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Checklists Often Fail to Address Important Aspects of Depression Diagnosis
> 4/3/2007 9:22:02 AM

Sometimes it can be difficult to distinguish bereavement from depression, especially in the moment immediately following a profound loss. That is one of the many roles of doctors and therapists who work with those who have experienced the damaging effects of persistent and deep sadness.

As it stands right now, the diagnosis for major depression specifically carves out exemptions for those who experience a major loss, like the death of a loved one, preceding their current demonstration of symptoms. New research that is drawn from NCS data shows just how important a complete picture can be when diagnosing depression and why some believe that the diagnosis might benefit from an expansion of the definition of the role of context to include losses or changes beyond those included in the bereavement exemption.

The new study, conducted by representatives from four northeastern universities, found that when depression is measured by a checklist, as it was with the NCS, respondents whose symptoms can be attributed to a death were not statistically different from those who had other contextual reasons for their symptoms. While the New York Times reported this new information under the headline, "Many Diagnoses of Depression May Be Misguided, Study Says," that declaration is in fact misleading. The team's work shows that checklist type survey's that rely on only a few broad questions to assess the possibility of a depression diagnosis are flawed because they do not take into account the life events that may have led to the symptoms.

While the study does highlight some important points--primarily that there is a difference between bereavement and depression and that our environments can have an important effect on our mental health--to say that the diagnosis for depression needs to be reworked might be a stretch. What this research clearly shows is that simple surveys are not ideal tools for diagnosing depression. It is virtually impossible to assess someone's mental health in a mere six or ten questions. That is why doctors and therapists often use thorough intake questionnaires and interviews that flesh out a full picture of the patient and their history. Only with this information in hand can an accurate and actionable diagnosis truly be provided.

In the data set that they were working with, the original National Comorbidity Survey, the team's conclusions may have been accurate, but in terms of drawing broader points, that is more difficult. A more thorough and in-depth survey, which may be a nuisance to randomly selected test subjects, could serve as a powerful clinical tool in other settings. Only through assessing a more thorough picture, including a medical and personal history, can a therapist or a doctor help guide the client through the best possible course of action.

Comments
I totally agree.The New York Times article and the knee-jerk reaction from John Grohol at psychcentral.com are overly simplistic, misinformed, and misleading.I cannot imagine any competent clinician relying on a checklist to diagnose depression.As I said elsewhere:"Most 'checklists' are painfully transparent and have little or no validity. If your clinician has to depend on such instruments to diagnose depression, i would suggest that you find another therapist."
URL: http://forum.psychlinks.ca
Posted by: David Baxter 4/4/2007 10:52:40 AM