Fisher et al developed a simple screening test to detect distress in a patient with diabetes. This can be modified to detect distress in other conditions. The authors are from the University of California in San Francisco.


The 2 items used in the screening instrument:

(1) feeling overwhelmed by disease-related demands

(2) failing in regimen


The original instrument used a 6 point scale for the patient's response.


The proposed modification is to use a 10-cm visual analogue scale (VAS) anchored at 0 cm (none) to 10 cm (extreme).



• A response > 7 cm in either question is associated with significant distress.

• Responses < 2 cm in both questions would be associated with no or little distress.

• Responses in the 2-7 range indicate some distress and the need to more closely monitor the patient.

• More categories can be identified. As with any grading system, there is a need to balance the number of categories with the limits of the system.



• The original 2-item instrument showed a sensitivity of 95% and specificity of 85% which was comparable to the performance with 3 or 4 items.


To read more or access our algorithms and calculators, please log in or register.