In an integrated screening workflow for psychosocial wellbeing in primary care, which step should occur first when screening for concerns?

• A. Refer to psychiatry without screening.
• B. Initial brief screen with a tool (PHQ-2 or PHQ-9); if positive, conduct targeted assessment (PHQ-9, GAD-7); assess suicide risk; refer for therapy or psychiatry; arrange follow-up and care coordination.
• C. Wait for symptoms to worsen before screening again.
• D. Only screen if patient requests.

Answer: (B)

A practical approach to psychosocial wellbeing in primary care uses a universal, stepwise screening process. Begin with a brief, validated screener that can be completed quickly by most patients. Tools like PHQ-2 or PHQ-9 let you flag those who may have depressive symptoms without delaying care for everyone. If the screen is positive or indicates risk, move to a targeted, more thorough assessment to gauge severity and specific issues—using PHQ-9 for depression severity and GAD-7 for anxiety, for example. At this point, assessing suicide risk is essential to safety and determines immediate actions needed.

After you’ve clarified the level of need, refer for therapy or psychiatry as appropriate and arrange follow-up and care coordination to monitor progress and adjust treatment. This sequence—universal brief screening, targeted assessment for positives, suicide risk evaluation, then referral and follow-up—facilitates early detection, ensures safety, and connects patients to appropriate care in a practical, scalable way.

Choosing alternatives that wait for symptoms to worsen, rely on patient requests, or skip initial screening would miss many cases and delay essential intervention, which is why the stepwise approach is the best fit.