Scoring the OSPRO-YF is complex. We suggest using the scoring website or integrating the scoring equations into your electronic health record. For those interested in developing their own scoring resource or using statistical programs to score the tool for research, instructions are provided below.
There are two types of results provided by the OSPRO-YF: Full-length questionnaire score estimates and Yellow flags based on those estimates. Each requires different scoring equations.
Questionnaire score estimates
First, determine which version you will use, the 7-item, 10-item, or 17-item version. Scoring equations are different for each.
To score, each patient response will be multiplied by an item weighting coefficient. Weighting coefficients are provided in Appendix C of the OSPRO-YF development paper for each version of the tool. After multiplying each response by its weighting coefficient, you will add these values along with an intercept value to get the questionnaire score estimate. The format of these equations looks like this:
PHQ-9 estimate = (Patient response #1 x Item #1 weighting coefficient for PHQ-9) + (Patient response #2 x Item #2 weighting coefficient for PHQ-9) + (Patient response #3 x Item #3 weighting coefficient for PHQ-9) + … + intercept value.
This process would be repeated for each of the other 10 questionnaires using the relevant weighting coefficients for those questionnaires.
Important note: If using the 17-item version, responses to question #2 and question #16 must be reverse-scored before multiplying by their weighting coefficient. To reverse score question 2, subtract the item response from 5. To reverse score question 16, subtract the item response from 6. Reverse scoring does not apply to the 10-item or 7-item version of the tools, since they do not include these two items (“I am content” and “Before I can make any serious plans…”)
Example:
If the 7-item OSPRO-YF version is used to estimate the total PHQ-9 score, the equation would be calculated as follows (item responses in parentheses are artificially generated): 3.864(2) + 0.403(3) + 0.357(3) + 0.565(4) + 0.141(4) + 0.227(4) – 0.445(3) + 4.324 = 16.729, which is best interpreted as a PHQ-9 estimate of 17 points. Note that the 4.324 value is the intercept and no items are reverse scored because we are using the 7-item version.
Identifying yellow flags
The process for identifying yellow flags is similar to generating score estimates, with a few key differences. First, the equation does not include an intercept. Second, once the equations are calculated, the resulting sum is compared to a cutoff value (see column in Appendix B of the OSPRO-YF development paper). If the sum of the equation is greater (more positive) than the cut-off value, it signifies a yellow flag for that questionnaire score. Otherwise, there is no yellow flag for that questionnaire.
As before, you must first determine which version you will use, the 7-item, 10-item, or 17-item version. Scoring equations are different for each.
Each patient response will be multiplied by an item weighting coefficient in Appendix B of the OSPRO-YF development paper for each version of the tool. After multiplying each response by its weighting coefficient, you will add these values to get the equation sum. This sum has no clinical relevance. It is only developed to compare against the cut-off value for that questionnaire in the Appendix Table.
The format for yellow flag equations looks like this:
PHQ-9 yellow flag equation sum = (Patient response #1 x Item #1 weighting coefficient for PHQ-9) + (Patient response #2 x Item #2 weighting coefficient for PHQ-9) + (Patient response #3 x Item #3 weighting coefficient for PHQ-9) + … and so on.
The equation sum for PHQ-9 is then compared against the cut-off value to determine if a yellow flag is present for depressive symptoms.
This process would be repeated for each of the other 10 questionnaires using the relevant weighting coefficients for those questionnaires.
Important note: As before, if using the 17-item version, responses to question #2 and question #16 must be reverse-scored before multiplying by their weighting coefficient. To reverse score question 2, subtract the item response from 5. To reverse score question 16, subtract the item response from 6. Reverse scoring does not apply to the 10-item or 7-item version of the tools, since they do not include these two items (“I am content” and “Before I can make any serious plans…”)
Example:
If the 7-item assessment OSPRO-YF version is used to determine the presence of a yellow flag for depressive symptoms, the equation would be calculated as follows (item responses in parentheses are artificially generated): 1.921(2) + 0.349(3) + 0.121(3) + 0.273(4) + 0.131(4) + 0.053(4) – 0.297(3) = 6.189.
In this case, the 6.189 value is the equation sum. Remember that it has no clinical value, it is only calculated to compare against the PHQ-9 cutoff value for the 7-item version of the tool, which is 0.528 (Appendix B of development paper). Because the equation sum is greater than the cutoff value (6.189 > 0.528), this result would indicate a yellow flag for depressive symptoms is present.
What about a “total score”?
Some studies have added all the OSPRO-YF item responses to create a total score, reversing items where needed so that higher scores reflect more distress. While this gives a very rough estimate of overall psychological distress, we don’t recommend using it in clinical settings. The OSPRO-YF includes items with different scales, therefore each item carries a different weight. That works well for its original purpose, estimating scores and identifying flags, but it hasn’t been thoroughly tested for accuracy as a single composite score, especially when measuring change in distress.
A better way to assess overall distress is to count the number of yellow flags and consider which domains they represent. That gives a more accurate picture of what the patient might be struggling with and helps guide care more effectively. Change in the number of yellow flags present might also be a helpful way to track progress.
Additional resources
Code for scoring (SPSS)
**To guarantee accuracy, cross-check a sample of results that use these codes against results from the online calculator
SPSS OSPRO 7-item scoring code
SPSS OSPRO 10-item scoring code
SPSS OSPRO 17-item scoring code
