rule-out performance for depression and anxiety in primary care. Future research should evaluate reliability and performance in diverse providers and patients, including non-physician settings and underserved communities.