Clinician-Rated and Self-Report Questionnaires/Tests for Depression
Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA
The following sections provide information on the various clinician-rated and self-report questionnaires and tests that you might be likely to encounter when being evaluated for depression or can take online.
Clinician Rating Scales
Hamilton Depression Rating Scale (HAM-D) is a multiple-choice form that is used to rate how severe a person's depression is. It is currently one of the most commonly used scales for rating depression in medical research.
Montgomery-Åsberg Depression Rating Scale (MADRS) is another diagnostic questionnaire that is used to measure how severe the depressive episodes are in patients with mood disorders. It was designed to help the Hamilton Rating Scale for Depression (HAM-D) with more sensitive changes brought on by antidepressants and other forms of treatment.
Raskin Depression Rating Scale rates how severe the symptoms are in three areas: verbal reports, behavior, and secondary or related symptoms of depression. It's not as specific as the HAM-D, so it is not as commonly used.
Beck Depression Inventory (BDI) - a commonly used tool for distinguishing between clinical depression and temporary unhappiness. This questionnaire is considered both reliable and valid. The current version is the BDI-II, which is designed for individuals aged 13 and over. It includes items relating to symptoms of depression such as hopelessness and irritability, thoughts such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. The BDI is a self-report instrument, so patients answer the 21 multiple-choice items themselves. A total score of 0-9 indicates that a person is not significantly depressed, 10-18 indicates mild to moderate depression, 19-29 indicates moderate to severe depression and a score of 30-63 suggests that a person is severely depressed.
Geriatric Depression Scale (GDS) - this questionnaire is answered by "yes" or "no", instead of a five-point rating scale. This allows the GDS to be used with ill people or those that have moderate cognitive impairments. It was designed specifically to identify depression in older adults. Many of the other scales were developed for use with younger or middle aged adults and are not appropriate for use with other groups of people. The GDS leaves out questions about common age-related physical symptoms so that older adults don't seem depressed when they actually aren't. The scale is less complicated than other scales, so it can be used with older adults who have mild to moderate problems with thinking and remembering. This might include patients with Alzheimer's or Parkinson's disease. This test alone is not used for diagnosis though. It is simply part of a more comprehensive evaluation.
Zung Self-Rating Depression Scale - this tool is similar to the Geriatric Depression Scale because it has simple "yes" or "no" types of questions. However, it follows the more specific scale of the BDI where scores range between 25 and 100. Scores of 25-49 indicate that a person is not depressed, 50-59 indicates mild depression, 60-69 suggests moderate depression, and a score of 70 and above suggests that someone is severely depressed. The use of this measure has declined in recent years due to some research suggesting that this scale is not very good at detecting symptom improvement after treatment has occurred.
The Patient Health Questionnaire (PHQ) - is a multiple-choice self-report inventory. It is used as a screening and diagnostic tool for depression and other related issues such as anxiety, substance abuse, and eating disorders. It is a public domain resource that is available without cost in several languages. There are several versions such as PHQ-2 or PHQ-9 that vary in sensitivity and specificity of identifying the disease. Although these tests were originally designed as self-report tools, they can also be given by trained health care professionals.
Center for Epidemiologic Studies Depression Scale Revised (CESD-R) is another common self-report screening test that measures symptoms of measuring major depressive disorder. It can be taken by clicking here.
Depressive symptoms are sometimes measured with general questionnaires designed to look at several different types of mental conditions at once. For example, the General Health Questionnaire (GHQ) is a screening test for identifying minor psychiatric disorders in the general population. It can be used in settings such as primary care or general medical outpatients. It is suitable for adolescents and older people, but not for children. It looks at the person's current state and asks if that is different from the usual state. It is sensitive to short-term psychiatric disorders, but not to long-standing characteristics of the person. This self-administered questionnaire focuses on two major areas - the inability to function in daily life and the appearance of new and distressing symptoms.
There is no diagnostic lab test that can determine whether someone has a depressive disorder. For some time, researchers looked at whether measurements of hormones could reliably separate people with depression and those without. An example of this sort of physical test was the dexamethasone suppression test. This test measured levels of the hormone called cortisol and the activation of the body's stress response system. The test was never found to be a reliable indicator of depression.
Even though lab tests cannot provide positive evidence for a diagnosis of major depressive disorder, they are very useful for ruling out medical causes of depression such as thyroid problems. A complete diagnostic evaluation for depression should include tests for bacterial and viral infections, thyroid hormone levels, metabolic deficiencies, and autoimmune conditions, such as rheumatoid arthritis or lupus.