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Screening and Assessment of Depression


Accurate screening and assessment are key to perform before, during and after depression treatment to assess the patient’s baseline, how they are doing during treatment, and their outcomes after treatment. Depression scales are also of fundamental importance when designing and conducting clinical trials regarding methods and medications for the treatment of depression. There are both clinician and patient-rated scales of depression. In this article you will find a description of some sample tools and their features.

The Hamilton Depression Rating Scale (HAM-D)

The Hamilton Depression Rating Scale is the most-used clinician-based depression scale. It was developed in 1960 for the inpatient population.

The test comes in several languages including English, French, German, Italian and others. Many versions have been adapted since then, including a structured interview version, self-report, and a computerized format.

The HAM-D is designed to measure depression in adult patients before, during and after treatment. The latter version contains 17 items that are measured on a five-point or three-point scale (depending on the item). The HAM-D takes only 20 minutes to complete and score.

Questions focus on depressed mood, feelings of guilt, suicide, insomnia (restless and disturbed sleep during night, wakening in early morning and unable to fall asleep), work and interests, anxiety, agitation, somatic anxiety, gastrointestinal anxiety, genital symptoms, hypochondriasis, weight loss, and insight.

Montgomery Depression Rating Scale (MADRS)

Another clinical rating tool is the Montgomery Depression Rating Scale. This screening tool measures the degree of depression in patients 18 years of age or older with each item rated on a seven-point scale.

The MADRS is an adaptation of the HAM-D and has a significant sensitivity to change.

Unlike the HAM-D, the MADRAS scale is completed by the interviewer. The scale may be used at any time interval during therapy, including weekly or otherwise. It takes about 20 minutes to complete.

Assessment areas addressed by MADRS include reduced sadness, concentration difficulty, reduced appetite, reduced sleep, lassitude (slowness in daily activities), inability to feel, pessimistic thoughts, and suicidal thoughts.

The Beck Depression inventory (BDI)

The Beck Depression inventory is widely used across worldwide populations to assess and measure for depression and calculate the seriousness of depression.

The BDI can be used from ages 13 to 80. The rating scale has 21 self-reported items that are answered by the client using multiple-choice responses. The inventory requires about 10 minutes to complete and is also available in Spanish.

When the BDI is completed, the individual values for each factor in the BDI are summed up and depending on scoring, ranges are applied to the value from minimal to severe depression.

Center for Epidemiologic Studies Depression Scale (CES-D)

Another depression scale is the Center for Epidemiologic Studies Depression Scale, which can be used in children as young as four and older.

It was tested across gender and cultural populations and proved both valid and reliable for both. It is designed for the general population and is used as a depression screening in primary care settings.

The tool includes 20 screening statements and uses a four-point scale. It measures major dimensions of depression in the past week.

Administration and scoring take 20 minutes with scoring being zero to three, and the positive items reversed. Possible range to score is zero to 60 with the higher score indicating the presence of greater symptomatology. The patient completes the rating scale.

Patient Health Questionnaire

The final depression screening tool is the Patient Health Questionnaire which takes about three minutes to complete and is available in over 20 languages including English, Russian, Somali, Arabic, Czech, and more. It is valid in several different populations internationally.

There are a total of nine assessed areas to address which include interest or pleasure in doing things, poor appetite or overeating, trouble concentrating on things, etc.

Key takeaways

Many screening tools for depression exist, as identified by the American Psychology Association.

Tools vary in what and how they are scored, and whether they include adults, children or both, and the factors they rate.

Each rating tool is chosen to fit the situation and individual.

Resources

American Psychology Association. Centre for Epidemiological Studies: Depression.

American Psychology Association. Depression Assessment Instruments.

American Psychology Association. Montgomery Asberg Scale.

Dunlop, B.W., Li, T., Kornstein, S.G., et. al. (2010). Correlation between patient and clinician assessments of depression severity in the Prevent study. Psychiatry Res.

Garcia-Batista, Z.E., Guerra-Peña, K., Cano-Videl, A., Herrera-Martinez, S.X., Medrano, L.A. (2018). Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. Plos One.

MD Calc. Montgomery Asberg Depression Rating Scale (MADRS).

University of Madison-Wisconsin. Beck Depression Inventory (BDI).

WebMD. Tests used to diagnose depression.

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