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774 PA R T V / Health Promotion and Disease Prevention

Table 33-4 ■ ESSI: ENRICHD SOCIAL SUPPORT INSTRUMENT
None of Little of Some of Most of All of
the Time the Time the Time the Time the Time
1. Is there someone available to you whom you can count on to listen 1 2 3 4 5
to you when you need to talk?
2. Is there someone available to you to give you advice about a problem? 1 2 3 4 5
3. Is there someone available to you who shows you love and affection? 1 2 3 4 5
4. Is there someone available to you to help you with daily chores? 1 2 3 4 5
5. Can you count on anyone to provide you with emotional support 1 2 3 4 5
(talking over problems or helping you make a difficult decision)?
6. Do you have as much contact as you would like with someone you feel 1 2 3 4 5
close to, in someone you can trust in, and confide?
7. Are you currently married, or living with a partner? Yes No

Adapted from Mitchell, P. H., Powell, L., Blumenthal, J., et al. (2003). A short social support measure for patients recovering from myocardial infarction: The ENRICHD Social
g
Support Inventory. Journal of Cardiopulmonary Rehabilitation, 23, 398–403.

structural support have a significantly poorer prognosis than those
with complex social networks, the size and quality of the patient’s Table 33-5 ■ PRIME-MD (PRIMARY CARE EVALUATION OF
network should also be evaluated. If the patient lives alone, he or MENTAL DISORDERS), DIAGNOSTIC ASSESSMENT FOR
she should be asked if they have someone who usually provides DEPRESSION AND ANXIETY—PATIENT QUESTIONNAIRE
support (e.g., driving him or her to a doctor’s appointment). Instructions: This questionnaire will help your health provider better
Questions such as, “How many times a week do you visit with understand problems that you may have.
friends or relatives?” or “How many times a week do you attend a
community or social event, such as church?” can elicit key infor- During the PAST MONTH, have you often been bothered by . . .
mation for evaluating social support.
1. Stomach pain Y N
2. Back pain Y N
3. Pain in your arms, legs, or joints (knees, hips, etc.) Y N
Screening for Anxiety and Hostility 4. Menstrual pain or problems Y N
5. Pain or problems during sexual intercourse Y N
A few screening tools for anxiety and hostility are mentioned be- 6.Headaches Y N
low but these can be more time-consuming and more useful in 7. Chest pain Y N
N
Y
8. Dizziness
research rather than clinically. If time permits and there are con- 9. Fainting spells Y N
cerns about anxiety, alcohol use, or other diagnoses, a nurse can 10. Feeling your heart pound or race Y N
also administer the Primary Care Evaluation of Mental Disorders 11. Shortness of breath Y N
(PRIME-MD), a diagnostic two-part instrument that combines 12. Constipation, loose bowels or diarrhea Y N
27 self-report screening questions and short clinical interview 13. Nausea, gas, or indigestion Y N
14. Feeling tired or having low energy
N
Y
modules. 110 This is a practical and useful tool designed for pri- 15. Trouble sleeping Y N
mary care physicians (Table 33-5). 16. The thought that you have a serious undiagnosed disease Y N
The three screening items for anxiety as mentioned in Table 33- 17. Your eating being out of control Y N
5 are 20, 21, and 22. A yes response to one of these may lead to a 18. Little interest or pleasure in doing things Y N
N
19. Feeling down depressed or hopeless
Y
more thorough interview or additional screening. Other anxiety 20. “Nerves” or feeling anxious or on edge Y N
screening tools for CHD patients include (a) the State Trait Anxi- 21. Worrying about a lot of different things Y N
ety Inventory, a 40-item standardized questionnaire for anxiety, 22. Have you had an anxiety attack (suddenly feeling Y N
that has been used in several nursing studies 111 ;(b) the Crown- fear or panic)
Crisp Experiential Index for excessive anxiety or phobias 112 ; and (c) 23. Have you thought you should cut down your drinking Y N
of alcohol
the Minnesota Multiphasic Personality Inventory-based Cook- 24. Has anyone complained about your drinking Y N
Medley Hostility Inventory, a 50-item questionnaire. Williams & 25. Have you felt guilty or upset about your drinking Y N
Williams 113 have adapted this questionnaire and scoring method for 26. Was there ever a single day in which you had five or Y N
lay audiences. Patients can also use this resource for self-assessment more drinks of beer, wine, or liquor
and education. Overall would you say your health is
As evident from the description above, depression and social Excellent
Very Good
support screening tools are more easily adapted for use by nurses; Good
however, screening tools for anxiety and hostility could be further Fair
refined for use in acute settings. Nevertheless, the choice of a Poor
screening instrument depends on the patient population, patient
Borrowed with permission from Spitzer, R., Williams, J. B., Linzer, M., et al. (1994).
readiness, clinician’s skill and comfort, her or his clinical experience
Utility of a new procedure for diagnosing mental disorders in primary care: The
interpreting the instrument’s results, available time, and resources. PRIME-MD 1000 study. JAMA, 272, 1749–1756.