Saturday, August 13, 2016

"How Do I Know If I Have Depression?" The Role of Self-Assessment

What is Self Assessment?

Unlike other fields of medicine where illnesses can be diagnosed using laboratory tests or imaging techniques, psychiatry heavily relies on an individual’s account of their current and past symptoms. This is also true for depression. However, recounting one’s depressive symptoms without using an objective self-assessment tool is fraught with inaccuracies. People overemphasize symptoms that need urgent attention and miss some, especially if they are unaware of the full spectrum of depressive symptoms.

What are the Available Tools for Self-Assessment?

The internet is flooded with the so-called "depression tests" with questionable validity. The following self-assessment tools have been extensively used in research and/or clinical settings and can be downloaded for no charge from the internet. 

Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16): This is a 16-item self-rating scale used for screening depression or assessing its severity (Lamoureux et al., 2010; Rush et al., 2003). The scale comprises of domains of depression as covered in DSM-IV and has been validated for use in trials on depression. QIDS-SR16, along with its scoring instruction, is available online (www.ids-qids.org/).The total score ranges from 0-27 and if you score above 13 or 14, the chances of you being correctly identified as having depression is above 80% (Lamoureux et al., 2010). If you have been diagnosed with depression, then you can assess the severity of depression using the following guidelines: 0-5 (no depression), 6-10 (mild depression), 11-15 (moderate depression), 16-20 (severe depression), and ≥21 (very severe depression).

The Patient Health Questionniare-9 (PHQ-9): The PHQ-9 is a self-reporting scale, which is extensively used in primary care and other medical settings for screening depression. It has nine items which parallel the DSM-IV criteria for major depressive disorder with a total score ranging from 0-27 (Kroenke al., 2001). A copy of the scale can be downloaded from a website (http://www.phqscreeners.com/). On this scale, the cut-off scores of 5, 10, and 15 represent mild, moderate, and severe depressive symptoms, respectively (Kroenke et al., 2010). If you score 10 or higher on PHQ-9, then you have an above 82% chance of being correctly identified as having clinical depression (Haddad et al., 2013).

If you screen above the cut-off score for depression in one of the above rating scales, it is prudent to consult your primary care provider. They will either assess you in depth for depression or refer you to a mental health provider to do the same. Once diagnosed with depression, you can continue to use these self-assessment tools to monitor the progress of your symptoms and also the impact of treatment as described next.

What are the Advantages of Self-Assessment?

  • Self-assessment tools provide you with an objective measure on whether or not you have depression.
  • Once diagnosed with depression, periodic self-assessments help you monitor your progress with treatment and change course if needed.  
  • Sharing information from the self-assessment tools with your provider ensures that you don’t forget to report any important symptoms. 
  • Repeated self-assessments broaden your understanding of depression and help you recognize early symptoms in case of a relapse or recurrence. 
  • Self-assessments, if tracked along with interventions, will help you figure out the kind of interventions that have worked for particular symptoms and to put them to use if these symptoms return.
To learn more about evidence-based self-management techniques that are proven to work for depression, check out Dr. Duggal's Author Page.

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Haddad, M., Walters, P., Phillips, R., Tsakok, J., Williams, P., Mann, A., & Tylee, A. (2013). Detecting depression in patients with coronary heart disease: a diagnostic evaluation of the PHQ-9 and HADS-D in primary care, findings from the UPBEAT-UK study. PLoS One, 8(10), doi: 10.1371/journal.pone.0078493.  

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613.

Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptoms scale: a systematic review. General Hospital Psychiatry, 32(4), 349-359.

Lamoureux, B. E., Linardatos, E., Fresco, D. M., Bartko, D., Logue, E., & Milo, L. (2010). Using the QIDS-SR16 to identify major depressive disorder in primary care medical patients. Behavior Therapy, 41, 423-431. 

Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., Markowitz, J. C., Ninan, P. T., Kornstein, S., Manber, R., Thase, M. E., Kocsis, J. H., & Keller, M. B. (2003). The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54, 573-583.

Tuesday, August 2, 2016

11 Ways on How the Most Comprehensive Book on Depression is Changing the Concept of Self-Help

You probably have heard or read a few self-help books on depression. Here's a new book The Complete Guide to Self-Management of Depression: Practical and Proven Methods, which to date is the most comprehensive self-help book on depression, and will change how depression is treated in the future. What makes this book different from others is highlighted by the following features unique to this book:

1. Depression is a complex illness, which presents in a myriad of ways and almost 60-70% people treated with antidepressants fail to achieve a symptom-free state when first treated with these medications. The treatment of depression cannot be pigeon-holed into one or two kinds of treatment modalities. This book offers the reader a broad menu of options for self-management of depression above and beyond medications.

2. Self-management is increasingly becoming the standard of care in people with long-standing medical conditions. Self-management puts one in the driver's seat with regards to making choices regarding one's health. People with diabetes, heart disease, emphysema, asthma, and other long-standing medical conditions have successfully used self-management to live a healthy life. However, treatment of depression has lagged behind in incorporating the concept of self-management with most popular self-help books on depression focusing mostly on cognitive-behavioral approaches. This book serves to fill this void.

3. This book broadens the narrow perspective of self-help beyond the traditional treatment of symptoms to self-management of depression. Self-management, besides a focus on treating symptoms, also addresses life style changes, social relationships, communication, problem-solving, and also includes elements of wellness and recovery.

4. This book also presents evidence-based approaches for complementary and alternative treatments of depression, including herbs, dietary supplements, exercise, mindfulness, and light therapy.

5. Treatments that work for anxiety, substance use, and grief, which may commonly co-occur with depression, are discussed in separate chapters in the book.

6. The book discusses the role of internet-based treatments for depression, what to look for in these treatments and also the treatments that are more likely to work.

7. Treatment-resistant depression and chronic depression, rarely discussed in self-help books, are discussed in separate chapters.

8. The book elaborates on recognition and treatment of cognitive symptoms (memory problems, poor concentration, etc.) as research now suggests that these symptoms influence functional outcomes in depression.

9. The book highlights the concept of measurement-based care, which emphasizes the role of periodic monitoring of symptoms using self-assessment tools to make treatment-related decisions.

10. While the highlight of this book is to make the reader aware of the proven strategies that work for depression based on research, where applicable, caveats or situations when a particular strategy may not work, are also discussed. This approach differs from the traditional self-help books on depression that sometimes tend to convey the "one-size-fits-all" paradigm.

11. In contrast to the traditional paternalistic model of healthcare, consumer-defined wellness and recovery are now becoming the norm for healthcare delivery in mental health settings. In line with the modern practice of behavioral medicine, this book highlights the role of wellness and recovery in self-management of depression.

Self-Management is a key component in the treatment of longstanding medical and psychiatric conditions. Learn more about this book and how to self-manage depression at The Complete Guide to Self-Management of Depression: Practical and Proven Methods.


Written by a board-certified psychiatrist and an international expert on self-management of depression, this blog focuses on proven scientific methods of treating depression that go beyond medications and traditional therapy. It discusses elements of healthy lifestyle, positive psychology, relationships, values, strengths, communication, and wellness. The content of the blog is not to be construed as treatment advice.

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