Rating scales for depression

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Rating scales for depression
Purposeto determine the presence and severity of depression

A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period.[1] When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis.[1] Several rating scales are used for this purpose.[1]

Scales completed by clinicians, researchers, and workers[edit]

Some depression rating scales are completed by clinicians or researchers. The Hamilton Depression Rating Scale includes 21 questions with between 3 and 5 possible responses which reflect increasing or decreasing severity. The clinician must choose the possible responses to each question by interviewing the patient and by observing the patient's symptoms. Designed by psychiatrist Max Hamilton in 1960, the Hamilton Depression Rating Scale is one of the two most commonly used among those completed by clinicians and researchers in assessing the effects of drug therapy.[2][3] Alternatively, the Montgomery-Åsberg Depression Rating Scale ((MADRS) has ten items to be completed for the purpose of assessing the effects of drug therapy. The MADRS is the other of the two most commonly used scales by clinicians and researchers who are involved with patients.[2][4] Another scale is the Raskin Depression Rating Scale; which rates the severity of the patients' symptoms in three areas: verbal reports, behavior, and secondary symptoms of depression.[5] Finally, the Occupational Depression Inventory[6][7] specifically focuses on depressive symptoms that people attribute to their jobs.[8][9]

Scales completed by patients[edit]

The two questions on the Patient Health Questionnaire-2 (PHQ-2):[10]

During the past month, have you often been bothered by feeling down, depressed, or hopeless?

During the past month, have you often been bothered by little interest or pleasure in doing things?

Some depression rating scales are completed by patients. The Beck Depression Inventory, for example, is a 21-question self-report inventory that covers symptoms such as irritability, fatigue, weight loss, lack of interest in sex, and feelings of guilt, hopelessness or fear of being punished.[11] The scale is completed by patients to identify the presence and severity of symptoms consistent with the DSM-IV diagnostic criteria.[12] The Beck Depression Inventory was originally designed by psychiatrist Aaron T. Beck in 1961.[11]

The Geriatric Depression Scale (GDS) is another self-administered scale, but in this case it is used for older patients, and for patients with mild to moderate dementia. Instead of presenting a five-category response set, the GDS questions are answered with a simple "yes" or "no".[13][14] The Zung Self-Rating Depression Scale is similar to the Geriatric Depression Scale in that the answers are preformatted. In the Zung Self-Rating Depression Scale, there are 20 items: ten positively worded and ten negatively worded. Each question is rated on a scale of 1 through 4 based on four possible answers: "a little of the time", "some of the time", "good part of the time", and "most of the time".[15]

The Patient Health Questionnaire (PHQ) sets are self-reported depression rating scales. For example, the Patient Health Questionnaire-9 (PHQ-9) is a self-reported, 9-question version of the Primary Care Evaluation of Mental Disorders.[16] The Patient Health Questionnaire-2 (PHQ-2) is a shorter version of the PHQ-9 with two screening questions to assess the presence of a depressed mood and a loss of interest or pleasure in routine activities; a positive response to either question indicates further testing is required.[10]

Scales completed by patients and researchers[edit]

The Primary Care Evaluation of Mental Disorders (PRIME-MD) is completed by the patient and a researcher. This depression rating scale includes a 27-item screening questionnaire and follow-up clinician interview designed to facilitate the diagnosis of common mental disorders in primary care. Its lengthy administration time has limited its clinical usefulness; it has been replaced by the Patient Health Questionnaire (PHQ-9).[16]


Screening programs using rating scales to search for candidates for a more in-depth evaluation have been advocated to improve detection of depression, but there is evidence that they do not improve detection rates, treatment, or outcome.[17] There is also evidence that a consensus on the interpretation of rating scales, in particular the Hamilton Rating Scale for Depression, is largely missing, leading to misdiagnosis of the severity of a patient's depression.[18] However, there is evidence that portions of rating scales, such as the somatic section of the PHQ-9, can be useful in predicting outcomes for subgroups of patients like coronary heart disease patients.[19]

Copyrighted vs. public domain scales[edit]

The Beck Depression Inventory is copyrighted, a fee must be paid for each copy used, and photocopying it is a violation of copyright. There is no evidence that the BDI-II is more valid or reliable than other depression scales,[20] and public domain scales such as the Major Depression Inventory, the revised Center for Epidemiological Studies Depression Scale (CES-D-R), the Zung Depression scale and Patient Health Questionnaire – Nine Item (PHQ-9) have been studied as a useful tools.[21][22][23]

Other copyrighted scales allow individual clinicians and researchers to make copies for their own use, but require licenses for electronic versions or large-scale redistribution.

List of depression rating scales[edit]

Questions regarding the validity of depression rating scales[edit]

Several research articles have come out in the past several years that investigate the validity of sum-score rating scales for depression.

Bianchi, R., Verkuilen, J., Toker, S., Schonfeld, I. S., Gerber, M., Brähler, E., & Kroenke, K. (2022). Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study. Psychological Assessment, 34, 595–603. https://doi.org/10.1037/pas0001124

Fried, E. I. (2017). The 52 symptoms of major depression: Lack of content overlap among seven common depression scales. Journal of Affective Disorders, 208, 191–197. [1]

Santor, D. A., Gregus, M., & Welch, A. (2006). Eight decades of measurement in depression. Measurement, 4(3), 135–155.

See also[edit]


  1. ^ a b c Sharp LK, Lipsky MS (September 2002). "Screening for depression across the lifespan: a review of measures for use in primary care settings". American Family Physician. 66 (6): 1001–8. PMID 12358212.
  2. ^ a b Demyttenaere K, De Fruyt J (2003). "Getting what you ask for: on the selectivity of depression rating scales". Psychotherapy and Psychosomatics. 72 (2): 61–70. doi:10.1159/000068690. PMID 12601223. S2CID 29899038.
  3. ^ Hamilton M (1960). "A Rating Scale for Depression". Journal of Neurology, Neurosurgery, and Psychiatry. 23 (1): 56–62. doi:10.1136/jnnp.23.1.56. PMC 495331. PMID 14399272.
  4. ^ Montgomery SA, Asberg M (April 1979). "A new depression scale designed to be sensitive to change". British Journal of Psychiatry. 134 (4): 382–9. doi:10.1192/bjp.134.4.382. PMID 444788. S2CID 22246215.
  5. ^ Raskin A, Schulterbrandt J, Reatig N, McKeon JJ (January 1969). "Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives". J. Nerv. Ment. Dis. 148 (1): 87–98. doi:10.1097/00005053-196901000-00010. PMID 5768895. S2CID 39730272.
  6. ^ Bianchi, R., & Schonfeld, I. S. (2020). The Occupational Depression Inventory: A new tool for clinicians and epidemiologists. Journal of Psychosomatic Research, 138, 110249. https://doi.org/10.1016/j.jpsychores.2020.110249
  7. ^ Schonfeld, I. S., & Bianchi, R. (2022). Distress in the workplace: Characterizing the relationship of burnout measures to the Occupational Depression Inventory. International Journal of Stress Management, 29, 253-259. https://doi.org/10.1037/str0000261
  8. ^ Bianchi, R., Verkuilen, J., Sowden, J. F., & Schonfeld, I. S. Towards a new approach to job-related distress: A three-sample study of the Occupational Depression Inventory. Stress and Health, n/a(n/a). https://doi.org/https://doi.org/10.1002/smi.3177
  9. ^ Schonfeld, I. S., & Bianchi, R. (2021). From burnout to occupational depression: Recent developments in research on job-related distress and occupational health. Frontiers in Public Health, 9(796401), 1-6. https://doi.org/10.3389/fpubh.2021.796401
  10. ^ a b Whooley MA, Avins AL, Miranda J, Browner WS (July 1997). "Case-Finding Instruments for Depression: Two Questions Are as Good as Many". J Gen Intern Med. 12 (7): 439–45. doi:10.1046/j.1525-1497.1997.00076.x. PMC 1497134. PMID 9229283.
  11. ^ a b Beck AT (1972). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press. p. 333. ISBN 978-0-8122-1032-3.
  12. ^ "Beck Depression Inventory — 2nd Edition". Nova Southeastern University Center for Center for Psychological Studies. Archived from the original on 2008-10-21. Retrieved 2008-10-17.
  13. ^ Yesavage JA (1988). "Geriatric Depression Scale". Psychopharmacology Bulletin. 24 (4): 709–11. PMID 3249773.
  14. ^ Katz IR (1998). "Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias". The Journal of Clinical Psychiatry. 59 Suppl 9: 38–44. PMID 9720486.
  15. ^ Zung WW (January 1965). "A self-rating depression scale". Arch. Gen. Psychiatry. 12: 63–70. doi:10.1001/archpsyc.1965.01720310065008. hdl:11059/13941. PMID 14221692.
  16. ^ a b Spitzer RL, Kroenke K, Williams JB (November 1999). "Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire". Journal of the American Medical Association. 282 (18): 1737–44. doi:10.1001/jama.282.18.1737. PMID 10568646.
  17. ^ Gilbody S, House AO, Sheldon TA (2005). Gilbody S (ed.). "Screening and case finding instruments for depression". Cochrane Database of Systematic Reviews. 2005 (4): CD002792. doi:10.1002/14651858.CD002792.pub2. PMC 6769050. PMID 16235301.
  18. ^ Kriston, L.; Von Wolff, A. (2011). "Not as golden as standards should be: Interpretation of the Hamilton Rating Scale for Depression". Journal of Affective Disorders. 128 (1–2): 175–177. doi:10.1016/j.jad.2010.07.011. PMID 20696481.
  19. ^ De Jonge, P.; Mangano, D.; Whooley, M. A. (2007). "Differential Association of Cognitive and Somatic Depressive Symptoms with Heart Rate Variability in Patients with Stable Coronary Heart Disease: Findings from the Heart and Soul Study". Psychosomatic Medicine. 69 (8): 735–739. doi:10.1097/PSY.0b013e31815743ca. PMC 2776660. PMID 17942844.
  20. ^ Zimmerman M. Using scales to monitor symptoms and treatment of depression (measurement-based care). In UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2011.
  21. ^ Kroenke K, Spitzer RL, Williams JB (September 2001). "The PHQ-9: validity of a brief depression severity measure". J Gen Intern Med. 16 (9): 606–13. doi:10.1046/j.1525-1497.2001.016009606.x. PMC 1495268. PMID 11556941.
  22. ^ "Terms of Use". PHQ Screeners. Pfizer. 2014-09-11. Retrieved 2 September 2016. Content found at the PHQ Screeners site is expressly exempted from Pfizer's general copyright restrictions; content found on the PHQ Screeners site is free for download and use as stated within the PHQ Screeners site.
  23. ^ "Screener Overview". PHQ Screeners. Pfizer. 2014-12-09. Retrieved 2 September 2016. All PHQ, GAD-7 screeners and translations are downloadable from this website and no permission is required to reproduce, translate, display or distribute them.
  24. ^ Zimmerman M, Chelminski I, McGlinchey JB, Posternak MA (2008). "A clinically useful depression outcome scale". Compr Psychiatry. 49 (2): 131–40. doi:10.1016/j.comppsych.2007.10.006. PMID 18243884. Copyright © Mark Zimmerman, M.D. All rights reserved. Not to be reproduced without the author's permission.
  25. ^ "Library of Scales". Outcome Tracker. Retrieved 2 September 2016. Scales that are included with permission of the authors are marked by an asterisk (*). These authors have granted permission for their scales only to be used by clinicians in their individual clinical practice, and to researchers for use in non-industry related studies. Any other uses of the scales represent a potential violation of copyright. … CUDOS*
  26. ^ a b "More Information". IDS/QIDS. University of Pittsburgh Epidemiology Data Center. Archived from the original on 26 June 2007. Retrieved 2 September 2016. Current translations of the pencil and paper versions of the IDS and QIDS are available at no cost to clinicians and researchers. Copies may be downloaded from this site and used without permission. … Those wishing to consider the IVR versions or other electronic versions should contact: Healthcare Technology Systems, Inc.
  27. ^ "The MFQ". Center for Developmental Epidemiology. Duke University Health System. Retrieved 2 September 2016. COPYRIGHT PERMISSION: Should you wish to administer the MFQ to your clients or for your research study, you may download a PDF of any version of the MFQ free of charge. We only ask that you cite the authors in any published work.
  28. ^ Bianchi, R., & Schonfeld, I. S. (2020). The Occupational Depression Inventory: A new tool for clinicians and epidemiologists. Journal of Psychosomatic Research, 138, 110249. https://doi.org/10.1016/j.jpsychores.2020.110249
  29. ^ Schonfeld, I. S., & Bianchi, R. (2022). Distress in the workplace: Characterizing the relationship of burnout measures to the Occupational Depression Inventory. International Journal of Stress Management, 29, 253-259. https://doi.org/10.1037/str0000261
  30. ^ Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32, 509–515. doi:10.3928/0048-5713-20020901-06
  31. ^ Bernstein IH, Wendt B, Nasr SJ, Rush AJ (March 2009). "Screening for major depression in private practice". J Psychiatr Pract. 15 (2): 87–94. doi:10.1097/01.pra.0000348361.03925.b3. PMC 2756171. PMID 19339842.