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Depression: Screening, assessment and diagnosis

Risk factors for major depressive episode

Patients with the following risk factors may be screened for major depressive episode (MDE):

  • chronic insomnia or fatigue
  • unexplained somatic symptoms
  • chronic medical illness
  • recent cardiovascular event (myocardial infarction, stroke)
  • recent trauma (psychological or physical)
  • other psychiatric disorder
  • family history of mood disorder
  • extensive use of the medical system ("thick chart" syndrome)

Two-question quick screen

Use the two-question "quick screen" for patients with risk factors for major depressive episode (MDE). Ask:

  • In the past month, have you lost interest or pleasure in things you usually like to do?
  • Have you felt sad, low, down, depressed or hopeless?

Answering "yes" to either question indicates the need for a more detailed assessment.

Making a diagnosis and assessing severity

Summary of DSM-5 MDE criteria

Use a diagnostic questionnaire, such as the widely available patient-rated Patient Health Questionnaire (PHQ-9) for depression. It can be used for diagnosis, assessing severity and monitoring treatment response.

Also remember the SIGECAPS mnemonic for MDE symptoms: 

Sleep (insomnia or hypersomnia)

Interest (reduced, with loss of pleasure)

Guilt (often unrealistic)

Energy (mental and physical fatigue)

Concentration (distractibility, memory disturbance)

Appetite (decreased or increased)

Psychomotor (retardation or agitation)

Suicide (thoughts, plans, behaviours)

Use a screening questionnaire, such as the Mood Disorder Questionnaire, to rule out bipolar disorder.

Psychiatric interviewing series

David Goldbloom and Nancy McNaughton demonstrate clinical interviewing situations.

Psychiatry in primary care toolkit

A powerful mobile app packed with features that will streamline screening and assessment in primary care.

Download the Toolkit

Frequently asked questions

Related links

Screening for depression and suicide in primary care (Canadian Association for Suicide Prevention)