03 - 3. Depression rating scales

3. Depression rating scales:

© SPMM Course 3. Depression rating scales: 2 Questions scale (also called PHQ-2): An affirmative response to the following two questions may be as effective as using longer screening measures or may indicate the need for the use of more in-depth diagnostic tools: (1) "Over the past two weeks, have you ever felt down, depressed, or hopeless?" and (2) "Have you felt little interest or pleasure in doing things?" HAMD/HDRS – Hamilton depression rating scale:  Observer rated.  17 – 21 items- 2 versions  Refers to last 1-2 weeks  More items for biological features  Remains a reference standard

MADRS – Montgomery-Asberg Depression rating scale:  10 items version  Most sensitive to change  Requires clinical interview like HDRS

BDI – Beck depression inventory:  Self-rating 21 items  Max score 63  Last 2 weeks profile  0-13 minimal; 14-19 mild; 20-28 moderate; >28 severe  Lacks discriminatory power among very severely ill  More psychological than somatic factors included  Can be repeated at short intervals

Zung Depression Inventory:  20 items  Self-rated  Avoids imbalance towards psychological factors seen in Beck’s  Poor correlation with observer rating  Insensitive to change

Visual Analogue Scale (VAS)  Easiest way to quantify depression severity  10cm line where patient indicates the state of mood

© SPMM Course Depression screening in special cases: Children with depression  Depression screening for children and adolescents are generally appropriate in children who are at least seven years of age. Reynolds Child Depression Scale and the Children's Depression Inventory (full version with 27 items; screening version with 10 items) were developed specifically for children and are written at lower reading levels. Measure Age appropriateness (years) Children's Depression Inventory (CDI) 7 to 17 Center for Epidemiological Studies-Depression Scale for Children (CES-DC) 12 to 18 Center for Epidemiological Studies-Depression Scale (CES-D) 14 and older Reynolds Child Depression Scale 8 to 12 Reynolds Adolescent Depression Scale 13 to 18 Beck Depression Inventory (BDI) 14 and older Mood and Feelings Questionnaire (MFQ) 8 to 18 Adapted from an online version at www.aafp.org/afp/20020915/contents.html.  Advantages of the BDI and CES-D include ease of scoring, low-cost, and comparable psychometric properties.  MFQ is endorsed by the NICE and has a self and a parent-rated versions. Perinatal depression:  The BDI, CES-D, and Edinburgh Postnatal Depression Scale (EPDS) have been used to screen for depression in women during the antepartum and postpartum periods.  The BDI and CES-D tend to produce higher scores and more false-positive results in symptomatic pregnant women.  Edinburgh Postnatal Depression Scale was specifically developed for assessing postpartum depression and relies much less on somatic questions.  Questions on the Edinburgh scale (10 items, can be self or clinician-rated) are framed within the "past seven days", and the response format is frequency-based.  Routine use of EPDS during the postpartum period has been shown to increase the detection of postpartum depression compared with usual care. Geriatric depression:  The GDS – Geriatric depression scale was specifically developed for use in geriatric patients, and it contains fewer somatic items. Questions pertain to symptoms within the past week, and responses require only a "yes" or ‘no’.  In patients who have cognitive deficits, interviewer-administered instruments such as the Cornell Scale for Depression in Dementia or the Hamilton Rating Scale for Depression are preferred.

© SPMM Course  The Cornell measure should be administered to the patient's primary caregiver.  The Brief Assessment Schedule Depression Cards (BASDEC) system is designed for general hospital use and eliminates the likelihood of questions being overheard on geriatric wards. Patients choose answers from a deck of 19 cards presented one at a time. Depression in schizophrenia:  Most depression scales are tuned to assess depression in nonpsychotic patients.  These scales contain items, which do not distinguish depressed from nondepressed psychotic patients (e.g. delusions of nihilism that can be present in psychosis in the absence of depression).  Calgary Depression Scale for Schizophrenia (CDSS) focuses on symptoms of depression in the presence of schizophrenia.