Screening For Depression: How Depression Tests Work
There isnt a single depression test or screening that determines if someone is clinically depressed. Unlike lab tests that diagnose some illnesses, a depression test is just one tool that a professional might use when screening for and diagnosing a mental health condition like depression.
Depression tests are often in the form of a questionnaire. A physician or mental health professional may ask the questions orally or an individual may be asked to read and answer the questions on paper or on a digital device.
The answers alone aren’t enough to determine if someone has depression because a test won’t account for other possible reasons for an individual’s answers.
For example, someone experiencing acute pain may report difficulty sleeping and poor appetitebut those symptoms may be caused by pain rather than depression. A clinician would need to take their physical health condition into account after reviewing the test results.
Similarly, a treatment provider would also need to take someone’s environment into account. Someone may report difficulty sleeping not because he’s depressed, but because he has a loud neighbor who keeps him up at night.
Be aware that depression tests don’t allow for explanations. They usually ask someone to report how often certain symptoms occur during a defined time period. A treatment provider would need to probe further to gain suficient information about an individual’s symptoms.
Iiipolicy Assumptions: Should Depression Screening Play A Role In Improving Mental Health Services
Even if depression screening guidelines could be made into accurate quality indicators, and even if adherence to these guidelines would improve clinical outcomes, there remains the question of what role such measures should play in efforts to enhance mental healthcare. As will be shown, the conclusion that adherence to depression screening guidelines should be adopted as a quality measure rests on several policy assumptions. This section will examine the evidence related to these assumptions.
1Depression screening is a priority among preventive services
The relative importance of depression screening compared to other preventive services was evaluated in a systematic review of all 25 recommended by the USPSTF. For each, it calculated the clinically preventable burden and the costeffectiveness, ranked these on a fivepoint scale and then added these to compute a total score. Depression screening in adults scored four, with 17 services ranked above it and only 4 below it. When attention is focused only on screening services it was outscored by colorectal screening, hypertension screening, vision screening in adults, cervical cancer screening, breast cancer screening, chlamydia screening, vision screening in children and obesity screening. Relative even to other screening measures, depression screening is not a priority.
2Depression screening is cost effective
3Screening is the most effective intervention to improve clinical outcomes in depression
Helping A Loved One Affected By Depression
Depression is very common among older adults, and the struggle can be unbearable at times. This is reflected in the suicide rate of people over age 65, which is 19 per 100,000 people, compared to 13 suicides per 100,000 people in younger populations.
Dont let it come to this. If you have a loved one affected by depression, heres how to show you care:
- Offer your support, understanding, patience, and encouragement.
- Be a good listener.
- Extend social invitations. If they decline, keep trying, but dont push.
- Never ignore comments about suicide. Instead, report them to your loved ones doctor, therapist, or the National Suicide Prevention Lifeline .
- Help your loved one find an effective treatment for them.
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Read This If You Answered Several Days More Than Half The Days Or Nearly Every Day To The Next To The Last Question
Your screen results indicate that you may be at risk for harming yourself or someone else. Please call 911 or go immediately to the nearest hospital emergency room. You may also call the Suicide Hotline at 1-800-273-TALK .
The PHQ-9 is a Pfizer product.
PRIME-MD® is a trademark of Pfizer Inc.
If you or someone you know is a Veteran in crisis, please call 1-800-273-8255 and press 1 visit www.VeteransCrisisLine.net or send a text message to 838255 today. Find out what VA suicide prevention resources are available.
Nering With Behavioral Health And Psychiatry
Screening for depression is an example of how a patient-centered care team can be a great asset, especially if they have internal resources that can improve not only screening rates but also a wide range of chronic conditions.
At Christiana Care, physicians have embedded behavioral health consultants who can provide clinical support and care for their populations. The system’s work-flow notifies the BHCs of patients with a positive screen, allowing for a warm hand-off from clinician to consultant. Physicians have found that patients are much more likely to follow up when they can meet the BHC in person at the time the referral is made. In addition, the physicians have found that sharing a medical record has been invaluable in easing communication between providers. The physicians were able to collaborate to establish clear practice guidelines regarding when to escalate care to a psychiatrist, which has reduced misunderstandings and unintentional delays in care.
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Itechnical Assumptions: Adherence To Depression Screening Guidelines Could Be Used As A Quality Indicator
Practice guidelines are clinical tools a clinician determines whether they are applicable to any particular patient using all available information. Quality indicators are administrative rules an administrator decides that they are applicable to all patients in a particular category unless excluded by an algorithm that can only utilise data available to administrators. The patients to whom a guideline may be clinically applicable are not necessarily the same as those to whom it is applied administratively. Since the extent of this difference may vary amongst the patient populations of different clinicians, sites or programmes, performance on this guideline may not provide a comparable measure of their quality. Without studying the clinical applicability of a quality indicator in a particular clinical setting, the extent of bias this introduces will remain unknown. This problem could be reduced if clinicians had the option of noting that a screening guideline is not applicable to a particular case, but administrators are loath to offer such an option for fear that its abuse could undermine the value of their quality indicator.
1You can determine how to screen
2You can determine who to screen
3You can determine who was screened
4You can determine a target screening rate
Prevalence Of Depressive And Anxiety Disorders
Australian and other studies have reported the 4-year period prevalence of antenatal depression as up to one in ten women . Primary anxiety disorders are prevalent and their comorbidity with depression is very high . Point prevalence of anxiety disorder of one in five in the third trimester of pregnancy has been reported .
Depression may arise in pregnancy or pre-date the pregnancy. In a subset of women in a large US study of women assessed at 6 weeks postnatally, two in five episodes of depression began postnatally, one in three during pregnancy and one in four before pregnancy . Australian studies have reported persistence of maternal depressive symptoms beyond the first year postpartum, with more mothers reporting depressive symptoms at 4 years follow-up than in the first 12 months postpartum , symptoms persisting from pregnancy to 4 years postpartum in one in eleven women and symptoms persisting from the first year to 67 years postpartum in one in six women .
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Diagnosing Depression And Other Testing Methods
The doctor may include other standard tests as part of the initial physical exam. Among them may be blood tests to check electrolytes, liver function, toxicology screening, and kidney function. Because the kidneys and liver are responsible for the elimination of depression medications, impairment to either of these two organs may cause the drugs to accumulate in the body.
Other tests may sometimes include:
- CT scan or MRI of the brain to rule out serious illnesses such as a brain tumor
- Electrocardiogram to diagnose some heart problems
- Electroencephalogram to record electrical activity of the brain
What Do The Results Mean
If you are diagnosed with depression, it’s important to get treatment as soon as possible. The sooner you get treatment, the better chance you have of recovery. Treatment for depression may take a long time, but most people who get treated eventually feel better.
If your primary care provider diagnosed you, he or she may refer you to a mental health provider. If a mental health provider diagnosed you, he or she will recommend a treatment plan based on the type of depression you have and how serious it is.
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About Your Mental Health
How Many People Are Diagnosed With Depression
Around 17.3 million US adults have had at least one major depressive episode.2 Some 20% of women and between 10 and 12% of men will experience depression at least once in their life, says says Steven Hollon, PhD, of Brentwood, Tennessee, a professor of psychology at Vanderbilt University.
Depression is relatively rare during childhood and comparably distributed across the genders, Hollon adds. The rates just explode during adolescence and that is when gender disparities first emerge. And, he adds, Half of all the folks who are going to be diagnosed with major depression at some point will have at least one episode during adolescence.
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Do I Need A Depression Screening
The U.S. Preventive Services Task Force recommends regular screening for depression in adults, including pregnant and postpartum women, as well as procedures for follow-up.
Why? Depression is a very common health conditionone that affected more than 17 million adults in the U.S. in 2017. In fact, according to the National Institute of Mental Health , more than 7% of the adult population of the U.S. has experienced at least one major depressive episode.
Since so many people are affected, just about anyone could benefit from doing a screening, according to Dr. Clark. I feel like everyone should sit down and do it, but definitely anyone who feels like something is not quite right, Dr. Clark explains.
You might be aware that youve been experiencing some symptoms of depression. But, you might notor you may not realize that your feelings are symptoms of depression. A depression screening can pick up on the signs that you may have missed.
But if youve recently been diagnosed with a condition like heart disease, stroke, or cancer, a depression screening might be an especially good idea. Depression and other mental health conditions often go hand-in-hand with other health conditions or medical comorbidities.
After all, the mind and body are connected, says Clark. So, if a patient is truly depressed and also has a physical illness, they are less likely to tend to that physical illness than they would if they were feeling better, she says.
Who Can Diagnose Depression
Primary care providers often diagnose depression. They may refer an individual to a mental health professional such as a psychiatrist or psychologist for treatment. Typically, says Steven Hollon, PhD, of Brentwood, Tennessee, a professor of psychology at Vanderbilt University, the provider uses the Diagnostic and Statistical Manual of Mental Disorders to make a diagnosis.3 They go through the criteria in the DSM to see how many criteria the person meets, Hollon says.
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What Does A Positive Screen Mean
- This woman is suffering from many of the symptoms of depression.
- It does NOT mean she has depression.
- Only a mental health professional or primary care provider can determine a diagnosis of depression.
- There is a 25 to 40% chance that she will be diagnosed with depression. The screening tools are designed to over-identify because of the potentially life-threatening consequences of depression.
Symptoms Of Depression Include:
- loss of interest in usual activities
- aches and pains with no other medical cause
- thoughts of death or suicide
We all have experienced some of these symptoms at one point or another, but, it may be considered the illness of Depression when the symptoms last for more than a couple of weeks, and they start to interfere with your home or work life.
Depression Screening evaluates these symptoms and how much these symptoms may be interfering with daily living.
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Is There Anything Else I Need To Know About Depression Screening
There are many types of mental health providers who treat depression. The most common types of mental health providers include:
L.C.S.W.s and L.P.C.s may be known by other names, including therapist, clinician, or counselor.
If you don’t know which type of mental health provider you should see, talk to your primary care provider.
Culturally Appropriate Screening For Depression
Aboriginal and Torres Strait Islander women
For Aboriginal and Torres Strait Islander women, EPDS score may be influenced by the womans understanding of the language used, mistrust of mainstream services or fear of consequences of depression being identified . Translations of the EPDS developed in consultation with women from Aboriginal communities have been found to identify a slightly higher number of women experiencing symptoms of depression . A recent adaptation of the EPDS assessed in the Kimberley region of Western Australia includes an additional component of psychosocial assessment, acknowledging the contribution that stressful events and social health issues play in mental health . Many elements of the approach taken to adapting this instrument are likely to have broader relevance to urban as well as remote and regional Aboriginal and Torres Strait Islander communities.
If use of the EPDS is considered inappropriate, involvement of an Aboriginal health worker may facilitate assessment of symptoms.
Use appropriately translated versions of the EPDS with culturally relevant cut-off scores.
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What Is A Depression Screening
A depression screening tool is just what it sounds like: a screening measure. Its designed to screen for symptoms of depression. It may be referred to colloquially as a depression test, but it isnt a true test like a blood pressure check that measures exact levels of something. Rather, a depression screening is an instrument that uses subjective answers to give a provider insight into your mental health.
A depression screening is intended to identify symptoms that might put a person at risk for having depression, explains Crystal Clark, MD, an associate professor of psychiatry and behavioral sciences and obstetrics and gynecology at Northwestern Feinberg School of Medicine.
A commonly used screening tool is the Patient Health Questionnaire-9 . Its a list of questions that asks you to think about things like your appetite and your energy levels. You complete this questionnaire so that you and your doctor can determine if youre frequently experiencing certain common symptoms of depression such as persistent sadness and loss of interest in your favorite activities.
A screening flags many symptoms that you might have. Its an indicator that could help you decide when its time to see a mental health professional. Depending on what you score, youll know if you need to move forward or not, says Lindsay Israel, MD, a psychiatrist and the chief medical officer of Success TMS.
How Does A Doctor Make A Depression Diagnosis
We’ve gotten used to doctors using special blood tests or other complex laboratory tests to help them make a conclusive diagnosis. But most lab tests arenât very helpful when it comes to diagnosing depression. In fact, talking with the patient may be the most important diagnostic tool the doctor has. The recommendation is that doctors routinely screen everyone for depression. This screening might take place during a visit for a chronic illness, at an annual wellness visit, or during a pregnancy or postpartum visit.
To effectively diagnose and treat depression, the doctor must hear about specific symptoms of depression. They may use a series of standard questions to screen for depression. While a physical examination will reveal a patient’s overall state of health, by talking with a patient, a doctor can learn about other things that are relevant to making a depression diagnosis. A patient, for example, can report on such things as daily moods, behaviors, and lifestyle habits.
A depression diagnosis is often difficult to make because clinical depression can show up in so many different ways. For example, some clinically depressed people seem to withdraw into a state of apathy. Others may become irritable or even agitated. Eating and sleeping patterns can be exaggerated. Clinical depression may cause someone to sleep or eat to excess, or almost eliminate those activities.
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Which Lab Tests Can Help Make The Depression Diagnosis
After reviewing the information from your appointment, including the signs and symptoms, patient history, family history, and physician exam, your doctor may ask for some lab tests to rule out a physical condition that may be causing your symptoms. Certain viruses, medicines, hormonal or vitamin deficiencies, and illnesses can cause depression-like symptoms. Your doctor will also want to review all medications youâre taking as well as the alcohol or recreational drugs you may be using.
Depression Screening Diagnostic Scale
Two self-completed scales aimed at detecting bipolar disorder have been validated recently, the Mood Disorder Questionnaire and the Bipolar Spectrum Diagnostic Scale .
These scales may help sort out the difficult but critical issue of unipolar vs bipolar depression. Indeed, all patients with depressive complaints should be carefully screened for periods of mania, hypomania, or mood instability.
BIPOLAR SPECTRUM DIAGNOSTIC SCALE
Instructions: Please read through the entire passage below before filling in any blanks.
Some individuals notice that their mood and/or energy levels shift drastically from time to time__ . These individuals notice that, at times, their mood and/or energy level is very low, and at other times, very high__ .
During their low phases, these individuals often feel a lack of energy a need to stay in bed or get extra sleep and little or no motivation to do things they need to do__. They often put on weight during these periods__ .
During their low phases, these individuals often feel blue, sad all the time, or depressed__ . Sometimes, during these low phases, they feel hopeless or even suicidal__ . Their ability to function at work or socially is impaired__ .
Sometimes, their behavior during these high periods seems strange or annoying to others__. These individuals get into difficulty with co-workers or the police, during these high periods__ . Sometimes they increase their alcohol or non-prescription drug use during these high periods__.
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