These instruments are relevant to the treatment of depression.
Careful assessment is an important part of evidence-based practice. Initial assessments of depressive symptoms can help determine possible treatment options, and periodic assessment throughout care can guide treatment and gauge progress.
Many of the instruments described below were used in the studies that served as the evidence base of the systematic reviews that undergird the guideline recommendations. These instruments include both interview and self-report measures and may be used to screen, diagnose and/or track treatment outcomes. Each instrument has been demonstrated to be valid and reliable, and most are available at no cost.
Clinicians are encouraged to review the evidence-based literature about these assessments, especially regarding their intended use and appropriate populations, in order to determine which tools are best suited for their patients and practices.
The Beck Depression Inventory (BDI) is widely used to screen for depression and to measure behavioral manifestations and severity of depression. The BDI can be used for ages 13 to 80. The inventory contains 21 self-report items which individuals complete using multiple choice response formats. The BDI takes approximately 10 minutes to complete. Validity and reliability of the BDI has been tested across populations, worldwide.
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561-571. http://dx.doi.org/10.1001/archpsyc.1961.01710120031004
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. Psychological Corporation.
Osman, A., Kopper, B.A., Barrios, F., Gutierrez, P.M., & Bagge, C.L. (2004). Reliability and validity of the Beck Depression Inventory—II with adolescent psychiatric inpatients. Psychological Assessment, 16(2), 120-132. http://dx.doi.org/10.1037/1040-3590.16.2.120
The Center for Epidemiologic Studies Depression Scale (CES-D) was designed for use in the general population and is now used as a screener for depression in primary care settings. It includes 20 self-report items, scored on a 4-point scale, which measure major dimensions of depression experienced in the past week. The CES-D can be used for children as young as 6 and through older adulthood. It has been tested across gender and cultural populations and maintains consistent validity and reliability. The scale takes about 20 minutes to administer, including scoring.
Radloff, L.S. (1977). The CES-D Scale: A self-report report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401. http://dx.doi.org/10.1177/014662167700100306
Saracino, R.M., Cham, H., Rosenfeld, B., & Nelson, C.J. (2018). Confirmatory factor analysis of the Center for Epidemiologic Studies Depression Scale in oncology with examination of invariance between younger and older patients. European Journal of Psychological Assessment. Advance online publication. http://dx.doi.org/10.1027/1015-5759/a000510
The EQ-5D is a standardized, non-disease specific instrument for describing and evaluating health-related quality of life. The instrument measures quality of life in five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It was introduced as a health-related quality of life measure by a group of European researchers, the EuroQol Group. Respondents can complete the questionnaire in under five minutes. There is a version for adults (age 16 and older) and the EQ-5D-Y for children/adolescents (8 to 15 years). The EQ-5D is available in a wide range of languages and is used worldwide.
The EuroQol Group (1990) EuroQol — A new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199-208. https://doi.org/10.1016/0168-8510(90)90421-9
Brooks, R., & EuroQol Group (1996).EuroQol: The current state of play. Health Policy, 37(1), 53-72. http://dx.doi.org/10.1016/0168-8510(96)00822-6
Devlin, N.J., & Brooks, R. (2017). EQ-5D and the EuroQol group: Past, present and future. Applied Health Economics and Health Policy, 15(2), 127-137. https://doi.org/ 10.1007/s40258-017-0310-5
The Hamilton Rating Scale for Depression, abbreviated HDRS, HRSD or HAM-D, measures depression in individuals before, during and after treatment. The scale is administered by a health care professionals and contains 21 items, but is scored based on the first 17 items, which are measured either on 5-point or 3-point scales. It takes 15 to 20 minutes to complete and score.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23, 56-61. http://dx.doi.org/10.1136/jnnp.23.1.56
Trajković, G., Starčević, V., Latas, M., Leštarević, M., Ille, T., Bukumirić, Z., & Marinković, J. (2011). Reliability of the Hamilton Rating Scale for Depression: A meta-analysis over a period of 49 years. Psychiatry Research, 189(1), 1-9. http://dx.doi.org/10.1016/j.psychres.2010.12.007
The 10-item Montgomery-Åsberg Depression Rating Scale (MADRS) measures severity of depression in individuals 18 years and older. Each item is rated on a 7-point scale. The scale is an adaptation of the Hamilton Depression Rating Scale and has a greater sensitivity to change over time. The scale can be completed in 20 to 30 minutes.
Montgomery, S.A., & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134, 382-389. http://dx.doi.org/10.1192/bjp.134.4.382
Davidson, J., Turnbull, C.D., Strickland, R., Miller, R., & Graves, K. (1986). The Montgomery‐Åsberg Depression Scale: Reliability and validity. Acta Psychiatrica Scandinavica, 73(5), 544-548. https://doi.org/10.1111/j.1600-0447.1986.tb02723.x
The scale, including all developments and translations, is copyright: © Stuart Montgomery 1978, Measures of Depression, Fulcrum Press, London.
The Social Problem-Solving Inventory-Revised (SPSI-RTM) is a self-report measure of social problem-solving strengths and weaknesses in individuals 13 years old and older. The revised version has both a long form (52 questions) and short form (25 questions). It takes 10 to 20 minutes to complete.
D'Zurilla, T.J., & Nezu, A.M. (1990). Development and preliminary evaluation of the Social Problem-Solving Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(2), 156-163. http://dx.doi.org/10.1037/1040-3590.2.2.156
D'Zurilla, T.J., Nezu, A.M., & Maydeu-Olivares, A. (2002). Social problem-solving inventory — revised (SPSI-R). Multi-Health Systems.
Designed to assess emotional disorders, personality constructs and behavioral problems in individuals from 2 to 21 years old, the BASC assesses behavior from three perspectives: teacher, parent and self (starting at age 8). The system includes five rating forms and three scales. Depending on the scale, it takes 20 to 30 minutes to administer.
Merenda, P.F. (1996). BASC: Behavior Assessment System for Children. Measurement and Evaluation in Counseling and Development, 28(4), 229-232.
Reynolds, C.R., & Kamphaus, R.W. (2015). Behavior assessment system for children (3rd ed.). Pearson Assessments.
BASC3 Copyright © 2015 NCS Pearson, Inc. Reproduced with permission. All rights reserved.
3.2. BASC is a trademark, in the U.S. and/or other countries, of Pearson Education, Inc. or its affiliates(s).
The Child Behavior Profiles were designed for children and adolescents ages 6 to 18. The Child Behavior Checklist (CBCL) is a standardized questionnaire administered to parents to obtain reports of their children’s social competence and behavioral problems. It takes parents five to 10 minutes to complete the questionnaire. Additional versions are available, including the Teacher’s Report Form and Youth Self-Report (from age 11). The CBCL has been translated into various languages.
Achenbach, T.M. (1978). The child behavior profile: An empirically based system for assessing children’s behavioral problems and competencies. International Journal of Mental Health, 7(3-4), 24-42. https://doi.org/10.1080/00207411.1978.11448806
Kariuki, S.M., Abubakar, A., Murray, E., Stein, A., & Newton, C.R.J.C. (2016). Evaluation of psychometric properties and factorial structure of the pre-school child behaviour checklist at the Kenyan Coast. Child and Adolescent Psychiatry and Mental Health, 10, Article 1. http://dx.doi.org/10.1186/s13034-015-0089-9
The Children’s Depression Inventory (CDI) is a modification of the Beck Depression Inventory for adults. The CDI is now on its second edition. It assesses depression severity in children and adolescents 7 to 17 years old. Two scales measure emotional problems and functional problems. Three separate rater forms are available: one for parents (17 items), one for teachers (12 items) and a self-report (28 items). Administration time is between five and 15 minutes.
Kovacs, M. (1981). Rating scales to assess depression in school-aged children. Acta Paedopsychiatrica: International Journal of Child & Adolescent Psychiatry, 46(5-6), 305-315. http://dx.doi.org/10.1037/t00788-000
Sun, S., & Wang, S. (2015). The children’s depression inventory in worldwide child development research: A reliability generalization study. Journal of Child and Family Studies, 24(8), 2352-2363. https://doi.org/10.1007/s10826-014-0038-x
Used by permission from Multi-Health Systems, Inc.
The Children’s Depression Rating Scale (CDRS) was originally designed to measure changes in depressive symptoms in children ages 6 to 12, but its validity and reliability have also been demonstrated in the adolescent population (up to 18 years old). Covering 17 symptom areas, the scale was adapted from the Hamilton Depression Rating Scale and is set up as a semi-structured interview with the child/adolescent. It takes 10 to 15 minutes to administer and score.
Poznanski, E.O., Cook, S.C., & Carroll, B.J. (1979). A depression rating scale for children. Pediatrics, 64(4), 442-450. https://doi.org/10.1542/peds.64.4.442
Poznanski, E.O., & Mokros, H.B. (1996). Children's depression rating scale, revised (CDRS-R). Western Psychological Services.
Mayes, T.L., Bernstein, I.H., Haley, C.L., Kennard, B.D., & Emslie, G.J. (2010). Psychometric properties of the children's depression rating scale–revised in adolescents. Journal of Child and Adolescent Psychopharmacology, 20(6), 513-516. https://doi.org/10.1089/cap.2010.0063
The Beck Hopelessness Scale is a self-report measure for adults age 17 to 80. It assesses an individual’s negative expectations about the future. The measure includes 20 items to which participants respond with “true” or “false.” It takes five to 10 minutes to complete.
Beck, A.T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865. http://dx.doi.org/10.1037/h0037562
Beck, A.T., & Steer, R.A. (1988). Manual for the Beck Hopelessness Scale. Psychological Corp.
Neufeld, E., O'Rourke, N., & Donnelly, M. (2010). Enhanced measurement sensitivity of hopeless ideation among older adults at risk of self-harm: Reliability and validity of likert-type responses to the Beck Hopelessness Scale. Aging & Mental Health, 14(6), 752-756. http://dx.doi.org/10.1080/13607860903421052
The QIDS-SR measures the severity of depressive symptoms in adults 18 and older. There are 16 measures, selected from the Inventory of Depressive Symptomology (IDS, 2000). These symptoms correspond to the diagnostic criteria from the DSM-IV. Respondents use a 4-point Likert-type scale to assess their behaviors and mood over the course of the past week. It takes five to seven minutes to complete the report.
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(5), 573-583. http://dx.doi.org/10.1016/S0006-3223(02)01866-8
The Patient Health Questionnaire (PHQ) is a self-report measure designed to screen depressive symptoms. It takes one to five minutes to complete and roughly the same amount of time for a clinician to review the responses. The PHQ-9 is available in multiple languages.
Spitzer, R.L., Kroenke, K., Williams, J.B.W., & Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA 282(18), 1737-1744. http://dx.doi.org/10.1001/jama.282.18.1737
Kroenke, K., Spitzer, R.L., & Williams, J.B.W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x
Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. General Hospital Psychiatry, 28(1), 71-77. https://doi.org/10.1016/j.genhosppsych.2005.07.003
The Reminiscence Functions Scale (RFS) is a 43-item questionnaire that takes 15 to 25 minutes to complete. The RFS assesses the frequency with which adults, 18 years and older, engage in the act of recollecting past experiences or events. Respondents answer questions on a 6-point Likert-type scale, and responses are scored in eight different categories.
Webster, J.D. (1993). Construction and validation of the Reminiscence Functions Scale. Journal of Gerontology, 48(5), P256-P262. http://dx.doi.org/10.1093/geronj/48.5.P256
Robitaille, A., Cappeliez, P., Coulombe, D., & Webster, J.D. (2010). Factorial structure and psychometric properties of the reminiscence functions scale. Aging & Mental Health, 14(2), 184-192. https://doi.org/10.1080/13607860903167820
Used by permission from Dr. Jeffrey Webster.
As part of the Medical Outcomes Study (MOS), a multi-year, multi-site study that investigated variations in patient outcomes, the RAND Corporation developed the 36-item Short Form Health Survey (SF-36) as a set of easily administered quality-of-life measures. These measures rely on patient self-reports and are widely used for routine monitoring and assessment of care outcomes in the adult population. The survey can be completed in 10 minutes or less.
Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473-483. http://dx.doi.org/10.1097/00005650-199206000-00002
McHorney, C.A., Ware Jr, J.E., Lu, J.R., & Sherbourne, C.D. (1994). The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40-66. http://www.jstor.org/stable/3766189
The Social Adjustment Scale (SAS-SR) TM is a self-report measure of social functioning. It contains 54 items rated on a 5-point scale. It takes about 20 minutes to complete and is intended for individuals 17 years and older. There are also Short and Screener versions available, which take five to 10 minutes to complete.
Weissman, M.M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33(9), 1111-1115. https://doi.org/10.1001/archpsyc.1976.01770090101010
Gameroff, M.J., Wickramaratne, P., & Weissman, M.M. (2012). Testing the Short and Screener versions of the Social Adjustment Scale–Self‐report (SAS‐SR). International Journal of Methods in Psychiatric Research, 21(1), 52-65. https://doi.org/10.1002/mpr.358
The Social Functioning Questionnaire (SFQ) is a self-report tool that measures social functioning in adults over the last two weeks. The questionnaire contains eight questions which are rated on a 4-point scale. It takes less than four minutes to complete.
Tyrer, P., Nur, U., Crawford, M., Karlsen, S., McLean, C., Rao, B., & Johnson, T. (2005). The social functioning questionnaire: A rapid and robust measure of perceived functioning. International Journal of Social Psychiatry, 51(3), 265-275. http://dx.doi.org/10.1177/0020764005057391
© 2005 by SAGE Publications. Reproduced by Permission of SAGE Publications.
The Geriatric Depression Scale (GDS) is specifically designed to screen and measure depression in older adults. It contains 30 forced-choice “yes” or “no” questions, a format that is helpful for individuals with cognitive dysfunction. Questions relate to how an individual has felt in a specified time frame. It takes five to seven minutes to complete the questionnaire.
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982-1983). Development and validation of a Geriatric Depression Screening Scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. http://dx.doi.org/10.1016/0022-3956(82)90033-4
Lopez, M.N., Quan, N.M., & Carvajal, P.M. (2010). A psychometric study of the Geriatric Depression Scale. European Journal of Psychological Assessment, 26(1), 55-60. http://dx.doi.org/10.1027/1015-5759/a000008
Also called the Life Satisfaction Ratings (LSR), the Life Satisfaction Index is designed to measure well-being and successful aging among adults over the age of 50. It is administered by a health care professional. There are five categories that are rated on a 5-point scale. The estimated time for completing the questionnaire is 10 minutes.
Neugarten, B.J., Havighurst, R.J., & Tobin, S.S. (1961). The measurement of life satisfaction. Journal of Gerontology, 16, 134-143. http://dx.doi.org/10.1093/geronj/16.2.134
Adams, D.L. (1969). Analysis of a life satisfaction index. Journal of Gerontology, 24(4), 470-474. https://doi.org/10.1093/geronj/24.4.470
Barrett, A.J., & Murk, P.J. (2006). Life satisfaction index for the third age (LSITA): A measurement of successful aging. In E. P. Isaac (Ed.), Proceedings of the 2006 Midwest research-to-practice conference in adult, continuing, and community education (pp. 7-12). University of Missouri-St. Louis.
Used by permission. Published by Oxford University Press on behalf of The Gerontological Society of America.
Other investigators may use the scales and indexes reproduced in this report without permission from either the present investigators or the Journal of Gerontology.
