Rating scales for depression

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Rating scales for depression
Purposeto determine the presence and severity of depression

A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period. [1] When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. [1] Several rating scales are used for this purpose. [1]

Contents

Scales completed by clinicians, researchers, and workers

Some depression rating scales are completed by clinicians or researchers. The Hamilton Depression Rating Scale includes 21 questions with between 3 and 5 possible responses which reflect increasing or decreasing severity. The clinician must choose the possible responses to each question by interviewing the patient and by observing the patient's symptoms. Designed by psychiatrist Max Hamilton in 1960, the Hamilton Depression Rating Scale is one of the two most commonly used among those completed by clinicians and researchers in assessing the effects of drug therapy. [2] [3] Alternatively, the Montgomery-Åsberg Depression Rating Scale ((MADRS) has ten items to be completed for the purpose of assessing the effects of drug therapy. The MADRS is the other of the two most commonly used scales by clinicians and researchers who are involved with patients. [2] [4] Another scale is the Raskin Depression Rating Scale; which rates the severity of the patients' symptoms in three areas: verbal reports, behavior, and secondary symptoms of depression. [5] Finally, the Occupational Depression Inventory [6] [7] specifically focuses on depressive symptoms that people attribute to their jobs. [8] [9]

Scales completed by patients

The two questions on the Patient Health Questionnaire-2 (PHQ-2): [10]

During the past month, have you often been bothered by feeling down, depressed, or hopeless?

During the past month, have you often been bothered by little interest or pleasure in doing things?

Some depression rating scales are completed by patients. The Beck Depression Inventory, for example, is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex, and feelings of guilt, hopelessness or fear of being punished. [11] The scale is completed by patients to identify the presence and severity of symptoms consistent with the DSM-IV diagnostic criteria. [12] The Beck Depression Inventory was originally designed by psychiatrist Aaron T. Beck in 1961. [11]

The Geriatric Depression Scale (GDS) is another self-administered scale, but in this case it is used for older patients, and for patients with mild to moderate dementia. Instead of presenting a five-category response set, the GDS questions are answered with a simple "yes" or "no". [13] [14] The Zung Self-Rating Depression Scale is similar to the Geriatric Depression Scale in that the answers are preformatted. In the Zung Self-Rating Depression Scale, there are 20 items: ten positively worded and ten negatively worded. Each question is rated on a scale of 1 through 4 based on four possible answers: "a little of the time", "some of the time", "good part of the time", and "most of the time". [15]

The Patient Health Questionnaire (PHQ) sets are self-reported depression rating scales. For example, the Patient Health Questionnaire-9 (PHQ-9) is a self-reported, 9-question version of the Primary Care Evaluation of Mental Disorders. [16] The Patient Health Questionnaire-2 (PHQ-2) is a shorter version of the PHQ-9 with two screening questions to assess the presence of a depressed mood and a loss of interest or pleasure in routine activities; a positive response to either question indicates further testing is required. [10]

Scales completed by patients and researchers

The Primary Care Evaluation of Mental Disorders (PRIME-MD) is completed by the patient and a researcher. This depression rating scale includes a 27-item screening questionnaire and follow-up clinician interview designed to facilitate the diagnosis of common mental disorders in primary care. Its lengthy administration time has limited its clinical usefulness; it has been replaced by the Patient Health Questionnaire (PHQ-9). [16]

Usefulness

Screening programs using rating scales to search for candidates for a more in-depth evaluation have been advocated to improve detection of depression, but there is evidence that they do not improve detection rates, treatment, or outcome. [17] There is also evidence that a consensus on the interpretation of rating scales, in particular the Hamilton Rating Scale for Depression, is largely missing, leading to misdiagnosis of the severity of a patient's depression. [18] However, there is evidence that portions of rating scales, such as the somatic section of the PHQ-9, can be useful in predicting outcomes for subgroups of patients like coronary heart disease patients. [19]

Copyrighted vs. public domain scales

The Beck Depression Inventory is copyrighted, a fee must be paid for each copy used, and photocopying it is a violation of copyright. There is no evidence that the BDI-II is more valid or reliable than other depression scales, [20] and public domain scales such as the Major Depression Inventory, the revised Center for Epidemiological Studies Depression Scale (CES-D-R), the Zung Depression scale and Patient Health Questionnaire – Nine Item (PHQ-9) have been studied as a useful tools. [21] [22] [23]

Other copyrighted scales allow individual clinicians and researchers to make copies for their own use, but require licenses for electronic versions or large-scale redistribution.

List of depression rating scales

Questions regarding the validity of depression rating scales

Several research articles have come out in the past several years that investigate the validity of sum-score rating scales for depression.

Bianchi, R., Verkuilen, J., Toker, S., Schonfeld, I. S., Gerber, M., Brähler, E., & Kroenke, K. (2022). Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study. Psychological Assessment, 34, 595–603. https://doi.org/10.1037/pas0001124

Fried, E. I. (2017). The 52 symptoms of major depression: Lack of content overlap among seven common depression scales. Journal of Affective Disorders, 208, 191–197.

Santor, D. A., Gregus, M., & Welch, A. (2006). Eight decades of measurement in depression. Measurement, 4(3), 135–155.

See also

Related Research Articles

Psychological testing refers to the administration of psychological tests. Psychological tests are administered or scored by trained evaluators. A person's responses are evaluated according to carefully prescribed guidelines. Scores are thought to reflect individual or group differences in the construct the test purports to measure. The science behind psychological testing is psychometrics.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects more than 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy. Depressed mood is a symptom of some mood disorders such as major depressive disorder and dysthymia; it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection or hopelessness and may experience suicidal thoughts. It can either be short term or long term.

The Beck Depression Inventory, created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.

The Hamilton Rating Scale for Depression (HRSD), also called the Hamilton Depression Rating Scale (HDRS), sometimes also abbreviated as HAM-D, is a multiple-item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery. Max Hamilton originally published the scale in 1960 and revised it in 1966, 1967, 1969, and 1980. The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.

The clinical global impression (CGI) rating scales are measures of symptom severity, treatment response and the efficacy of treatments in treatment studies of patients with mental disorders. It is a brief 3-item observer-rated scale that can be used in clinical practice as well as in researches to track symptom changes. It was developed by Early Clinical Drug Evaluation Program (ECDEU) team of researchers for use in NIMH-led clinical trials that could provide clinical judgment based assessment for determining the severity of symptoms and the treatment progress. This was meant to assess the patient's functioning prior to and after initiating medication in trials which is an important part of study process. Its 3 items assess, 1) Severity of Illness (CGI-S), 2) Global Improvement (CGI-I), and 3) Efficacy Index. Many researchers, while recognizing the validity of the scale, consider it to be subjective as it requires the user of the scale to compare the subjects to typical patients in the clinician experience.

The Young Mania Rating Scale (YMRS), developed by Vincent E Ziegler and popularised by Robert Young, is an eleven-item multiple choice diagnostic questionnaire which psychiatrists use to measure the presence and severity of mania and associated symptoms. The scale was originally developed for use in the evaluation of adult patients with bipolar disorder, but has since been adapted for use in pediatric patients. The scale is widely used by clinicians and researchers in the diagnosis, evaluation, and quantification of manic symptomology.

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders. It was designed in 1979 by British and Swedish researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD) which would be more sensitive to the changes brought on by antidepressants and other forms of treatment than the Hamilton Scale was. There is, however, a high degree of statistical correlation between scores on the two measures.

<span class="mw-page-title-main">Occupational burnout</span> Type of occupational stress

According to the World Health Organization (WHO), occupational burnout is a phenomenon resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy". While occupational burnout may influence health and can be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition or mental disorder. WHO additionally states that "Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."

The Health Dynamics Inventory (HDI) is a 50 item self-report questionnaire developed to evaluate mental health functioning and change over time and treatment. The HDI was written to evaluate the three aspects of mental disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM): "clinically significant behavioral or psychological syndrome or pattern...associated with present distress...or disability". This also corresponds to the phase model described by Howard and colleagues Accordingly, the HDI assesses (1) the experience of emotional or behavioral symptoms that define mental illness, such as dysphoria, worry, angry outbursts, low self-esteem, or excessive drinking, (2) the level of emotional distress related to these symptoms, and (3) the impairment or problems fulfilling the major roles of one's life.

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.

The Hamilton Anxiety Rating Scale (HAM-A) is a psychological questionnaire used by clinicians to rate the severity of a patient's anxiety. Anxiety can refer to things such as "a mental state...a drive...a response to a particular situation…a personality trait...and a psychiatric disorder." Though it was one of the first anxiety rating scales to be published, the HAM-A remains widely used by clinicians. It was originally published by Max Hamilton in 1959. For clinical purposes, and the purpose of this scale, only severe or improper anxiety is attended to. This scale is considered a "clinical rating" of the extensiveness of anxiety, and is intended for individuals that are "already diagnosed with anxiety neurosis."

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

<span class="mw-page-title-main">Hypomania Checklist</span> Diagnostic questionnaire in psychology

The Hypomania Checklist (HCL-32) is a questionnaire developed by Dr. Jules Angst to identify hypomanic features in patients with major depressive disorder in order to help recognize bipolar II disorder and other bipolar spectrum disorders when people seek help in primary care and other general medical settings. It asks about 32 behaviors and mental states that are either aspects of hypomania or features associated with mood disorders. It uses short phrases and simple language, making it easy to read. The University of Zurich holds the copyright, and the HCL-32 is available for use at no charge. More recent work has focused on validating translations and testing whether shorter versions still perform well enough to be helpful clinically. Recent meta-analyses find that it is one of the most accurate assessments available for detecting hypomania, doing better than other options at recognizing bipolar II disorder.

<span class="mw-page-title-main">Mood Disorder Questionnaire</span>

The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire designed to help detect bipolar disorder. It focuses on symptoms of hypomania and mania, which are the mood states that separate bipolar disorders from other types of depression and mood disorder. It has 5 main questions, and the first question has 13 parts, for a total of 17 questions. The MDQ was originally tested with adults, but it also has been studied in adolescents ages 11 years and above. It takes approximately 5–10 minutes to complete. In 2006, a parent-report version was created to allow for assessment of bipolar symptoms in children or adolescents from a caregiver perspective, with the research looking at youths as young as 5 years old. The MDQ has become one of the most widely studied and used questionnaires for bipolar disorder, and it has been translated into more than a dozen languages.

The Mood and Feelings Questionnaire is a survey that measures depressive symptoms in children and young adults. It was developed by Adrian Angold and Elizabeth J. Costello in 1987, and validity data were gathered as part of the Great Smokey Mountain epidemiological study in Western North Carolina. The questionnaire consists of a variety of statements describing feelings or behaviors that may manifest as depressive symptoms in children between the ages of 6 and 17. The subject is asked to indicate how much each statement applies to their recent experiences. The Mood and Feelings Questionnaire has six versions, short and long forms of each of the following: a youth self-report, a version that a parent would complete, and a self-report version for adults. Several peer-reviewed studies have found the Mood and Feelings Questionnaire to be a reliable and valid measure of depression in children. Compared to many other depression scales for youth, it has more extensive coverage of symptoms and more age-appropriate wording and content.

<span class="mw-page-title-main">General Behavior Inventory</span> Overview of the clinical use of the GBI a clinical assessment for bipolar disorder symptoms.

The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations, as well as a short version that allows for it to be used as a screening test.

The nine-item Patient Health Questionnaire (PHQ-9) is a depressive symptom scale and diagnostic tool introduced in 2001 to screen adult patients in primary care settings. The instrument assesses for the presence and severity of depressive symptoms and a possible depressive disorder. The PHQ-9 is a component of the larger self-administered Patient Health Questionnaire (PHQ), but can be used as a stand-alone instrument. The PHQ is part of Pfizer's larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than three minutes to complete. It is scored by simply adding up the individual items' scores. Each of the nine items reflects a DSM-5 symptom of depression. Primary care providers can use the PHQ-9 to screen for possible depression in patients.

The Somatic Symptom Disorder - B Criteria Scale (SSD-12) is a brief self-report questionnaire used to assess the B criteria of DSM-5 somatic symptom disorder, i.e. the patients’ perceptions of their symptom-related thoughts, feelings, and behaviors.

The Occupational Depression Inventory (ODI) is a psychometric instrument, the purpose of which is to assess the severity of work-related depressive symptoms and arrive at a provisional diagnosis of depressive disorder. The ODI can be used by occupational health specialists and epidemiologists.

References

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  2. 1 2 Demyttenaere K, De Fruyt J (2003). "Getting what you ask for: on the selectivity of depression rating scales". Psychotherapy and Psychosomatics. 72 (2): 61–70. doi:10.1159/000068690. PMID   12601223. S2CID   29899038.
  3. ↑ Hamilton M (1960). "A Rating Scale for Depression". Journal of Neurology, Neurosurgery, and Psychiatry. 23 (1): 56–62. doi:10.1136/jnnp.23.1.56. PMC   495331 . PMID   14399272.
  4. ↑ Montgomery SA, Asberg M (April 1979). "A new depression scale designed to be sensitive to change". British Journal of Psychiatry. 134 (4): 382–9. doi:10.1192/bjp.134.4.382. PMID   444788. S2CID   22246215.
  5. ↑ Raskin A, Schulterbrandt J, Reatig N, McKeon JJ (January 1969). "Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives". J. Nerv. Ment. Dis. 148 (1): 87–98. doi:10.1097/00005053-196901000-00010. PMID   5768895. S2CID   39730272.
  6. ↑ Bianchi, R., & Schonfeld, I. S. (2020). The Occupational Depression Inventory: A new tool for clinicians and epidemiologists. Journal of Psychosomatic Research, 138, 110249. https://doi.org/10.1016/j.jpsychores.2020.110249
  7. ↑ Schonfeld, I. S., & Bianchi, R. (2022). Distress in the workplace: Characterizing the relationship of burnout measures to the Occupational Depression Inventory. International Journal of Stress Management, 29, 253-259. https://doi.org/10.1037/str0000261
  8. ↑ Bianchi, R., Verkuilen, J., Sowden, J. F., & Schonfeld, I. S. Towards a new approach to job-related distress: A three-sample study of the Occupational Depression Inventory. Stress and Health, n/a(n/a). https://doi.org/https://doi.org/10.1002/smi.3177
  9. ↑ Schonfeld, I. S., & Bianchi, R. (2021). From burnout to occupational depression: Recent developments in research on job-related distress and occupational health. Frontiers in Public Health, 9(796401), 1-6. https://doi.org/10.3389/fpubh.2021.796401
  10. 1 2 Whooley MA, Avins AL, Miranda J, Browner WS (July 1997). "Case-Finding Instruments for Depression: Two Questions Are as Good as Many". J Gen Intern Med. 12 (7): 439–45. doi:10.1046/j.1525-1497.1997.00076.x. PMC   1497134 . PMID   9229283.
  11. 1 2 Beck AT (1972). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press. p. 333. ISBN   978-0-8122-1032-3.
  12. ↑ "Beck Depression Inventory — 2nd Edition". Nova Southeastern University Center for Center for Psychological Studies. Archived from the original on 2008-10-21. Retrieved 2008-10-17.
  13. ↑ Yesavage JA (1988). "Geriatric Depression Scale". Psychopharmacology Bulletin. 24 (4): 709–11. PMID   3249773.
  14. ↑ Katz IR (1998). "Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias". The Journal of Clinical Psychiatry. 59 Suppl 9: 38–44. PMID   9720486.
  15. ↑ Zung WW (January 1965). "A self-rating depression scale". Arch. Gen. Psychiatry. 12: 63–70. doi:10.1001/archpsyc.1965.01720310065008. hdl: 11059/13941 . PMID   14221692.
  16. 1 2 Spitzer RL, Kroenke K, Williams JB (November 1999). "Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire". Journal of the American Medical Association . 282 (18): 1737–44. doi:10.1001/jama.282.18.1737. PMID   10568646.
  17. ↑ Gilbody S, House AO, Sheldon TA (2005). Gilbody S (ed.). "Screening and case finding instruments for depression". Cochrane Database of Systematic Reviews. 2005 (4): CD002792. doi:10.1002/14651858.CD002792.pub2. PMC   6769050 . PMID   16235301.
  18. ↑ Kriston, L.; Von Wolff, A. (2011). "Not as golden as standards should be: Interpretation of the Hamilton Rating Scale for Depression". Journal of Affective Disorders. 128 (1–2): 175–177. doi:10.1016/j.jad.2010.07.011. PMID   20696481.
  19. ↑ De Jonge, P.; Mangano, D.; Whooley, M. A. (2007). "Differential Association of Cognitive and Somatic Depressive Symptoms with Heart Rate Variability in Patients with Stable Coronary Heart Disease: Findings from the Heart and Soul Study". Psychosomatic Medicine. 69 (8): 735–739. doi:10.1097/PSY.0b013e31815743ca. PMC   2776660 . PMID   17942844.
  20. ↑ Zimmerman M. Using scales to monitor symptoms and treatment of depression (measurement-based care). In UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2011.
  21. ↑ Kroenke K, Spitzer RL, Williams JB (September 2001). "The PHQ-9: validity of a brief depression severity measure". J Gen Intern Med. 16 (9): 606–13. doi:10.1046/j.1525-1497.2001.016009606.x. PMC   1495268 . PMID   11556941.
  22. ↑ "Terms of Use". PHQ Screeners. Pfizer. 2014-09-11. Retrieved 2 September 2016. Content found at the PHQ Screeners site is expressly exempted from Pfizer's general copyright restrictions; content found on the PHQ Screeners site is free for download and use as stated within the PHQ Screeners site.
  23. ↑ "Screener Overview". PHQ Screeners. Pfizer. 2014-12-09. Retrieved 2 September 2016. All PHQ, GAD-7 screeners and translations are downloadable from this website and no permission is required to reproduce, translate, display or distribute them.
  24. ↑ Zimmerman M, Chelminski I, McGlinchey JB, Posternak MA (2008). "A clinically useful depression outcome scale". Compr Psychiatry. 49 (2): 131–40. doi:10.1016/j.comppsych.2007.10.006. PMID   18243884. Copyright © Mark Zimmerman, M.D. All rights reserved. Not to be reproduced without the author's permission.
  25. ↑ "Library of Scales". Outcome Tracker. Retrieved 2 September 2016. Scales that are included with permission of the authors are marked by an asterisk (*). These authors have granted permission for their scales only to be used by clinicians in their individual clinical practice, and to researchers for use in non-industry related studies. Any other uses of the scales represent a potential violation of copyright. … CUDOS*
  26. 1 2 "More Information". IDS/QIDS. University of Pittsburgh Epidemiology Data Center. Archived from the original on 26 June 2007. Retrieved 2 September 2016. Current translations of the pencil and paper versions of the IDS and QIDS are available at no cost to clinicians and researchers. Copies may be downloaded from this site and used without permission. … Those wishing to consider the IVR versions or other electronic versions should contact: Healthcare Technology Systems, Inc.
  27. ↑ "The MFQ". Center for Developmental Epidemiology. Duke University Health System. Retrieved 2 September 2016. COPYRIGHT PERMISSION: Should you wish to administer the MFQ to your clients or for your research study, you may download a PDF of any version of the MFQ free of charge. We only ask that you cite the authors in any published work.
  28. ↑ Bianchi, R., & Schonfeld, I. S. (2020). The Occupational Depression Inventory: A new tool for clinicians and epidemiologists. Journal of Psychosomatic Research, 138, 110249. https://doi.org/10.1016/j.jpsychores.2020.110249
  29. ↑ Schonfeld, I. S., & Bianchi, R. (2022). Distress in the workplace: Characterizing the relationship of burnout measures to the Occupational Depression Inventory. International Journal of Stress Management, 29, 253-259. https://doi.org/10.1037/str0000261
  30. ↑ Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32, 509–515. doi:10.3928/0048-5713-20020901-06
  31. ↑ Bernstein IH, Wendt B, Nasr SJ, Rush AJ (March 2009). "Screening for major depression in private practice". J Psychiatr Pract. 15 (2): 87–94. doi:10.1097/01.pra.0000348361.03925.b3. PMC   2756171 . PMID   19339842.
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