Description/Samples/Epidemiologic Evidence

DEPRESSION

Diagnostic instruments:

(1) Structured Clinical Interview (SCID)

Semi-structured interview for making Axis I DSM-III-R diagnoses. Current (past month) and lifetime diagnoses.

(2) Diagnostic Interview Schedule (DIS)

Structured interview used by trained interviewers who are not clinicians.
Used in ECA Study (Robins & Regier), Stirling County Study (Murphy J)

(3) Composite International Diagnostic Interview (CIDI)

Structured interview used by trained interviewers who are not clinicians.
Used in National Comorbidity Survey (Kessler)

(4) Canberra Interview for the Elderly (CIE; Social Psychiatry Research Unit 1992: Mackinnon et al. 1993; Henderson et al. 1993).

A standardized assessment of depressive symptoms and cognitive performance, suitable for administration by nonclinician interviewers after brief training. Includes an informant interviwer. Allows persons to be identified as cases of depressive disorder or dementia by ICD-10 and DSM-III-R or IV. In addition, a Depression Scale of 28 items from the CIE includes all symptoms specified in the criteria for ICD-10 depressive episode and dysthymia and for DSM-III-R major depressive disorder and dysthymia.

Symptom rating scales:

(1) Beck Depression Inventory (BDI; Beck, 1961, 1978)

List of 21 symptoms (e.g. mood, pessimism, sense of failure, lack of satisfaction, etc.) Most often self-administered and takes 5-10 min. Has been used to assess severity of depression in clinically depressed samples but has also been used as a screening tool in general population samples. Available in various forms for different populations, cultures, & age groups.

o Ahern DK et al. (1990). 502 post-MI/arrhthymia patients followed 1 yr. Higher BDI was risk factor for death or cardiac arrest.

(2) Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977)

20-item measure of current level of depressive symptoms.

o Davidson K et al. (2000). Coronary Artery Risk Development Study (CARDIA). 3343 adults aged 25-35 followed for 5 yrs. Respondents with elevated CES-D scores were at significantly increased risk of incident hypertension

o Bassuk SS et al. (1998). New Haven site, Established Populations for Epidemiologic Studies of the Elderly. Elevated CES-D scores predict decline in cognitive functioning among respondents already evincing cognitive difficulties at baseline but are not associated with cognitive decline in respondents with good cognitive function at baseline.

o Simonsick EM et al. (1995). Established Populations for Epidemiologic Studies of the Elderly. 6 yr follow-up of East Boston, New Haven & Iowa residents aged 65+, with diagnosed hypertension at baseline. CES-D scores were not associated with blood pressure control either cross-sectionally or longitudinally. High CES-D scores were associated with incident stroke, and, in some subgroups, with CVD deaths.

o Wassertheil-Smoller S et al. (1996). 4367 hypertensive men & women aged 60+, followed for 4.5 yrs. Baseline CES-D score was not related to subsequent ACM, fatal or nonfatal stroke, or MI. However, an increase in CES-D score over time was associated with a substantial increased risk of death and stroke or MI.

o Zonderman AB et al. (1989) National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. CES-D scores were not associated with cancer incidence or cancer mortality in 10-15 yr follow-up.

Linkins & Comstock (1990). CES-D scores associated with development of cancer, but in smokers only, not total study pop'n.

o Burack JH et al. (1993). 277 HIV+ men followed for up to 5.5 yrs. High CES-D scores predicted greater CD4 lymphocyte decline, but were not associated with earlier AIDS diagnosis or mortality.

o Lyketsos CG et al. (1993). Multicenter AIDS Cohort Study. 1809 HIV+ men followed for 8 yrs. CES-D scores were not related to time to AIDS or to death.

(3) Geriatric Depression Scale (GDS; Brink &Yesavage, 1982).

o Whooley & Browner (1998). Study of Osteoporotic Fractures Research Group. 7518 white women aged 67+ followed for 7 yrs. Depressive symptoms (GDS short form) were associated with all-cause mortality, CVD mortality, non-cancer/non-CVD mortality, but not with cancer deaths.

o Fried et al. Cardiovascular Health Study uses GDS.

o Fried et al. Women's Health and Aging Study uses GDS.

(4) Zung Self-Rating Depression Scale (Zung, 1965)

Measures current level of depressive symptoms. 20 items grouped in 4 categories: psychic-affective (depressed mood, crying spells); physiological disturbance (diurnal variation, sleep disturbance, decreased appetite, decreased libido, decreased weight, constipation, tachycardia, increased fatigue); psychomotor retardation/agitation; psychological disturbance (confusion, hopelessness, irritability, indecisiveness, personal devaluation, emptiness, suicidal rumination, and dissatisfaction). Scale has been used in many studies, but not recently.

o Barefoot JC et al. 1250 patients with established CAD were followed for up to 19 yrs. Depression (Zung) was associated with cardiac death and total mortality.

(5) Depression Adjective Checklist (DACL; Lubin, 1965).

Measures "transient depressive mood, feeling, or emotion" as opposed to chronic enduring depression. 7 lists, four containing 32 adjectives & three containing 34 adjectives. Respondents indicate whether each adjective "applies to me" or "does not apply to me." Does not measure standard symptoms of depression as sleep disturbance, weight loss, & loss of sexual interest. Taps dysphoric affect component of depression, which may be of most value in nonclinical populations. Lubin has also developed a trait (dispositional dysphoria) version of DACL, with manual of norms, psychometric data, etc.

(6) Attributional Style Questionnaire (ASQ; Peterson, Semmel, von Baeyer, Abramson, Metalsky, & Seligman, 1982) (See also Steptoe, p. 235)

Measures a stable tendency to make particular kinds of causal inferences or attributions, which are hypothesized to play a causal role in depression. It is the most popular of the cognitive measures.

Epidemiologic evidence:

Jorm (2000). Is depression a risk factor for dementia or cognitive decline? A meta-analytic review of the epidemiologic evidence found that depression was associated with an increased risk of subsequent dementia in both case-control studies and prospective studies. Six hypothesis that might explain the association were reviewed.

HOPELESSNESS

Beck Hopelessness Scale (Beck, 19XX)

Epidemiologic evidence:

o Anda et al. (1993). NHEFS. Risk of fatal ischemic heart disease associated with levels of severe hopelessness, measured using a single item from General Well-Being Schedule, Depression subscale, was 2.1, p<0.05.

o Everson et al. (1996). Kuipio Ischemic Heart Disease study. 2428 men aged 42-60, followed for 6 yrs. Hopelessness, assessed using 2-item scale, was associated with incident MI, independent of depression.

o Everson et al. (2000). Positive association betw hopelessness, assessed using 2-item scale, & HTN.