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Severity Ranges

Global Distress Scale (GDS) scores represent a client's global distress on a scale that ranges from 0 to 4. Obviously, small differences between scores should be interpreted with caution, and the clinician may wish to round the result to the nearest whole number for ease of interpretation.

The clinician should bear in mind that any self-report questionnaire should be interpreted in the context of the clinical situation. At any individual point in time, a patient's responses may be influenced by his or her beliefs about the purpose of the questionnaire, feelings about the therapy or therapist, and other factors which may bias responses in one direction or another.

The following severity ranges are provided as an aid to interpreting test scores. GDS scores are color coded to reflect the range of scores found in typical outpatient mental health and substance abuse treatment settings. Green indicates the quartile (25%) of patients with lowest levels of reported symptoms and problems while red indicates scores in the upper quartile of all patients, indicating a high level of symptom severity and frequency, accompanying by difficulties in personal relationships and impaired functionality and performance at work or school.

Severity Ranges (by questionnaire)

Questionnaire Normal/Mild Distress Moderate Distress Severe Distress Extreme Distress
% at intake (25%) (50%) (25%) (10%)
ACORN-Adult 0-1.5 1.6-2.5 2.6-4 3.3-4
ACORN-Youth-Self report 0-1 1.1-1.8 1.9-4 2.3-4
ACORN-Youth-Caregiver report 0-1.2 1.3-1.9 2-4 2.5-4
PHQ9-GAD7 0-.6 .7-1.7 1.8-3 2.2-3

Normal range of distress

Scores in this range are typical of individuals who are not seeking mental health services. The mean GDS for a community sample is estimated to be 1, with a standard deviation of .6. Approximately 75% of individuals in the community will have scores in this range.

Approximately 25% of individuals seeking mental health treatment will also have scores in this range at the first assessment. Individuals seeking treatment with scores in this range are most likely to have a diagnosis of adjustment disorder, or no diagnosis at all. Also, patients referred for substance abuse treatment often have scores in this range.

Patients who begin treatment reporting low levels of distress tend to report high satisfaction with treatment while showing little to no improvement as measured by the test scores. Also, patients who began treatment with GDS scores in the Moderate or Severe range tend to show a rapidly diminishing rate of improvement once their test scores enter this "normal" range. The closer the scores come to this range, the more likely the patient is to terminate treatment voluntarily.

Moderate distress

GDS scores in this range are typical of individuals seeking mental health services. Patients diagnosed with an adjustment disorder, substance abuse disorder, or attention deficit/hyperactivity have mean intake scores at the low end of this range. Patients diagnosed with anxiety disorders or personality disorders have mean intake scores in the middle of this range. Patients diagnosed with depression, bi-polar disorders, and PTST have mean intake scores towards the high end of this range.

Patients with scores in this range tend to show improvement with continued treatment.

Severe distress

An estimated 25% of individuals seeking outpatient services will have scores in this range.Patients with scores in this range are much more likely to be diagnosed with major depression, bi-polar disorder, or other serious mental illness.

GDS scores in this range tend to improve relatively rapidly with treatment. If patients with this level of distress fail to experience relief, they may become discouraged and terminate treatment, prematurely. Research suggests, however, that these patients are likely to report improvement over time, if they remained engaged in treatment.

Extreme Distress

Some clinicians and organizations prefer to include a fourth level of severity that define the upper 10% of a clinical sample, and is a subset of those patients classified in the Severe range.

These patients should be evaluated carefully. Often such high scores reflect a crisis in the patients live. These patients are likely to show relatively rapid improvement. Only a very small percentage of patients will have scores in this range over an extended period of time. These patients are likely to be diagnosed with one or more serious psychiatric disorders.

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