Mental Disorder

You’ve probably heard of depression if you’ve listened to a radio or watched a TV in the past 25 years. You can’t miss the commercials for medications that treat it (“Depression hurts”). Depression is the common cold of mental disorders, because it affects so many people over the course of a lifetime. If you don’t end up having at least a mild case of it in your life, I bet you know a loved one who has. And while some minor depressive feelings may be a normal part of modern life, major depression (also known as clinical depression) is a more serious and debilitating condition.

The problem arises when depression overtakes your life and becomes your life’s focus. Nobody wants that, and it feels like a black hole that there’s no way you can climb out of (nor point in doing so). And unlike a broken arm, the insidious part of depression is that it takes away the drive to go get treatment.

Before most people seek treatment for a mental disorder these days, they go to see their family doctor. Family doctors usually are pretty good at recognizing the signs of depression and help a person seek appropriate treatment and followup care. But sometimes they misdiagnose depression when it’s really something else, because the symptoms a person (or their doctor) may focus on (like weight change or insomnia, the most physical symptoms of depression) are not unique to depression. Such symptoms are common to many mental disorders.

Like many mental disorders, depression has a symptom list that can be a little daunting to remember. There are nine general symptoms of depression, amongst other criteria, including those things that are common to other disorders. What if someone could simplify the depression criteria so it would be quicker and easier to diagnose?

Leave it to some intrepid researchers from Down Under to do just that. Andrews et. al. (2007) boiled down the diagnosis of depression to just 5 out of the typical 9 symptoms:

1. Depressed mood (feelings of sadness or being blue)
2. Lack of interest (in activities that you previously enjoyed)
3. Feelings of worthlessness
4. Poor concentration
5. Thoughts of death

The researchers found in two data analyses that 99.6% and 96.8% of patients who met criteria for five or more of the nine traditional symptoms also met the restricted criteria for three or more of the five psychological symptoms. Diagnostic accuracy was maintained, according to the researchers, by using the simplified set of 5. And since 5 sets of symptoms are easier to remember than 9, the reliability of this diagnosis amongst even primary care physicians should also be increased.

Could this restricted set lead to overdiagnosis of depression, since according to the researchers a person could be accurately diagnosed with depression with just 3 criteria (out of 5) as opposed to the current 5 (out of 9)? Perhaps, but that would be something additional research would have to answer.

The bigger problem in mental health isn’t overdiagnosis (despite the media hype about ADHD overdiagnosis that pops up from time to time), it’s under-diagnosis. It’s people not bothering to talk to a professional about their emotional concerns or mood, because they’re anxious, uncertain, embarrassed or scared.

To try and help people take the first step in determining whether they may or may not have depression, we’ve designed a new quick screening test for depression based upon this latest research. Our new depression quiz has only 8 questions (as opposed to our usual 18). We hope you find it useful.

Reference: Andrews et al. (2007). Issues for DSM-V: Simplifying DSM-IV to Enhance Utility: The Case of Major Depressive Disorder. Am J Psychiatry, 164:1784-1785.