Comprehensive Psychiatric Symptom Screening Questionnaire (CPSSQ) and Level of Functioning Scale (LoF-5) in Adults Aged 30–60 Years

The Need for Self-Administered Screening for Mental Health

Mental health conditions are among the leading contributors to the global burden of disease, yet remain grossly underdiagnosed and undertreated—particularly in low-resource and high-stigma settings like India. Traditional pathways to diagnosis depend on clinical interviews and psychiatric evaluations, which are neither scalable nor accessible to the vast majority of at-risk populations. The gap is most acute among individuals with subthreshold symptoms who experience distress and functional impairment but never reach specialized care.

Self-administered screening offers a transformative solution to this challenge. It empowers individuals to assess their psychological well-being privately, at their own pace, and in non-clinical environments such as their homes, workplaces, or educational institutions. Such tools reduce barriers imposed by stigma, fear of judgment, or logistical difficulties in accessing mental health professionals. Digital self-screening platforms, in particular, ensure confidentiality, encourage honest reporting, and allow automated feedback and referral recommendations.

Globally, self-administered mental health screeners—like the PHQ-9, GAD-7, and Kessler scales—are widely used in primary care, workplaces, and public health programs (Kroenke et al., 2001; Kessler et al., 2002). The WHO’s mhGAP initiative similarly emphasizes simple, scalable tools that non-specialists and individuals themselves can use for early detection (WHO, 2019). In India, where mental health literacy is low and stigma remains high, self-screening can act as an essential gateway for initiating help-seeking, reducing delay in care, and facilitating early intervention.

However, the development of such tools must ensure cultural relevance, linguistic accessibility, and scientific validity. They should integrate not only symptom measures but also functioning, resilience, and contextual risks to avoid over-pathologizing normal emotional variation while capturing true distress.

In summary, self-administered screening is not a replacement for clinical diagnosis but a critical public health strategy to identify hidden distress, enable early triage, and bridge the gap between population needs and available mental health services.

Mental health disorders are a leading cause of disability worldwide, with adults aged 30–60 representing a high-risk group for undetected depression, anxiety, substance use disorders, and cognitive decline (WHO, 2021). In India, mental health screening in this demographic is sparse, contributing to treatment gaps exceeding 70% (NMHS, 2016). The CPSSQ and LoF-5 were designed to provide comprehensive, culturally sensitive screening aligned with ICD criteria. Validation of these tools in both clinical and community samples is essential to ensure accuracy, reliability, and practical utility.

To validate the CPSSQ and LoF-5 in 300 patients with diagnosed psychiatric disorders and 300 healthy controls, assessing psychometric properties, diagnostic performance, and usability.

Objectives:

• Assess internal consistency, test-retest reliability, and construct validity of CPSSQ and LoF-5.
• Establish cut-off scores for symptom severity and functional impairment.
• Evaluate sensitivity, specificity, and predictive value against gold-standard clinical diagnosis.

Executive Summary

Mental disorders contribute substantially to the disease burden in India, yet they often go unrecognized and untreated, particularly among adults aged 30–65 years. This population navigates critical life transitions, occupational stress, caregiving roles, and health challenges, which place them at heightened risk for psychological distress and mental illness. Despite this, access to timely mental health evaluation remains limited, especially in rural and underserved regions.

This project seeks to address this gap by developing and implementing a digital, ICD-11-informed psychometric screening tool designed for community-based use among Indian adults. The tool screens for emotional, cognitive, functional, and psychosocial risk domains, while also capturing life events and protective factors. Delivered through mobile and web platforms, it ensures privacy, scalability, and cultural adaptability.

The primary objectives are to:

• Enable early detection of mental health concerns.
• Stratify risk levels using a staging framework for tailored interventions.
• Provide triage recommendations (e.g., self-help, counseling, psychiatric referral).
• Promote stigma-free, equitable mental health access aligned with India’s National Mental Health Programme and WHO’s mhGAP framework.

Pilot data suggest high feasibility and acceptability in both rural and urban populations. This project represents a step toward integrating mental health screening into primary care and community health systems, bridging the gap between early distress and formal diagnosis.