Global Distress

The home page of the ACORN toolkit shows a column of the most recent Global Distress score (GDS) on the client’s questionnaire. Low scores are color coded green and high scores are red.

Q: What is Global Distress?

A: The PHQ9 and GAD7 are popular screening tools due to their wide spread usage and due to their high face-validity. For example, splitting up the questions to ask in myriad ways about anxiety looks useful. It is also very familiar in the primary care setting, which means many people get more exposure to these tools, as opposed to other screening measures.

What is ACORN measuring?

It turns out, when you factor analyze anxiety and depression, you do not see two separate factors. You see one common factor, which is called Global Distress. For this reason, ACORN doesn’t necessitate use of multiple types of questionnaires.

In ACORN questionnaires, you’ll notice items very similar to the PHQ9/GAD7. We ask about feeling down, sleep, eating, energy level, concentration and self harm. We have factor analyzed all of our items and we only use them if the correlate highly with the common factor: Global Distress.

So you can think of Global Distress as a many-in-1, something that assures you will catch symptoms for not only anxiety and depression, but risk indicators, social cohesion, and functioning impairments. While substance abuse and therapeutic alliance don’t correlate with GDS, we have separate subscales for them that you can break out on the case graph (see below).

Global Distress is shown over time by the black dotted line on the case graph.