Case 72: Assessment of Depression: Which are the Prominent Mental Health Instruments in Research Studies?

Assessment of Depression: Which are the Prominent Mental Health Instruments in Research Studies?

        Historically, the assessment of depression has garnered a central role in evaluation of mental health (Brantley et al., 2004; Cusin, et al., 2010; IsHak et al., 2002; Piotrowski, 1996). Indeed, a perusal of 2 popular texts on psychological assessment (i.e., Hunsley & Mash, 2008; Maruish, 2000) finds several chapters on the issue of depression in children, adolescents, adults, and the elderly. Noteworthy, several modern scales purporting to assess depression levels have gained the attention of clinicians and assessment faculty. For example, instruments like the Patient Health Questionnaire (PHQ-9), the Patient-Reported Outcomes Measurement Information System (PROMIS; Young et al., 2019), and the Hospital Anxiety and Depression Scale (HADS: see Turk et al., 2015) may offer alternative avenues for the efficient, brief assessment of mood states.

        A careful review of rankings of the most popular tests reported in „test usage‟ studies, over the past 50 years, indicates that symptom-focused scales in the area of depression have been quite prominent (see Archer et al., 1991), including usage at psychology internship sites (Piotrowski & Belter, 1999). Piotrowski and Lubin (1990) found the following instruments highly ranked by clinical-health psychologists in the assessment of depression: the MMPI, Beck Depression Inventory, Profile of Mood States, the Zung Self-Rating Scale for Depression, the CES-D; the Children‟s Depression Inventory and the Geriatric Depression Scale were used moderately. More recently, a national survey of professional psychologists found that symptom-specific measures, including the Beck Depression Inventory (BDI), were the most frequently used tests (Wright et al., 2017).

        It would be of interest to examine the level of clinical acceptance of various measures of depression over the past few decades. One approach would be to determine the magnitude of usage of depression assessment instruments most noted by researchers in the mental health field. To that end, the current exercise involved an online search in the database PsycINFO. The main keyword was „depression‟ which needed to appear as a term in the Title of published articles. In order to appreciate changes over time, this analysis was performed across 3 timeframes (1920-1989; 1990-2004; 2005-2020). The issue was not in the total number of articles, but in the ranking of the top tests which were the most emphasized across research studies.

Table 1 presents the aggregated results of these analyses, with a listing of the top assessment instruments cited across thousands of studies. Interestingly, the BDI (I & II) and the Hamilton Rating Scale for Depression were the top 2 tests across all time frames.

Table 1. Top Assessment Instruments in Research on Depression indexed in PsycINFO

        A recent analysis found that the BDI was used at least moderately in 21 (60%) of the 35 survey-based studies of practice settings since 1989 (Piotrowski, 2018). Apparently, this high level of clinical acceptability has impacted professional training, in that 7 of the 10 surveys of academic settings, in the 2018 analysis, showed from moderate to high levels of training emphasis with the BDI. Thus, the BDI has been strongly embraced by mental health professionals.

        These findings, based on bibliometric data, can indeed inform assessment practices. The BDI is popular in mental health assessment, perhaps due to brevity, ease of scoring, specificity, and a substantial body of research literature. Moreover, the BDI furnishes the busy clinician with interpretable quantitative assessment data. This supports comprehensive mental health evaluation, in that brief, symptom-focused measures tend to facilitate treatment planning, monitoring of clinical progress, and evaluation of outcome assessment (Maruish, 2000, pp. 398-405).

        In fact, recent survey data indicate that professional acceptance of the Beck inventories is on the increase (see Piotrowski, 2018; Wright et al., 2017). Evidently, this popularity of the BDI has been reflected in survey studies on test usage, and in the clinical curriculum of both professional psychology training programs and internship settings in recent years (see Table 2).

        What factors may account for the popularity of these 2 scales? Indeed, the BDI and the Hamilton Rating Scale for Depression have had few self-report competitors in the assessment of depression when first introduced in the mental health literature. As a result, even 30 years later, these instruments have outranked all other brief instruments used in assessing depression (see Piotrowski & Lubin, 1990). Moreover, following robust revisions, the BDI-II emerged as a much-improved instrument both conceptually and clinically (confirmed by the positive reviews of the BDI-II in the Mental Measurements Yearbook).

Table 2. Emphasis or Use of the BDI in Training/Practice Settings across Studies (2010-2017)

Note. Studies marked with asterisk (*) focused on graduate/internship training.

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