ICD-10 Symptom Rating

The ISR gives a quick overview of the patient's psychological symptoms, organised along the syndromes of chapter F of the ICD-10. The patient rates 29 symptoms; the result gives scores for depression, anxiety, compulsion, somatization and eating disorders, a supplementary scale with screening items for further syndromes, and a total score for overall burden. It was developed in Germany by the IQP in Munich and is used in routine inpatient and outpatient care.

The patient rates each symptom from 0 (does not apply) to 4 (applies extremely) for the past two weeks; item 28 refers to the past few years. Each scale score is the mean of its items (range 0–4): depression (4 items), anxiety (4), compulsion (3), somatization (3), eating disorder (3) and a supplementary scale (12 items) covering for example concentration, suicidal thoughts, sleep, appetite, memory, traumatic memories, stress reactions, depersonalization, derealization and sexuality. The total score is the mean of all scale scores, with the supplementary scale weighted twice.

Clinicians use the ISR at the start of treatment to screen broadly for co-occurring mental health problems, for example in patients with alcohol or drug use. Because it is short, it also suits repeated measurement to track change.

The ISR was developed by Karin Tritt, Friedrich von Heymann, Michael Zaudig, Wolfgang Söllner, Thomas Loew and colleagues at the IQP (Institut für Qualitätsentwicklung in der Psychotherapie und Psychosomatik, Munich), together with the Department of Psychosomatic Medicine at the University of Regensburg. German is the original language; English, French, Italian and Turkish versions are available from the IQP.

Norms are based on a representative, clinically unremarkable sample of 2,512 people and a sample of 2,800 psychosomatic patients. In 3,755 psychosomatic inpatients, the ISR total score correlated highly with the Global Severity Index of the SCL-90-R (r = .84), and the syndrome scales were more clearly separated from each other than those of the SCL-90-R. The ISR has been used with well over 30,000 inpatients and outpatients. Validation studies found convergent correlations with the Beck Depression Inventory (BDI), the German depression scale ADS and the State-Trait Anxiety Inventory (STAI), and the depression scale has been shown to be sensitive to change in clinical samples (Brandt et al., 2015). The scale structure was also examined in a largely non-clinical sample (Braun et al., 2017). Validation data refer to the German version.

The ISR is a screening and severity measure, not a diagnostic instrument. Published cutoffs exist per scale; the supplementary scale has none, because its items cover different syndromes and are read individually. Its psychometric data come from German-speaking samples, so evidence for the English version is more limited. Item 19 asks about suicidal thoughts; any answer above 0 shows the crisis note on the results page.