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
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.
Major depressive disorder in adults: Diagnosis and management (BC Guidelines, 2013)
Depression in adults: Recognition and management (Nice guideline CG 90, 2009)
Depression in adults with chronic physical health problems: Recognition and management (NICE guideline CG91, 2009)
Depression in children and young people: Identification and management (NICE guideline CG28, 2005)