Multistate instruments

The Minnesota Multiphasic Personality Inventory (MMPI) is a long questionnaire comprising 567 items in a 'true/false' format. There are 10 clinical scales including one for depression, as well as several other groups of subscales, some of which may also be used for assessing aspects of depression. It has recently been extensively revised (Butcher & Williams, 2000).

The Kellner Symptom Questionnaire is a 92-item adjective checklist measuring depression, anxiety, hostility, and somatic concern. Reliability, validity and sensitivity to change are good. British norms are available (Zeffert et al., 1996).

The Symptom Check List (SCL-90) is a 90-item self-report instrument designed to measure nine different dimensions of mental health problems on a five-point scale, including depression, as well as such dimensions as phobic anxiety, hostility and interpersonal sensitivity. Depression items include loss of interest in sex, no interest in things, and feeling hopeless. Global scores (such as overall severity) can also be derived. Normative data are extensive, and reliability and validity are good. A key reference is Derogatis et al. (1970). A revised version (SCL-90-R) is now available.

The Brief Symptom Inventory (BSI) is a short form of the SCL-90-R. It comprises 53 items rated on a five-point scale, and takes about 10 minutes to complete. There are nine symptom scales and three global indices.

The General Health Questionnaire (GHQ) has four different versions, with, respectively, 12, 28, 30 or 60 items. It is very widely used in studies to detect mental health problems 'over the last few weeks' in non-psychiatric settings. It should not be used to arrive at a clinical diagnosis, or to assess long-standing problems. Subjects are asked to rate a series of statements on a four-point scale assessing change from the 'usual'; responses can be scored in four different ways. There are four sets of items, measuring, respectively, depression, anxiety, social dysfunction and somatic symptoms. A key reference is Goldberg (1972).

The Brief Psychiatric Rating Scale (BPRS) comprises 24 items rated on a seven-point scale from 'not present' to 'extremely severe'. There is one specific item for depression, but other relevant items include 'suicidality', 'guilt' and 'motor retardation'. The original reference is Overall and Gorham (1962). Crippa et al. (2001) have produced a structured interview guide to accompany the BPRS, which is said to increase interrater agreement.

The Hospital Anxiety and Depression Scale (HADS) is a widely used scale, developed by Zigmond and Snaith (1983); items concerned with biological aspects of depression are excluded, permitting its use to assess depression in physically ill populations. There are seven items in each of the two subscales, rated on a 0-3 scale. It is quick to complete and to score. The psychometric properties have been extensively investigated, most impressively by Mykletun et al. (2001), who used the HADS with a population of over 50 000 subjects; with such a large sample, they were able to rerun their principal components analysis and other analyses with numerous subgroups. Their findings strongly supported the clinical and research value of the HADS, in that the factor structure corresponded closely (but not perfectly) to the two subscales of anxiety and depression, the subscales correlated with each other at about +0.55, the items had an acceptable level of homogeneity, and internal consistency was high (about 0.80). The psychometric properties were even better when a more psychologically disturbed subsample was selected. It appears that HADS is a useful instrument for clinical and research purposes, but its value in detecting psychological morbidity in early breast cancer has been questioned (Hall et al., 1999).

In intercorrelations of the various scales within a multistate instrument, strong relationships are often reported, particularly between depression and anxiety. This has led some researchers (e.g., Tyrer, 1990) to suggest that anxiety and depression may not be distinct states, but form a single dimension.

Recently developed scales

A number of scales have been developed recently that appear promising for use in particular circumstances, but need further investigation before they can be recommended for routine clinical or research use. Teasdale and Cox (2001) developed a checklist of affective and self-devaluing cognitions (such as 'downhearted' and 'worthless') that may be activated when people are entering a depressive phase, particularly those who have a history of depression. It could be useful as an assessment of cognitive vulnerability to depression, and for use in clinical work or in epidemiological studies. McKenzie and Marks (1999) used a single-item rating scale to assess depression in patients with anxiety disorders; it was completed by clinicians and by patients. The scale correlated at over +0.70 with the BDI.

A self-report device was developed by Bech et al. (2001) to measure severity in moderate to severe depression. It is consistent with DSM-IV and ICD-10. Sensitivity and specificity were reported as high (0.82-0.92). An observer-completed scale for assessing depression in elderly medical patients, particularly those who can not communicate, has been described by Hammond et al. (2000). It comprises six items, selected using psychometric criteria from an original set of nine items. The six items refer to looking sad, crying, agitation, lethargy, needing encouragement and withdrawal from surroundings. Sensitivity, specificity and predictive values were acceptable.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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