Deciding Which Depression Screening Tools to Use

Depression Screening Tools

The US Preventative Services Task Force (USPSTF) recommends that all adolescents between 12 and 18 years old undergo screening for major depressive disorder (MDD), commonly referred to as depression. For patients under 12, there is no consensus on the need to screen for MDD, meaning that providers can use their discretion to determine when it is necessary. The USPSTF recommends depression screening for all adult populations, including pregnant, postpartum, and geriatric patients.

For depression alone, the American Psychological Association (APA) lists 19 available screening tools, dividing them into age-appropriate screenings. While these are not the only tools available, they are some of the most widely used assessments.

All Age Ranges

Across all ages, six available screenings for depression include the following:

• the Beck Depression Inventory (BDI)
• the Center for Epidemiologic Studies Depression Scale (CES-D)
• the EQ-5D
• the Hamilton Depression Rating Scale (HAM-D)
• the Montgomery–Åsberg Depression Rating Scale (MADRS)
• the Social Problem-Solving Inventory-Revised (SPSI-RTM)

The BDI can be used for patients between 13 and 80 to measure the severity of depression and how it manifests behaviorally. Patients are asked to respond to 21 assessments; each response is scored on a scale of zero to three. Higher scores are indicative of a higher risk of depression. This assessment can be self-administered or administered by a provider in ten minutes or less. Considering the broad range of patients eligible to be screened using this tool, providers who see patients of many ages may consider using it as their standard of care.

Like the BDI, the CES-D is a self-assessment where each response is scored on a scale of zero to three. However, the CES-D has only 20 questions and can be used for people as young as six. This assessment takes about double the time to complete but may be a better option for providers treating a younger population.

For providers looking to measure the quality of life as an assessment of depression, the EQ-5D may be a better tool as it looks at the quality of life in five dimensions, including mobility, self-care, usual activities, pain and discomfort, anxiety, and depression. This questionnaire can be completed in under five minutes, making it a preferred option for high-volume or bustling facilities. There are two test versions, one for patients 16 and older and one for patients 8–15. While having these versions may mean reaching a broader patient population, it can also cause confusion when documenting results and administering the assessment.

The MADRS is often used to measure depression in adults over 18. Ten items are scored on a seven-point scale, and it can take up to 30 minutes to score. MADRS is often used when researching medications for depression to measure how the drug changes the baseline score. As a more comprehensive assessment, providers may use this screening tool when they have more time or are seeing a patient specifically for depression.

These tools are most applicable in family medicine or hospital settings where a broad range of ages is seen daily.

Children and Adolescents

There are a few more specialized screening tools for children and adolescents that may involve the input of the patient, parents, and teachers. Facilities that focus exclusively on children and adolescents may opt for these screening devices, including the following:

• the Behavior Assessment System for Children (BASC)
• the Child Behavior Checklist (CBCL)
• the Children’s Depression Inventory (CDI)
• the Children’s Depression Rating Scale (CDRS)

The BASC can be used for patients as young as 2 or as old as 21. This screening tool includes a behavioral assessment from the teachers’, parents’, and patients’ points of view; however, self-assessments are not considered until the patient is eight. According to the APA, “the system includes five rating forms and three scales. Depending on the scale, it takes 20–30 minutes to administer.”

If providers see more patients daily and need to save time to minimize physician burnout and accommodate their patients, they may opt for the CBCL screening — a shorter, 5–10 minutes assessment. While quicker, this screening tool has some limitations as it is designed for a smaller patient population, only for children between six and eighteen years old. This screening tool requires parent input on social skills and behavior. There are also versions to be completed by the child’s teacher and the patient.

The CDI is a modified version of the BDI to be used for children between 7 and 17 years to measure emotional and functional problems. The self-assessment is 28 items long; the parent version is 17 items long; the teacher version is 12 items long. Providers who regularly use the BDI and are familiar with it may be more comfortable administering the CDI for younger populations while still having some standard facility practices. 

Finally, the CDRS is for children between 6 and 18, although initially designed for children between 6 and 12. This tool was adapted from the HAM-D and occurs in an interview-like format which can take up to 15 minutes.

Adult Population

For the general adult population, there are multiple different screening tools, including the following:

• the Beck Hopelessness Scale
• the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR)
• the Patient Health Questionnaire (PHQ-9)
• the Reminiscence Functions Scale (RFS)
• the Short Form Health Survey (SF-36)
• the Social Adjustment Scale- Self Report (SAS-SR)
• the Social Functioning Questionnaire (SFQ)

This patient population has the most extensive set of available and tested assessments. According to the APA, the Beck Hopelessness Scale “assesses an individual’s negative expectations about the future. The measure includes 20 items to which participants respond with ‘true’ or ‘false.’ It takes 5–10 minutes to complete.”

The PHQ-9 is a commonly used self-report screening tool for depressive symptoms, which takes as little as 1–5 minutes to complete and an additional 1–5 minutes to score. The ease of this tool and its short length makes it easy to incorporate in primary care settings; however, some providers may opt for more comprehensive assessments such as the SAS-SR, which is 54 items long.

Geriatric Populations

Older adults also have screening tools specifically developed or adapted for assessing depression in more senior or geriatric populations, including the following:

• the Geriatric Depression Scale (GDS)
• the Life Satisfaction Index

This population has a unique set of needs that may not be met and can exacerbate feelings of depression. Misconceptions about aging may also contribute to the underdiagnosis of depression. The GDS measures depression in geriatric populations through 30 yes or no questions. This type of assessment is easier for patients who suffer from some cognitive impairment. It is also a relatively short assessment that can be completed in seven minutes on average. This assessment benefits providers who see many adults with cognitive impairment or other neurodegenerative conditions.

The Life Satisfaction Index, used for adults over 50, measures well-being and successful aging through five categories of questions that are rated on a five-point scale.