There are several validated scales for measuring / assessing depressive symptomatology and its severity. The most often used are the Beck Depression Inventoire (BDI - has a dimension which assess somatic symptoms of depression), the Hamilton Depression Rating Scale (HDRS), the PHQ-9. These scales are validated and used worldwide, but I am not aware of depression scales specifically validated for the Indian culture.

The manifestation of depressoin is heterogeneous and usually there is no predominance of one dimension of symptoms over the others in population studies (though at the individual level we can observe the predominance of one cluster of symptoms). Also, well designed clinical trials failed to demonstrate the superiority of antidpressant treatment to improve specific cluster of symptoms.

Hi Shrikant,

You might also want to look at the Hospital Anxiety and Depression Scale (HADS) by Snaith & Zigmond. It is often used in publications and has accepted and documented cut-offs. It utilizes 14 items (7 for anxiety/ 7 for depression).

I welcome you to read my paper, "Screening for Depression in Emergency Department Patients". David Hoyer, MD

Thanks to everyone who contributed to the discussion.

i will look at the HADS, which I have not used before, whereas I am familiar with the other scales.

David - would you be kind enough to send a copy of your paper.

David, I have downloaded the full text from your profile.

Dear Shrikant,

This is my first post on Research Gate ad I hope it will be of some use. I have done my capstone on depressive symptomologies in relation to cardiovscular disease and one of the difficulties I found is that often the symptomologies are similar to other illnesses which then mask (will come back to this), or present as depressive symptomology. Often cognitive content is used on scales, thus the scales in general need to be normalized according to the target population. Versions of the BDI and HADS have a better chance of having been normalized in different countries due to their popularity. Coming back to determining depressive symptomology - If one considers the processes of depression you could look at the Meta Cognitive Institute - UK. Dr Adrian Wells has developed tests such as the Thought Control Questionnaire and the Meta Cognitive Questionnaire, which take approximately 15 minutes each to administer. This establishes for instance what strategies are used to maintain dysfunctional cognition. This can provide a way of distinguishing between symptomology due to a co-existing medical disorderT, or other form of existing disorder. Tey may not be normed for India, but it does consider depressive processes from a different perspective. The issue around depressive symptomologies is that not only do they vary across individuals, but present themselves in different cultures in socially acceptable behavioural formats. Depressive symptomologies also vary depending on the type of Depression the patient presents with, thus establishing the clinical presence of the type of Depression when examining depressive symptomology is often critical. Though symptomology is there, if tested in two months time, the depression may be gone as it was essentially normal reactive depression, whereas Dysthmic depression may occur in 3 month cycles and at testing for a second time for instance after a Depressive episode may appear to be gone, but in fact may re occur in another month's time.

I am not sure if this helps at all, but if you want some more information on the Meta Cognitive institute I will send you the link.

Hello Shrikant,

The core symptoms of depression are only a limited picture of the clinical syndrome, where anxiety symptoms, physical symptoms are common and relevant. Moreover, social and family context, thoughts, attitudes, prejudices and interpretations... that are not strictly symptoms (nos pathologic conditions) usually are a relevant -and rarely assessed- part of the clinical landscape of depression.

So, I think that if you want to assess the phenomenology of depression in a comprehensive mode you should use more than a depression specific questionnaire. A specific depression scale must be complemented by a generic scale, as th GHQ-60 or the SCL-90, plus specific scales on anxiety, somatization, social support, cogntions, attitudes, etc. (according the specific aims of your reserach project).

Kind regards,

Hi everybody,

I agree with Enric's comment and I have used the SCL-90R in previous research successfully. With 90 items it is rather long though. This might be relevant for the setting in which it is used.

Kind Regards,

Dear Cheryl,

I would be very much interested in Meta Cognitive Questionnaire, if you will be kind enough to send a link for the same.

Cheers

Dear Enric and Burkhard,

It makes sense to use a symptom check list.

My aim is to have a comprehensive list of symptoms to be evaluated in a field trial, and then see which are most commonly reported symptoms in Indian population.

Another option I was thinking about was to go through all depression rating scales, and make a symptom check list to be administered, and also note other symptoms which patients complain of but are not in this checklist.

I would be grateful if you can forward a copy of SCL90R and GHQ60, if it is not copyrighted.

many thanks

Hi again Shrikant,

I used the german version which is copyrighted, don't know about the original Derogatis version though.

The english version of SCL-90 can be purchased at http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAg514

Hi Shrikant, I have uploaded under my profile a very detailed dcument on the BDI-II in relation to adaption for use in other cultures, should you need detailed psychometric and "how to adapt the instrument" information.

Thanks to every one.

Cheryl, I am assuming that I can download the information from your profile - I will give this a try.

Dear Enric, I was afraid that this may be paid. This is very low budget study (read it as zero budget).

I have been working on the paper records of outpatient clinic attendance at our hospital. With the help of some staff, I have now access to about 4000 records of all outpatients, which also includes the presenting complaints. So this maybe a good starting point to select the depression cases and compile a list of presenting symptoms.

If you want to use a very quick and free tool, I would recommend PHQ-9. it is based on the DSM criteria for depression, so seems to me to be in line with what you are asking. I would also recommend using CORE-OM, alongside the PHQ-9. Although CORE-OM is not a specific measure of depression, it is a good tool for measuring global distress and functional impairment. It has four sub-scales which cover risk, well-being, symptoms/ problems and functioning. CORE-OM is also free.

Another quick and free tool useful at the bedside is the mnemonic "In SAD CAGES". In SAD CAGES summarizes the DSM-4&5 criteria. "In" is for loss of interest, "S" is sleep changes, "A" is appetite change, "D" is depressed mood, "C" is trouble concentrating, "A" is change in activity level, "G" is excessive guilt, "E" is for energy (usually low) and "S" is for suicidal thoughts/plan/action. Of course, according to the DSMs, you must have "In" or "D" and 5 of the 9 criteria present for 2 weeks to make the diagnosis of depression. Attached is my article on using In SAD CAGES in the emergency department, but the mnemonic can be used in any clinical venue.

DSM V is the latest version, was released in May this year. Standard therapy may be a relative term depending where you practice medicine.

When i teach about pharmacology of antidepressants i often provide this Mnemonic

"SPACE DIGS" for depression

S= Sleep disruption

P= Psychomotor retardation

A= Appetite change

C= Concentration ↓

E= Energy ↓

D= Depressed mood

I= Interest wanes

G= Guilt

S= Suicidal tendencies

-------------------------------------

and "RED DIRT" for MANIA.

R= Risky behavior

E= Enhanced focus on goals

D= Distractibility

D= Decreased need for sleep

I= Inflated self-esteem

R= Racing thoughts

T= Talkativeness

hope that helps

The best book for medicine is Harrion's Internal medicine where you could get more depth of information regarding depression.

sPaCE shorter Psychotherapy and Counselling Evaluation is a nineteen item self-report measure of depression and anxiety. It can be accessed via my profile.

Bodily manifestations are just over-looked in Western countries.

Before present dark-ages of depression many studies have been performed in the 70ies in various countries, especially by OMS.

The are summarized in my book in french "La dépression et son traitement: aspects méconnus" L'Harmattan Paris 2005 and 2011;

If you want it, I can send you the references of these articles.