Depression assessment instruments

Patient selection based on symptom severity. This can be defined directly by a minimal acceptable severity score as measured by a rating instrument (e.g. the Hamilton Rating Scale for Depression, the Positive and Negative Symptom Scale or other established assessment instruments see Section 5.6). An indirect definition of symptom severity may be a consequence of the status of a patient population a clinical trial designed for inpatients generally implies a more severe symptom profile than a study with... 

In a double-blind, parallel-group study, Bondareff et id. (2000) compared the SSRI sertraline and the tricyclic compound nortriptyline with regard to their efficacy and safety in a group of 210 outpatients 60 years and older. The patients met the DSM-DI-R criteria for major depressive episode and had a minimum score of 18 on the Hamilton Rating Scale for Depression. Their mean age was about 68 years, most patients were white and about 60% were female the severity of depression was rated as moderate in more than 70% and as severe in more than 20% of the cases. The daily doses of sertraline were between 50 and 150 mg, and those of nortriptyline were 25 100 mg the treatment lasted 12 weeks. In addition to clinical rating scales and self-assessment instruments, patients took the following tests of cognitive performance ... 

An integral part of social work intervention with depressed clients is the inclusion of outcome measures that provide empirical data on changes in the reported symptoms and treatment effectiveness. Gathering empirical, objective data allows the social worker to evaluate the course of treatment, make changes in the treatment, and evaluate overall practice effectiveness (Dziegielewski Leon, 1998). Assessment instruments that provide baseline data and subsequent changes provide consistency for the entire interdisciplinary team. 

The results were not completely consistent, but these findings seem to favor a dimensional model of depression. However, this may reflect inadequate indicator selection. Taxometric power analysis suggests this is not the case, but the power analyses may have presented an overly optimistic view of indicator quality. In addition, the construct validity of the indicators used in this study is unknown. The validity of the BDI and the MMPI Scale 2 are well established, but the authors used indicators derived from these instruments, not the scales themselves. We cannot assume that the indicators assessed depression as accurately as the original scales. In fact, we don t know whether the derived scales are reliable. It is possible that the indicators actually did not tap syndromal depression, but instead they tapped a closely related factor such as negative affect, and thus are largely irrelevant to the question about the taxonicity of depression per se. 

Another way that professionals assess for psychiatric disorders is to use an inventory that assesses for personality characteristics. The most famous of these inventories is the Minnesota Multiphasic Personality Inventory (MMPI), which is now in its second edition as an instrument. Although the MMPI is actually a personality inventory, as it names suggests, many professionals will use it to spot suspected psychiatric disorders, such as depression, Bipolar Disorder, Schizophrenia, and Anxiety Disorder. The MMPI has several scales to assess common personality traits, such as depression, mania, psychopathic deviance, and even alcohol and drug use (Weed, Butcher, McKenna, Ben-Porath, 1992). 

The MADRS is a ten-item investigator-rated instrument for the assessment of depressive symptoms. It focuses on symptoms of sadness, lassitude, pessimistic thoughts and suicidality in contrast to the HRSD. no items are dedicated to the somatic aspects of depression. 

The Krawiecka Goldberg Scale (or Manchester Scale) is a brief ten-item scale for assessment of changes in the clinical status of patients suffering from psychosis. The items include depression, anxiety, delusions and hallucinations, incoherence, flattened affect, poverty of speech and psychomotor retardation. The absence of items typical of schizoaffective and manic psychoses limits the use of this instrument. It is, however, useful for follow-up of inpatients and outpatients for longer periods of time (Krawiecka et al.y 1977). 

The 17-item HDRS is the most commonly used scale in antidepressant clinical trials. This version of the HDRS is heavily weighted toward melancholic symptoms. There are also 21-item, 24-item, and 28-item versions with the additional items assessing nonmelancholic symptoms. The Montgomery-Asberg Depression Scale (MADRS) is another instrument that is frequently used in antidepressant clinical trials. 

It is important to try to assess mood after stroke, even though this is often difficult since the risk is high and depression contributes to poor cognitive function and outcome. The Short Form-36 is the most widely used generic instrument for assessment of quality of Ufe but the EuroQol is also used. Neither is reliable enough to monitor individuals over time but they may be used to compare groups of patients (de Haan et al. 1993 Dorman et al. 1998). 

Gurland B, Golden RR, Teresi JA, et al. The short-care an efficient instrument for the assessment of depression, dementia and disability. J Gerontol 1984 39 166-9. 

These scales provide objective clinical data on the existence of and changes in a client s depression. Social workers should become familiar in the use of such instruments and utilize them as pretests during the assessment phase and as posttests during different treatment intervals. 

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