Review article
Assessment of mood: Guides for clinicians

https://doi.org/10.1016/j.jpsychores.2009.05.003Get rights and content

Abstract

Objective

This article is one of the series of review articles aiming to present a convenient guideline for practicing clinicians in their selection of scales for clinical and research purposes. This article focuses on assessment scales for mood (depression, mania).

Methods

After reviewing the basic principles of clinical psychometrics, we present a selective review of representative scales measuring depressed or manic mood.

Results

We reviewed and reported on reliability, validity, interpretability, and feasibility of the following rating scales: Patient Health Questionnaire-9 (PHQ-9), K6, Beck Depression Inventory II (BDI-II), and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) as self-report scales for depressed mood; Hamilton Rating Scale for Depression (HAM-D) and Montgomery–Asberg Depression Rating Scale (MADRS) as clinician-administered measure for depression; and Young Mania Rating Scale (YMRS) as a clinician-administered instrument for mania.

Conclusion

Although the rating scales for mood represent a well-trodden terrain, this brief review of the most frequently used scales in the literature revealed there is still some room for improvement and for further research, especially with regard to their clinical interpretability.

Introduction

This article aims to present a convenient compendium of assessment scales for mood (depression and mania) for practicing clinicians to help them select scales to use for their clinical as well as research purposes. When we practice psychiatry, we are constantly assessing and measuring our patients' status. We can categorize these clinical assessments according to their purposes and their formats. There are four purposes to our assessments, namely, to screen for a disorder, to diagnose a disorder, to measure severity of the disorder, and to measure change in severity of the disorder, and there are two formats to psychiatric assessments, namely, clinician-rated and self-report [1]. Table 1 lists a number of representative scales in this area according to this grid.

The introduction to this series provides an excellent framework in evaluating measurement scales in health [13]. To recapitulate very briefly, all the scales need be reliable and valid. The most appropriate index to capture this reproducibility for a continuous scale is the ANOVA intraclass correlation coefficient (ICC). For a scale to be valid, it must produce results that fit the purpose of the scale's usage: the validity therefore depends on whether it is used for screening, for diagnosing, for measuring severity, or for measuring change.

In addition to reliability and validity, all the scales need be interpretable and feasible. The scale is said to be interpretable when there is a well-established, albeit rough, guideline as to what a certain score, say 25 on a certain scale, would mean when used as a screening instrument and when used as a severity measure, and what a certain change in score, say 25 to 15 on that scale, would mean when used to measure change in the psychopathology. A useful scale must also be feasible, i.e., the stated reliable, valid, and interpretable results must be readily accessible to the clinicians and patients. One important aspect of feasibility of a self-report scale is the time it takes to complete the scale, and those for a clinician-rated scale are, in addition to the time it takes to complete and score the scale, the time and effort it takes for the clinician to get the training in its administration. For example, it would serve the clinicians well if there are readily attendable workshops and/or well-prepared training videos.

Mood disorder being among the most prevalent and the most disabling disorders that afflict humankind [14], [15], it is no wonder that we have a plethora of scales for the assessment of mood and, to a lesser extent, of reviews of these scales. However, to the current author's knowledge, not many reviewers have fully examined the four aspects listed above for the many rating scales for mood and, unfortunately, not many researchers have taken the toil to establish these four characteristics that are nonetheless sine qua non to their sensible usage in clinical practices. In this review, I will therefore restrict myself to a relatively small number of representative scales that basically meet these requirements.

Section snippets

Description of the scale

The Patient Health Questionnaire-9 (PHQ-9) was developed in 1999 as a self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) which aims at criteria-based diagnosis of several mental disorders commonly seen in primary care [3]. The depression module of the PHQ is called PHQ-9 and consists of the nine diagnostic criteria items of DSM-IV, namely, anhedonia, depressed mood, trouble sleeping, feeling tired, change in appetite, guilt or worthlessness, trouble concentrating,

Description of the scale

The Young Mania Rating Scale (YMRS) was developed in 1978, when there were very few rating scales for mania and the available ones were either too long or too narrow. The YMRS is a checklist of 11 items that are ranked on a scale of 0–4 or 0–8, the latter anchoring given to the four items which can be rated even with patients with poor cooperation. The score range therefore is between 0 and 60. The time frame for assessment is usually set to the past 48 h, based on the patient's subjective

Conclusions

Table 2 summarizes the psychometric characteristics of the rating scales covered in this review. Given the word limit, we were unable to cover some frequently used scales for depression such as the Zung Self-Rating Depression Scale [53], the Center for Epidemiologic Studies Depression Scale [54], or the depression subscale of the Hopkins Symptom Checklist-90 [55]. Nor could we cover a self-rating screening instrument for lifetime mania/hypomania (Mood Disorder Questionnaire) and other mania

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