> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # Depression + anxiety screening in Rivet > When to screen, what the severity bands tell you, and how to pick between overlapping measures like PHQ-9 vs QIDS or CES-D-R. The depression and anxiety screening family is the most-used corner of the template library. PHQ-9 and GAD-7 are the universally expected pair — insurers ask for them, EFAP referrals often require them, and outcome- informed therapy treats them as the standard depression and anxiety measures. Rivet includes three more depression scales (QIDS-SR-16, CES-D-R) and a social anxiety scale (SPIN) for cases where the standard pair isn't the right fit. ## When to screen The common cadence: * **Intake.** A PHQ-9 + GAD-7 baseline on the first session, often sent async ahead of time so they're already filled when you sit down together. * **Every 2–4 weeks during treatment.** Track response without screening burnout. PHQ-9 takes the client about two minutes. * **Pre/post a discrete intervention.** Around an EMDR target, a CBT protocol, a medication change, or any time you want to attribute a symptom change to a specific piece of work. * **Discharge.** Outcome documentation for the chart, for the referrer, and for the client to see what changed. You're free to administer them less often — these are tools, not rules — but most outcome-informed practices land on something close to this rhythm. ## What the severity bands tell you Every measure in this family has a published total-score-to-severity-band mapping (e.g. PHQ-9: 0–4 Minimal, 5–9 Mild, 10–14 Moderate, 15–19 Moderately severe, 20–27 Severe). Rivet shows you the band live as soon as the total crosses a threshold. The bands are interpretive aids, not diagnoses. A PHQ-9 of 14 doesn't mean the client has Major Depressive Disorder — it means their self-reported symptoms over the last two weeks fall in the moderate-severity range on a nine-item screening instrument. The clinical interview is what makes a diagnosis; the band is what helps you triage attention. The most useful question to ask about a score is what *changed*. A drop from 18 to 10 over six weeks is a clinically meaningful response. A flat 14 across three months suggests the current approach isn't moving the client. ## Picking between depression measures Rivet includes four self-report depression scales. They cover overlapping ground; the practical differences: * **[PHQ-9](/clinical-templates/screening/phq-9)** — Nine items, two-week frame, the universal default. Pair with GAD-7. Item 9 surfaces suicidal ideation in a single item. * **[QIDS-SR-16](/clinical-templates/screening/qids-sr-16)** — Sixteen items, two-week frame, mirrors DSM-IV-TR symptom domains. Used widely in research and outcome-tracking. Item 12 is the suicidality item. * **[CES-D-R](/clinical-templates/screening/ces-d-r)** — Twenty items, past-week frame, covers all nine DSM symptom groups. Often selected when there's continuity with prior CES-D documentation. Items 14 and 15 split death wish and self-harm into two items. * **[SPIN](/clinical-templates/screening/spin)** — Seventeen items specifically for social anxiety / Social Phobia. Past-week frame. Different family from the other three; use when the presenting concern is social-evaluative anxiety. If you don't have a preference, start with PHQ-9. It's the expected default and pairs naturally with GAD-7. ## The risk-flag rule Every depression measure in this family carries a suicidality item (sometimes two). Across PHQ-9, QIDS, and CES-D-R, the rule is the same: **Any positive answer on a suicidality item warrants follow-up regardless of the total score.** A PHQ-9 of 6 with Item 9 answered "Several days" matters more than a PHQ-9 of 22 with Item 9 at zero. Rivet surfaces a flag in the scoring pill when the cutoff is crossed; the clinical judgment about what to do next is yours. Each per-measure article calls out the specific item(s) that trigger the flag and how Rivet displays it. ## A note on clinical change A common practitioner question is "how big a drop counts as real change?" The convention from the literature varies by measure — a 5-point PHQ-9 drop is often cited (Kroenke 2010 follow-up), and similar conventions exist for GAD-7 and the others. Rivet doesn't compute "change" between two responses; the in-session scoring pill shows the current total only. If you want week-over-week trends, that's the role of [measurement-based care](/measurement-based-care/index), not the in-session template. ## Every measure in this section Twenty-five instruments, grouped by what they are for. Each page carries the scoring rules, the cutoffs and what a change in score actually means. ### Depression and mood The default depression measure. Nine items, and Item 9 carries a risk flag. Depression severity with a highest-item rule across the sleep, weight and psychomotor domains. Depressive symptoms over the past week, with a longer look-back than the PHQ-9. Five items on well-being rather than symptoms. Reverse-scored — higher is better. Screens for a history of hypomanic or manic episodes before you treat for depression. ### Anxiety, worry and stress The standard anxiety companion to the PHQ-9. Depression, anxiety and stress on three separate subscales. Worry as a trait rather than a symptom — useful in GAD work. Social anxiety across fear, avoidance and physiological arousal. Obsessive-compulsive symptoms across six dimensions. Perceived stress over the last month — appraisal rather than event count. ### Trauma The DSM-5 PTSD checklist. The adult standard. The pediatric counterpart to the PCL-5, ages 8 to 18. The ICD-11 measure, and the one that separates PTSD from Complex PTSD. Childhood adversity as a count, not a severity score. Read the caveats before using it. ### Sleep Insomnia severity, with a published 6-point threshold for meaningful change. Sleep quality across seven components over the past month. ### Eating A five-question screen. Two or more positives warrants a fuller assessment. Eating-disorder psychopathology across four subscales. ### Personality, regulation and function A brief screen for borderline personality features. Borderline symptom severity, tracked over time — the DBT outcome standard. Reappraisal and suppression as emotion-regulation strategies. Functional disability across six life domains, independent of diagnosis. General psychological distress. A wide net when the presentation is unclear. Perceived social support from family, friends and a significant other. ## Related articles The three kinds of templates and how scoring works. The live collaborative flow from picker to PDF.