Severity should be taken into account when deciding whether concurrent (or alternative) physical treatments or hospitalization are necessary, and in determining where to begin within cognitive therapy. Severity can be assessed through clinical interview (e.g. intensity, pervasiveness, and reactivity of depressed mood; extent of behavioural and interpersonal deficits). The Beck Depression Inventory ( BDI)(43> provides a rapid overview of symptoms. The BDI is a 21-item self-report inventory scoring 0 to 3 on each item (<10, not depressed; 10-19, mild; 20-25, moderate; >25, severe). Routine completion of the BDI before sessions allows clinicians to observe overall progress, as well as tracking scores on particular items: for example, low self-esteem (items 3, 7, and 8). Hopelessness and suicidality (items 2 and 9) should be routinely assessed. Scores above 9 on the Beck Hopelessness Scale,(44) a 21-item, self-report inventory, predict subsequent suicidal behaviour more accurately than depression perse.(4 46) High scores are thus a sign that suicide risk should be investigated in more depth.

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