Depression Screening: Online And In-Person
By: Sarah Fader
Updated May 26, 2020
Medically Reviewed By: Richard Jackson
Depression is a very common mental illness. These days, most of us know someone who has been affected by a type of depression, whether it is a friend, co-worker, or family member. Maybe even yourself.
If you have suffered from depression you are familiar with the persistent feelings of sadness, guilt, difficulty making decisions, and sleepless nights. You recognize the increasing amount of time that you spend in bed, away from people and avoiding your usual responsibilities.
According to the Anxiety and Depression Association (ADAA), Major Depressive Disorder (MDD) is, "The leading cause of disability in the US for ages 15 - 44" in America. That's more than 16 million American adults, with more women than men being diagnosed with this mental illness.
An additional 3.3 million American adults suffer from Persistent Depressive Disorder (PDD, or dysthymia), a chronic form of depression where the patient suffers from a low mood for several years but the symptoms are generally less severe.
Depression can be very debilitating and decreases your quality of life, but it is highly treatable. Even though it might seem like no one can help the way you are feeling when you are depressed, reaching out for help can make a big difference.
Following and maintaining your prescribed treatment can lead not only remission but also empowerment. Once you know what you are dealing with and know that there are treatments that work, it can give you a whole new outlook if you suffer from future depressive episodes.
If you are worried that you or someone you know is suffering from depression, there are both online and in-person depression screening methods that can help you get on the right track towards getting the diagnosis and treatment that you need.
Many doctors use the PRIME-MD instrument for diagnosing mental disorders. Patients can find the depression module, PHQ-9, which scores you on the DSM IV's depression criteria at Patient.info. This tool is not only used for screening but also to monitor the severity of patients' depression and their response to treatment.
When screening for depression, doctors are doing to look mainly for a depressed mood and/or a loss of interest or pleasure in normal activities for a period of at least two weeks. In addition, there needs to be several other symptoms accompanying this, including five of the following:
- Depressed mood
- Loss of interest or pleasure
- Significant weight loss or weight gain
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Inability to concentrate
- Thoughts of death or suicidal ideation
As part of the screening, your doctor will likely conduct a physical exam to see if there are any underlying biological causes for your depression, tests to see if there is another medical condition that can explain your symptoms, and perform a psychological exam all to ensure a proper diagnosis.
The main difference between screening for MDD and PDD is that a patient suffering from PDD shows a depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. For children, it can be either depressed mood or irritability for much of the day over a one-year period.
Depression Screening for Adults
While online depression screening tests can be a helpful tool, they should never replace proper diagnosis. Untreated depression can be dangerous, and so if you suspect you have depression you should make an appointment with your physician for an official diagnosis.
If you have your suspicions but still aren't sure, Mental Health America has a quick, free depression test on their website that helps assess depression symptoms as self-reported by yourself over the last two weeks. They recommend printing the results and bringing them to a physician or other health professional who is trained to properly diagnose mental illness.
Your physician might have questionnaires of their own for you to fill out that will help them accurately assess your symptoms.
As part of the next steps your physician will help you narrow down an appropriate treatment for your symptoms and individual circumstances. They consider factors like your family medical history, co-existing diagnoses, and whether you are currently on any medications before coming to a conclusion.
Depression Screening for Children
Unfortunately, depression can occur at almost any age. It affects the young, the elderly, and even children. Diagnosing childhood depression and other mental illnesses should be done by a professional, and there are often different criteria for childhood mental disorders compared to diagnosing adults.
There are also several tools online that are geared towards parents who are concerned about their children. In most cases, these quizzes are meant to be taken by the parents on their children's behalf. There are also self-reporting tests for adolescents, including tools used for monitoring depression symptoms in teen patients. It is important to keep in mind these are screenings and does not replace a diagnostic assessment by a mental health professional.
Depression Screening for the Elderly
It is suggested that when screening for depression in older patients, short self-reporting scales can be just as useful and can be simpler and easier for them to complete.
Another study, conducted by F. Lamers, C.C.M. Jonkers, H. Bosma et al. (2008) found that the PHQ-9 was reliable and valid when used to screen for depression in chronically ill elderly patients ages 60 and up.
Elderly patients concerned that they might be suffering from depression and their families can find an online version of the 30-item Geriatric Depression Scale online as a free pre-screening tool, but it is important to follow up with a medical professional for official diagnosis at any age.
After Depression Screening and Diagnosis: Treatment
Studies have shown that depression is a highly treatable mental illness, About two-thirds of people with major depression never seek appropriate treatment. That is why proper diagnosis is such an important first step. Next, patients and their physicians have several treatment options to choose from. These options primarily include psychotherapy and pharmacotherapy.
A paper published by R.J. DeRubeis, G.J. Siegle and S. D. Hollon3 (2008) shares that medication and cognitive therapy are equally effective in treating depression, with cognitive therapy showing the potential to reduce the risk of relapse even post-treatment. They suggest that better understanding the differences between medication and therapy in treating depression could lead to better future outcomes.
To find a licensed mental health practitioner that is qualified to treat depression, you can ask for a referral from your primary care physician or turn to an online directory to find someone in your local area. If for some reason, you can't attend therapy sessions or can't afford them, there are other alternatives.
One alternative is turning to an online counseling/therapy service like BetterHelp. BetterHelp is an affordable service that can be accessed online via your computer or mobile device. The set-up is easy. You simply fill out their questionnaire and BetterHelp matches you with a qualified counselor who is experienced at dealing with the problems that you are facing.
BetterHelp and similar services are great because they offer an ongoing relationship where patients have someone that they can turn to at any time. Users can also take part in phone sessions and therapy groups.
In addition to medication and therapy, lifestyle changes can also bring about a reduction in symptoms and provide a sense of resilience against future depressive episodes. A few important lifestyle changes that you can make to fight against depression are embracing exercise and nutrition, getting better sleep, relying on a social support system, and reducing the amount of stress in your life.
Depression is most often treated by primary care physicians, who should be aware of the symptoms of depression and make use of the screening tools that are available to them. Too often, patients go to their physician and report symptoms of depression that go unnoticed.
Symptoms like insomnia and hypersomnia, weight loss or weight gain, and inability to concentrate may not look like depression at first glance but knowledgeable health professionals should consider it as a possibility and screen patients to rule depression out.
If you suspect depression is the cause of your symptoms, bring it up to your doctor in case they overlook it.
After initial screening, patients may go through several other procedures to receive a full diagnosis and recommendation of treatment options. These options might include prescription medication or referring the patient to a licensed medical health professional for psychotherapy.initial screening, patients may go through several other procedures to receive a full diagnosis and recommendation of treatment options. These options might include prescription medication or referring the patient to a licensed medical health professional for psychotherapy.
Prompt screening and treatment can help reduce the symptoms of depression and provide patients with the skills to avoid, or at least cope better with, future episodes. Both medication and psychological treatments have been proven effective in treating depression and in some cases, doctors may even prescribe a combination of the two to get symptoms under control.