What to expect from a depression screening

What is a depression screening? | How to access a screening | Who needs a screening | Questions to expect | Screening results | Diagnosis | Treatment

When you arrive at your doctor’s office for your appointment, the receptionist asks for a copy of your insurance card—then, hands you a brief questionnaire, asking about how you’ve been feeling lately. Many healthcare providers have some sort of depression screening tool used to help them recognize early signs of a mood disorder that could justify some further evaluation.

In honor of National Depression Screening Day on Oct. 8, learn more about how a depression screening can help you assess your mental health status and needs. It could be the first step toward understanding your moods and improving your quality of life.

What is a depression screening?

A depression screening tool is just what it sounds like: a screening measure. It’s designed to screen for symptoms of depression. It may be referred to colloquially as a “depression test,” but it isn’t a true “test” like a blood pressure check that measures exact levels of something. Rather, a depression screening is an instrument that uses subjective answers to give a provider insight into your mental health.

“A depression screening is intended to identify symptoms that might put a person at risk for having depression,” explains Crystal Clark, MD, an associate professor of psychiatry and behavioral sciences and obstetrics and gynecology at Northwestern Feinberg School of Medicine. 

A commonly used screening tool is the Patient Health Questionnaire-9 (PHQ-9). It’s a list of questions that asks you to think about things like your appetite and your energy levels. You complete this questionnaire so that you and your doctor can determine if you’re frequently experiencing certain common symptoms of depression such as persistent sadness and loss of interest in your favorite activities. 

A screening flags many symptoms that you might have. It’s an indicator that could help you decide when it’s time to see a mental health professional. “Depending on what you score, you’ll know if you need to move forward or not,” says Lindsay Israel, MD, a psychiatrist and the chief medical officer of Success TMS.

How do I access a depression screening tool? 

Your primary care provider might give you a copy to fill out in the waiting room. Or you might receive a questionnaire to complete when waiting to see a specialist.

You can also go online to complete a self-assessment. Organizations like the United States Preventive Services Task Force (USPSTF) and the Anxiety and Depression Association of America (ADAA) offer depression screening tools like the PHQ-9 on their websites. However, none of these self-assessments are substitutes for a formal evaluation by a mental health professional.

Do I need a depression screening?

The U.S. Preventive Services Task Force recommends regular screening for depression in adults, including pregnant and postpartum women, as well as procedures for follow-up. 

Why? Depression is a very common health condition—one that affected more than 17 million adults in the U.S. in 2017. In fact, according to the National Institute of Mental Health (NIMH), more than 7% of the adult population of the U.S. has experienced at least one major depressive episode. 

Since so many people are affected, just about anyone could benefit from doing a screening, according to Dr. Clark. “I feel like everyone should sit down and do it, but definitely anyone who feels like something is not quite right,” Dr. Clark explains. 

You might be aware that you’ve been experiencing some symptoms of depression. But, you might not—or you may not realize that your feelings are symptoms of depression. A depression screening can pick up on the signs that you may have missed. 

But if you’ve recently been diagnosed with a condition like heart disease, stroke, or cancer, a depression screening might be an especially good idea. Depression and other mental health conditions often go hand-in-hand with other health conditions or medical comorbidities. 

In fact, depression is considered a risk factor for some conditions like cardiovascular disease. Research suggests that as many as 40% of people who have experienced a serious cardiac event meet the criteria for a major depressive disorder (MDD). The American Cancer Society also estimates that 1 out of every 4 people with cancer also suffers from major depression. 

And unfortunately, depression can make a bad situation worse. For example, research shows that people with cardiovascular disease who also suffer from depression tend to have poorer outcomes. Depression can make it very hard for people with a serious illness to manage that illness. 

After all, the mind and body are connected, says Clark. “So, if a patient is truly depressed and also has a physical illness, they are less likely to tend to that physical illness than they would if they were feeling better,” she says. 

What questions are asked in a depression screening?

A typical depression screening will ask you to think about how you’ve been feeling over the past two weeks. The PHQ-9 will ask you to assess how often you’ve experienced the following:

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling asleep, staying asleep or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself
7. Trouble concentrating
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or hurting yourself

You’ll go down the list and assign a frequency to each question. Your choices are:

• Not at all
• Several days
• More than half the days
• Nearly every day

The important thing is to be honest with your responses. You’re trying to learn more about your mental health, and this is a good entry point for doing so. 

“It’s not foolproof, like anything, but it’s another tool that we can use,” explains Anandhi Narasimhan, MD, a child, adolescent, and adult psychiatrist in a private clinical practice in California who also serves as staff psychiatrist at Masada Homes in Gardena, California.

What do my depression screening results mean?

Your responses are just supposed to be used as a guide. You won’t get a depression diagnosis from a screening. But you may get some advice to pursue additional evaluation that may (or may not) eventually lead to an accurate diagnosis. 

If you’re taking the screening questionnaire at your doctor’s office, your healthcare provider may want to discuss the results of the screening with you. Depending on the results, they may refer you to a mental health professional for a conversation.

If you choose to do a self-assessment online, it’s important to note that you cannot diagnose yourself. Screenings that are available online are just designed to serve as a guide. For example, the ADAA recommends that you download the PHQ-9, complete the survey, and then take the results to your doctor and discuss them. It won’t give you a score or a description of your situation. But the answers can help your doctor understand what you’re going through. Then you can have a conversation about it. 

Can I diagnose depression in myself?

You cannot officially diagnose yourself with depression. You do need a healthcare professional for that, says Dr. Narasimhan.

To assess you, a psychiatrist will use the criteria from a handbook for assessing and diagnosing mental illnesses that’s known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (also known as the DSM-5). You need to have at least five symptoms to receive a diagnosis of major depressive disorder. Your doctor will also consider the frequency and duration of your symptoms when making a diagnosis. 

Your doctor may also want to rule out other medical conditions that can sometimes cause symptoms of depression to appear. According to the American Psychiatric Association, a brain tumor, certain vitamin deficiencies, and thyroid disorders are among these conditions. Substance abuse and other mental health conditions can also cause similar symptoms.

But that doesn’t mean that you can’t take a proactive role in learning more about your own mental and emotional well-being. 

You can learn the symptoms of depression and monitor yourself for them. Though, always remember that some people aren’t aware that certain feelings are actually symptoms of depression, even if they occur regularly. 

Take the classic depression symptom of experiencing decreased pleasure in activities that you normally like to do. “That, to me, is one of the best markers that a patient can recognize,” Dr. Israel says. “They’ll say, “I used to love to play golf.’ Or ‘I used to love to go to the gym.’ Or ‘I used to love to cook.’ And now they’re not doing any of that. That, to me, is a pretty black-and-white change that you can put your finger on.”

You can also learn more about your own risk factors. For example, women are more likely than men to develop depression. Research also suggests that a family history of depressive disorders can increase your risk. So can a major life change or a traumatic event. Depression is also common among older adults, although the National Institute on Aging emphasizes that it’s not a normal part of the aging process. 

The bottom line: Recognizing and understanding your risk factors can put you at heightened awareness—and that may make it easier for you to seek help. 

How do I get treatment after my depression screening? 

It’s important to remember: Depression can be treated. 

If your depression screening leads you to seek out a mental health professional for an evaluation, you may receive a diagnosis. There are numerous possible diagnoses; two of the most common are major depression (also known as clinical depression) and persistent depressive disorder. 

Your recommended treatment will depend on your specific diagnosis. You might be a good candidate for an antidepressant or other medication. You may benefit from psychotherapy. Or you may find that a combination of medication, behavioral health strategies, and therapy are the most effective way to help you, along with some self-care measures. 

And it’s always possible to change things up if they don’t work well. For example, if the first medication you try isn’t effective or the dose is not right, your doctor can always adjust the dose or suggest that you switch antidepressants.  

Just as it’s important to be honest when answering the questions in a screening questionnaire, it’s important to be honest with your provider—and yourself—about what you are experiencing. Your provider needs to know what you’re feeling so that you can get a correct diagnosis and effective treatment. That’s the only way you’ll be able to get the help that you need.

“Hiding it or minimizing it is not going to get you the help you need,” Dr. Israel says. 

A depression screening tool is not just a one-time thing. Your situation may change, and you may develop depressive symptoms later. So you may encounter them in future doctor’s office visits, and your answers might be different.

You can also use a depression screening tool to help you monitor your progress after receiving a diagnosis and beginning treatment. 

For more information on seeking help or treatment or depression support, visit the National Alliance on Mental Health or call the Substance Abuse and Mental Health Services Administration helpline at 1-800-662-HELP. If you or a loved one is experiencing suicidal thoughts or self-harm, call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit the nearest emergency room.