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Table 1 Recommended screening for depression, negative body image and eating disorders [136]

From: Providing lifestyle advice to women with PCOS: an overview of practical issues affecting success

Assessment of anxiety and or depressive symptoms involves assessment of risk factors, symptoms and severity. Symptoms can be screened according to regional guidelines, or by using the following stepped approach:

Step 1: Initial questions could include: Over the last 2 weeks, how often have you been bothered by the following problems?

• feeling down, depressed, or hopeless?

• little interest or pleasure in doing things?

• feeling nervous, anxious or on edge?

• not being able to stop or control worrying?

Criteria: If any of the responses are positive, further screening should involve:

assessment of risk factors and symptoms using age, culturally and regionally appropriate tools, such as the Patient Health Questionnaire (PHQ) or the Generalised Anxiety Disorder Scale (GAD7) and/or refer to an appropriate professional for further assessment.

Negative body image, can be screened according to regional guidelines or by using the following stepped approach:

Step 1: Initial questions could include:

• Do you worry a lot about the way you look and wish you could think about it less?

• On a typical day, do you spend more than 1 hour per day worrying about your appearance? (More than 1 hour a day is considered excessive)

• What specific concerns do you have about your appearance?

• What effect does it have on your life?

• Does it make it hard to do your work or be with your friends and family?

Criteria: If an issue is identified, health professionals could further assess by:

• Identifying any focus of concern of the patient and respond appropriately

• Assessing the level of depression and/or anxiety

• Identifying distortion of body image or disordered eating

Eating disorders and disordered eating can be screened using the following stepped approach.

Step 1: The SCOFF (Sick, Control, One stone, Fat, Food) screening tool can be used or initial screening questions can include:

◦ Does your weight affect the way you feel about yourself?

◦ Are you satisfied with your eating patterns?

Criteria: If the SCOFF tool or any of these questions are positive, further screening should involve:

◦ assessment of risk factors and symptoms using age, culturally and regionally appropriate tools;

◦ referral to an appropriate health professional for further mental health assessment and diagnostic interview. If this is not the patient’s usual healthcare provider, inform the primary care physician.