Rating scales for depression
Encyclopedia
A depression rating scale is a psychiatric measuring instrument having descriptive words and phrases that indicate the severity of depression symptoms for a time period. 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. Several rating scale
s are used for this purpose.
includes 21 questions with between 3 and 5 possible responses which increase in 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 researchers assessing the effects of drug therapy. Alternatively, the Montgomery-Åsberg Depression Rating Scale
has ten items to be completed by researchers assessing the effects of drug therapy and is the other of the two most commonly used among such researchers. Other 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.
, 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. The scale is completed by patients to identify the presence and severity of symptoms consistent with the DSM-IV
diagnostic criteria. The Beck Depression Inventory was originally designed by psychiatrist Aaron T. Beck in 1961.
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". 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".
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. 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.
.
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. 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 patients depression.
ed, a fee must be paid for each copy used, and photocopy
ing it is a violation of copyright. There is no evidence that the BDI-II is more valid or reliable than other depression scales, and public domain
scales such as the Patient Health Questionnaire
– Nine Item (PHQ-9) has been studied as a useful tool. Other public domain scales include the Clinically Useful Depression Outcome Scale (CUDOS) and the Quick Inventory of Depressive Symptoms – Self Report 16 Item (QIDS-SR16).
Rating scale
A rating scale is a set of categories designed to elicit information about a quantitative or a qualitative attribute. In the social sciences, common examples are the Likert scale and 1-10 rating scales in which a person selects the number which is considered to reflect the perceived quality of a...
s are used for this purpose.
Scales completed by researchers
Some depression rating scales are completed by researchers. For example, the Hamilton Depression Rating ScaleHamilton Depression Rating Scale
The Hamilton Rating Scale for Depression , also known as the Hamilton Depression Rating Scale or abbreviated to HAM-D, is a multiple choice questionnaire that clinicians may use to rate the severity of a patient's major depression. Max Hamilton originally published the scale in 1960 and reviewed...
includes 21 questions with between 3 and 5 possible responses which increase in 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
Max Hamilton
Professor Max Hamilton was born on 9 February 1912 at Offenbach am Main, Germany. In 1915, his family emigrated to England. He was educated at the Foundation School in Cowper Street and went on to study medicine at University College Hospital, London. He served from 1939 to 1946 in the Royal Air...
in 1960, the Hamilton Depression Rating Scale is one of the two most commonly used among those completed by researchers assessing the effects of drug therapy. Alternatively, the Montgomery-Åsberg Depression Rating Scale
Montgomery-Åsberg Depression Rating Scale
The Montgomery-Åsberg Depression Rating Scale is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders...
has ten items to be completed by researchers assessing the effects of drug therapy and is the other of the two most commonly used among such researchers. Other 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.
Scales completed by patients
Some depression rating scales are completed by patients. The Beck Depression InventoryBeck Depression Inventory
The Beck Depression Inventory , created by Dr. Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used instruments for measuring the severity of depression...
, for example, is a 21-question self-report inventory
Self-report inventory
A self-report inventory is a type of psychological test in which a person fills out a survey or questionnaire with or without the help of an investigator...
that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex, and feelings of guilt, hopelessness or fear of being punished. The scale is completed by patients to identify the presence and severity of symptoms consistent with the DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
diagnostic criteria. The Beck Depression Inventory was originally designed by psychiatrist Aaron T. Beck in 1961.
The Geriatric Depression Scale
Geriatric Depression Scale
The Geriatric Depression Scale is a 30-item self-report assessment used to identify depression in the elderly.-Description:The GDS questions are answered "yes" or "no", instead of a five-category response set. This simplicity enables the scale to be used with ill or moderately cognitively impaired...
(GDS) is another self-administered scale, but in this case it is used for older patients, and for patients with mild to moderate dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
. Instead of presenting a five-category response set, the GDS questions are answered with a simple "yes" or "no". The Zung Self-Rating Depression Scale
Zung Self-Rating Depression Scale
The Zung Self-Rating Depression Scale was designed by Duke University psychiatrist Dr. William W.K. Zung to assess the level of depression for patients diagnosed with depressive disorder....
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".
The Patient Health Questionnaire
Patient Health Questionnaire
The Patient Health Questionnaire is a multiple-choice self-report inventory, used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform. It was designed for use in the primary care setting and lacks coverage for disorders seen in...
(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. 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
Anhedonia
In psychology and psychiatry, anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. hobbies, exercise, social interaction or sexual activity....
; a positive response to either question indicates further testing is required.
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 QuestionnairePatient Health Questionnaire
The Patient Health Questionnaire is a multiple-choice self-report inventory, used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform. It was designed for use in the primary care setting and lacks coverage for disorders seen in...
.
Usefulness
ScreeningScreening (medicine)
Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike what generally happens in medicine, screening tests are performed on persons without any clinical sign of disease....
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. 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 patients depression.
Copyrighted vs. Public Domain scales
The Beck Depression Inventory is copyrightCopyright
Copyright is a legal concept, enacted by most governments, giving the creator of an original work exclusive rights to it, usually for a limited time...
ed, a fee must be paid for each copy used, and photocopy
Photocopier
A photocopier is a machine that makes paper copies of documents and other visual images quickly and cheaply. Most current photocopiers use a technology called xerography, a dry process using heat...
ing it is a violation of copyright. There is no evidence that the BDI-II is more valid or reliable than other depression scales, and public domain
Public domain
Works are in the public domain if the intellectual property rights have expired, if the intellectual property rights are forfeited, or if they are not covered by intellectual property rights at all...
scales such as the Patient Health Questionnaire
Patient Health Questionnaire
The Patient Health Questionnaire is a multiple-choice self-report inventory, used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform. It was designed for use in the primary care setting and lacks coverage for disorders seen in...
– Nine Item (PHQ-9) has been studied as a useful tool. Other public domain scales include the Clinically Useful Depression Outcome Scale (CUDOS) and the Quick Inventory of Depressive Symptoms – Self Report 16 Item (QIDS-SR16).