Appendix: Assessing depression and its severity

Appendix: Assessing depression and its severity

In this guideline, the assessment of depression is based on the criteria in DSM‑IV. Assessment should include the number and severity of symptoms, duration of the current episode, and course of illness.

Key symptoms:

  • persistent sadness or low mood; and/or

  • marked loss of interests or pleasure.

At least 1 of these, most days, most of the time for at least 2 weeks.

If any of above present, ask about associated symptoms:

  • disturbed sleep (decreased or increased compared to usual)

  • decreased or increased appetite and/or weight

  • fatigue or loss of energy

  • agitation or slowing of movements

  • poor concentration or indecisiveness

  • feelings of worthlessness or excessive or inappropriate guilt

  • suicidal thoughts or acts.

Then ask about duration and associated disability, past and family history of mood disorders, and availability of social support

1. Factors that favour general advice and active monitoring:

  • 4 or fewer of the above symptoms with little associated disability

  • symptoms intermittent, or less than 2 weeks' duration

  • recent onset with identified stressor

  • no past or family history of depression

  • social support available

  • lack of suicidal thoughts.

2. Factors that favour more active treatment in primary care:

  • 5 or more symptoms with associated disability

  • persistent or long-standing symptoms

  • personal or family history of depression

  • low social support

  • occasional suicidal thoughts.

3. Factors that favour referral to mental health professionals:

  • inadequate or incomplete response to 2 or more interventions

  • recurrent episode within 1 year of last one

  • history suggestive of bipolar disorder

  • the person with depression or relatives request referral

  • more persistent suicidal thoughts

  • self-neglect.

4. Factors that favour urgent referral to specialist mental health services

  • actively suicidal ideas or plans

  • psychotic symptoms

  • severe agitation accompanying severe symptoms

  • severe self-neglect.

Depression definitions (taken from DSM‑IV)

Subthreshold depressive symptoms: Fewer than 5 symptoms of depression.

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

The ICD‑10 threshold is lower at 4 symptoms.

Moderate depression: Symptoms or functional impairment are between 'mild' and 'severe'.

Severe depression: Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.

  • National Institute for Health and Care Excellence (NICE)