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"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 self-management techniques for depression, please refer to the evidence-based bestseller The Complete Guide to Self-Management of Depression: Practical and Proven Methods. This comprehensive and easy-to-read book offers the reader a menu of options to self-manage depression that go above and beyond the traditional approaches to treat depression and includes complementary and alternative medicine approaches, exercise, mindfulness, role of social support, and bright light therapy. Besides therapy techniques, the book also provides an evidence-based overview of the role medications in treating depression - when to take them, how long to take them, when and how to stop them, and what to do when medications stop working.


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.

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