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Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 57 (from laksa033)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa057.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://cks.nice.org.uk/topics/depression/diagnosis/assessment/\')), getAhrefsUnparsedNoserviceFromURL(\'https://cks.nice.org.uk/topics/depression/diagnosis/assessment/\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/","crawl_time":1774706015,"first_indexed_time":1665283038,"http_code":200,"src_unparsed":"uk,org,nice!cks,\/topics\/depression\/diagnosis\/assessment\/ s443","src_root_hash":"2740109274380393857","history_drop_reason":null,"meta_title":"Assessment | Diagnosis | Depression | CKS | NICE","meta_descriptions":["Assessment, Diagnosis, Depression, CKS"],"attrs_boilerpipe_text":"If a person has a\nsuspected\n diagnosis of depression:\nAsk about:\nThe onset, duration, pattern, and severity of\nsymptoms\n, including impact on daily functioning at work, on carer role(s), and on relationships including any safeguarding concerns for children or vulnerable adults in their care. See the CKS topic on\nChild maltreatment - recognition and management\nfor more information.\nCurrent lifestyle including diet, physical activity, sleep; gambling, alcohol and\/or substance misuse. See the CKS topics on\nAlcohol - problem drinking\nand\nInsomnia\nfor more information.\nAny past history of depression and\/or episodes of self-harm. See the CKS topic on\nSelf-harm\nfor more information.\nAny current symptoms or past history of coexisting mental health conditions, including mood elevation or psychotic symptoms suggesting bipolar disorder or psychotic depression, psychosis, anxiety, post-traumatic stress disorder (PTSD), or eating disorders. See the CKS topics on\nBipolar disorder\n,\nEating disorders\n,\nGeneralized anxiety disorder\n,\nPost-traumatic stress disorder\n, and\nPsychosis and schizophrenia\nfor more information.\nAny learning disability or acquired cognitive impairment including dementia, traumatic brain injury, or Parkinson's disease. See the CKS topics on\nDementia\n,\nHead injury\n,\nLearning disabilities\n, and\nParkinson's disease\nfor more information.\nAny\nrisk factors\nfor depression including family history of depression, suicide, or self-harm; chronic physical health conditions; history of domestic violence.\nCurrent or previous supportive relationships including partner, other family, friends, carers; and support from any other statutory or voluntary organisations.\nAny recent or past stressful or traumatic life events, including difficult interpersonal relationships or relationship breakdown including divorce; job stress or redundancy; debt or financial difficulties; bereavement or other trauma; housing and living conditions; immigration status; social isolation.\nAny current or previous forensic history.\nCurrent medication, any previous treatments for depression, symptom response and any adverse effects.\nAlways ask about any thoughts, ideas, plans, or intent to self-harm or commit suicide, and any protective factors.\nIf there is a risk of self-harm or suicide:\nAssess the person's level of social support and awareness of sources of help.\nArrange help appropriate to their level of need\nAdvise the person to seek further help if their situation deteriorates.\nSee the CKS topic on\nSelf-harm\nfor more information.\nConsider using a validated depression questionnaire\nto assess for depression, severity of symptoms, functioning, and response to treatment.\nSee the section on\nDepression questionnaires\n for more information.\nAssess the person's mental state and cognitive function.\nConsider performing a physical examination including neurological examination and arranging additional investigations,\ndepending on clinical judgement, particularly if a coexisting condition or alternative cause for symptoms is suspected.\nSee the section on\nDifferential diagnosis\nfor more information on possible alternative causes for symptoms.\nDepression questionnaires\nDepression questionnaires which are validated for use in primary care include:\nPHQ-9 (Patient Health Questionnaire-9)\nA nine-item, self-administered scale, which reflects the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria.\nIt classifies current symptoms on a scale of 0 (not at all) to 3 (nearly every day) — the maximum score is 27.\nIt can be downloaded free of charge from \nwww.phqscreeners.com\n.\nHADS (Hospital Anxiety and Depression Scale) \nA self-administered scale, with 14 questions in total (seven covering depression and seven covering anxiety).\nThe maximum score for each subscale is 21.\nScores of 8–10, 11–14, and 15–21 represent cut-off points for mild, moderate, and severe depression respectively. \nA paper version is available to purchase from \nhttps:\/\/www.gl-assessment.co.uk\/products\/hospital-anxiety-and-depression-scale-hads\/\n.\nBDI-II (Beck Depression Inventory-II)\nA 21-item, self-administered scale that uses DSM-5 criteria.\nEach question is rated from 0 to 3 — the maximum score is 63.\nScores of 14–19, 20–28, and 29–63 can be interpreted as mild, moderate, and severe depression respectively.  \nIt is available to purchase from \nwww.pearsonassessments.com\n.\nIn people who have concerns about gambling the NHS gambling questionnaire may be helpful\nhttps:\/\/www.nhs.uk\/live-well\/addiction-support\/gambling-addiction\/\n. \nBasis for recommendation\nThe recommendations for assessment are based on the National Institute for Health and Care Excellence (NICE) guidelines\nDepression in adults: treatment and management\n [\nNICE, 2022b\n], the NICE guideline\nGambling-related harms: identification, assessment and management\n[\nNICE, 2025\n] the British Association for Psychopharmacology (BAP) guidelines\nEvidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines\n [\nCleare, 2015\n], and expert opinion in review articles on depression [\nMalhi, 2018\n;\nFerenchick, 2019\n].\nClinical features on history-taking\nThese recommendations are based on the NICE guideline [\nNICE, 2022b\n], the BAP guidelines [\nCleare, 2015\n], expert opinion in review articles [\nMalhi, 2018\n;\nFerenchick, 2019\n], and are also pragmatic, based on what CKS considers to be good clinical practice.\nThe BAP guidelines note that the use of antidepressants in people with undiagnosed bipolar disorder can trigger hypomania\/mania.\nUsing a validated depression questionnaire\nThis recommendation is based on the NICE guideline [\nNICE, 2022b\n] and expert opinion in review articles [\nMalhi, 2018\n;\nFerenchick, 2019\n].\nThe NICE guideline notes that a validated questionnaire can help to assess symptoms, functioning, impairment, and evaluate treatment.\n Assessing mental state and cognitive function\nThis recommendation is based on the NICE guideline [\nNICE, 2022b\n] and expert opinion in a review article [\nFerenchick, 2019\n].\nCognitive testing can help to assess for coexisting or alternative conditions that may present with depressive symptoms, including neurological conditions and dementia [\nFerenchick, 2019\n].\nPerforming a physical examination and arranging additional investigations\nThis recommendation is based on expert opinion in a review article [\nFerenchick, 2019\n]. It is also pragmatic, based on what CKS considers to be good clinical practice.","attrs_markdown":"- [Skip to content](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/#content-start)\n- [Accessibility help](https:\/\/www.nice.org.uk\/accessibility)\n\nMenu\n\n- [Guidance](https:\/\/www.nice.org.uk\/guidance)\n- [Standards and indicators](https:\/\/www.nice.org.uk\/standards-and-indicators)\n- [Clinical Knowledge Summaries (CKS)](https:\/\/cks.nice.org.uk\/)\n  - [![](data:image\/svg+xml;base64,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)](https:\/\/cks.nice.org.uk\/)\n 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[NICE](https:\/\/www.nice.org.uk\/)\n2. [CKS](https:\/\/cks.nice.org.uk\/)\n3. [Health topics A to Z](https:\/\/cks.nice.org.uk\/topics\/)\n4. [Depression](https:\/\/cks.nice.org.uk\/topics\/depression\/)\n5. [Diagnosis](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/)\n6. Assessment\n\n# Depression: How should I assess a person with suspected depression?\nLast revised in April 2025\n\nPrint this page\n\nAssessment\n\n- [Summary](https:\/\/cks.nice.org.uk\/topics\/depression\/)\n- [Have I got the right topic?](https:\/\/cks.nice.org.uk\/topics\/depression\/have-i-got-the-right-topic\/)\n- [How up-to-date is this topic?](https:\/\/cks.nice.org.uk\/topics\/depression\/how-up-to-date-is-this-topic\/)\n- [Goals and outcome measures](https:\/\/cks.nice.org.uk\/topics\/depression\/goals-outcome-measures\/)\n- [Background information](https:\/\/cks.nice.org.uk\/topics\/depression\/background-information\/)\n- [Diagnosis](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/)\n  - [Diagnosis](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/diagnosis\/)\n  - [Assessment](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/)\n  - [Differential diagnosis](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/differential-diagnosis\/)\n- [Management](https:\/\/cks.nice.org.uk\/topics\/depression\/management\/)\n- [Prescribing information](https:\/\/cks.nice.org.uk\/topics\/depression\/prescribing-information\/)\n- [Supporting evidence](https:\/\/cks.nice.org.uk\/topics\/depression\/supporting-evidence\/)\n- [How this topic was developed](https:\/\/cks.nice.org.uk\/topics\/depression\/how-this-topic-was-developed\/)\n- [References](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\n\n## On this page\n1. [Depression questionnaires](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/#depression-questionnaires)\n2. [Basis for recommendation](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/#basis-for-recommendation-0e7)\n\n## How should I assess a person with suspected depression?\n**If a person has a **[suspected](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/diagnosis\/)** diagnosis of depression:**\n\n- **Ask about:**\n  - The onset, duration, pattern, and severity of [symptoms](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/diagnosis\/), including impact on daily functioning at work, on carer role(s), and on relationships including any safeguarding concerns for children or vulnerable adults in their care. See the CKS topic on [Child maltreatment - recognition and management](https:\/\/cks.nice.org.uk\/topics\/child-maltreatment-recognition-management\/) for more information.\n  - Current lifestyle including diet, physical activity, sleep; gambling, alcohol and\/or substance misuse. See the CKS topics on [Alcohol - problem drinking](https:\/\/cks.nice.org.uk\/topics\/alcohol-problem-drinking\/) and [Insomnia](https:\/\/cks.nice.org.uk\/topics\/insomnia\/) for more information.\n  - Any past history of depression and\/or episodes of self-harm. See the CKS topic on [Self-harm](https:\/\/cks.nice.org.uk\/topics\/self-harm\/) for more information.\n  - Any current symptoms or past history of coexisting mental health conditions, including mood elevation or psychotic symptoms suggesting bipolar disorder or psychotic depression, psychosis, anxiety, post-traumatic stress disorder (PTSD), or eating disorders. See the CKS topics on [Bipolar disorder](https:\/\/cks.nice.org.uk\/topics\/bipolar-disorder\/), [Eating disorders](https:\/\/cks.nice.org.uk\/topics\/eating-disorders\/), [Generalized anxiety disorder](https:\/\/cks.nice.org.uk\/topics\/generalized-anxiety-disorder\/), [Post-traumatic stress disorder](https:\/\/cks.nice.org.uk\/topics\/post-traumatic-stress-disorder\/), and [Psychosis and schizophrenia](https:\/\/cks.nice.org.uk\/topics\/psychosis-schizophrenia\/) for more information.\n  - Any learning disability or acquired cognitive impairment including dementia, traumatic brain injury, or Parkinson's disease. See the CKS topics on [Dementia](https:\/\/cks.nice.org.uk\/topics\/dementia\/), [Head injury](https:\/\/cks.nice.org.uk\/topics\/head-injury\/), [Learning disabilities](https:\/\/cks.nice.org.uk\/topics\/learning-disabilities\/), and [Parkinson's disease](https:\/\/cks.nice.org.uk\/topics\/parkinsons-disease\/) for more information.\n  - Any [risk factors](https:\/\/cks.nice.org.uk\/topics\/depression\/background-information\/risk-factors\/) for depression including family history of depression, suicide, or self-harm; chronic physical health conditions; history of domestic violence.\n  - Current or previous supportive relationships including partner, other family, friends, carers; and support from any other statutory or voluntary organisations.\n  - Any recent or past stressful or traumatic life events, including difficult interpersonal relationships or relationship breakdown including divorce; job stress or redundancy; debt or financial difficulties; bereavement or other trauma; housing and living conditions; immigration status; social isolation.\n  - Any current or previous forensic history.\n  - Current medication, any previous treatments for depression, symptom response and any adverse effects.\n  - Always ask about any thoughts, ideas, plans, or intent to self-harm or commit suicide, and any protective factors.\n  - If there is a risk of self-harm or suicide:\n    - Assess the person's level of social support and awareness of sources of help.\n    - Arrange help appropriate to their level of need\n    - Advise the person to seek further help if their situation deteriorates.\n    - See the CKS topic on [Self-harm](https:\/\/cks.nice.org.uk\/topics\/self-harm\/) for more information.\n- **Consider using a validated depression questionnaire** to assess for depression, severity of symptoms, functioning, and response to treatment.\n  - See the section on [Depression questionnaires](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/#depression-questionnaires) for more information.\n- **Assess the person's mental state and cognitive function.**\n- **Consider performing a physical examination including neurological examination and arranging additional investigations,** depending on clinical judgement, particularly if a coexisting condition or alternative cause for symptoms is suspected.\n  - See the section on [Differential diagnosis](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/differential-diagnosis\/) for more information on possible alternative causes for symptoms.\n\n### Depression questionnaires\n- **Depression questionnaires which are validated for use in primary care include:**\n  - **PHQ-9 (Patient Health Questionnaire-9)**\n    - A nine-item, self-administered scale, which reflects the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria.\n    - It classifies current symptoms on a scale of 0 (not at all) to 3 (nearly every day) — the maximum score is 27.\n    - It can be downloaded free of charge from [www.phqscreeners.com](https:\/\/www.phqscreeners.com\/select-screener).\n  - **HADS (Hospital Anxiety and Depression Scale)**\n    - A self-administered scale, with 14 questions in total (seven covering depression and seven covering anxiety).\n    - The maximum score for each subscale is 21.\n    - Scores of 8–10, 11–14, and 15–21 represent cut-off points for mild, moderate, and severe depression respectively.\n    - A paper version is available to purchase from <https:\/\/www.gl-assessment.co.uk\/products\/hospital-anxiety-and-depression-scale-hads\/>.\n  - **BDI-II (Beck Depression Inventory-II)**\n    - A 21-item, self-administered scale that uses DSM-5 criteria.\n    - Each question is rated from 0 to 3 — the maximum score is 63.\n    - Scores of 14–19, 20–28, and 29–63 can be interpreted as mild, moderate, and severe depression respectively.\n    - It is available to purchase from [www.pearsonassessments.com](http:\/\/www.pearsonassessments.com\/).\n- In people who have concerns about gambling the NHS gambling questionnaire may be helpful <https:\/\/www.nhs.uk\/live-well\/addiction-support\/gambling-addiction\/>.\n\n### Basis for recommendation\nThe recommendations for assessment are based on the National Institute for Health and Care Excellence (NICE) guidelines *Depression in adults: treatment and management* \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], the NICE guideline *Gambling-related harms: identification, assessment and management* \\[[NICE, 2025](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\] the British Association for Psychopharmacology (BAP) guidelines *Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines* \\[[Cleare, 2015](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], and expert opinion in review articles on depression \\[[Malhi, 2018](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/); [Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n\n#### Clinical features on history-taking\n- These recommendations are based on the NICE guideline \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], the BAP guidelines \\[[Cleare, 2015](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], expert opinion in review articles \\[[Malhi, 2018](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/); [Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], and are also pragmatic, based on what CKS considers to be good clinical practice.\n  - The BAP guidelines note that the use of antidepressants in people with undiagnosed bipolar disorder can trigger hypomania\/mania.\n#### Using a validated depression questionnaire\n- This recommendation is based on the NICE guideline \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\] and expert opinion in review articles \\[[Malhi, 2018](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/); [Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n  - The NICE guideline notes that a validated questionnaire can help to assess symptoms, functioning, impairment, and evaluate treatment.\n#### Assessing mental state and cognitive function\n- This recommendation is based on the NICE guideline \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\] and expert opinion in a review article \\[[Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n  - Cognitive testing can help to assess for coexisting or alternative conditions that may present with depressive symptoms, including neurological conditions and dementia \\[[Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n#### Performing a physical examination and arranging additional investigations\n- This recommendation is based on expert opinion in a review article \\[[Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\]. It is also pragmatic, based on what CKS considers to be good clinical practice.\n\nThe content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of [Clarity Informatics Limited (trading as Agilio Software Primary Care)](https:\/\/agiliosoftware.com\/primary-care\/). By using CKS, you agree to the licence set out in the [CKS End User Licence Agreement](https:\/\/www.nice.org.uk\/terms-and-conditions\/cks-end-user-licence-agreement).\n\n[Back to top](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/#top)\n\n- [Guidance](https:\/\/www.nice.org.uk\/guidance)\n- [Standards and indicators](https:\/\/www.nice.org.uk\/standards-and-indicators)\n- [Clinical Knowledge Summaries (CKS) Clinical Knowledge SummariesClinical Knowledge Summaries](https:\/\/cks.nice.org.uk\/)\n- [British National Formulary (BNF) British National FormularyBritish National Formulary](https:\/\/bnf.nice.org.uk\/)\n- [BNF for Children (BNFC) British National Formulary for ChildrenBritish National Formulary for Children](https:\/\/bnfc.nice.org.uk\/)\n- [Life sciences](https:\/\/www.nice.org.uk\/about\/what-we-do\/life-sciences)\n- [Library and knowledge services](https:\/\/www.nice.org.uk\/library-and-knowledge-services)\n\n- [What NICE does](https:\/\/www.nice.org.uk\/what-nice-does)\n- [Implementing NICE guidance](https:\/\/www.nice.org.uk\/implementing-nice-guidance)\n- [Get involved](https:\/\/www.nice.org.uk\/get-involved)\n- [About us](https:\/\/www.nice.org.uk\/about-us)\n- [Careers](https:\/\/www.nice.org.uk\/careers)\n- [News, blogs and podcasts](https:\/\/www.nice.org.uk\/news)\n- [Newsletters and alerts](https:\/\/www.nice.org.uk\/nice-newsletters-and-alerts)\n- [Contact us](https:\/\/www.nice.org.uk\/contact-us)\n- [Leave feedback](https:\/\/www.nice.org.uk\/forms\/leave-feedback)\n- [Reusing our content](https:\/\/www.nice.org.uk\/reusing-our-content)\n- [NICE UK Open Content Licence](https:\/\/www.nice.org.uk\/forms\/use-of-nice-content-in-the-uk)\n- [Syndicate our content](https:\/\/www.nice.org.uk\/about\/what-we-do\/nice-syndication-api)\n- [Events](https:\/\/www.nice.org.uk\/events)\n\n- [Facebook](https:\/\/en-gb.facebook.com\/NationalInstituteforHealthandCareExcellence\/)\n- [X](https:\/\/x.com\/NICEcomms)\n- [YouTube](https:\/\/www.youtube.com\/user\/NICEmedia)\n- [LinkedIn](https:\/\/www.linkedin.com\/company\/national-institute-for-health-and-clinical-excellence)\n\n- [Accessibility](https:\/\/www.nice.org.uk\/accessibility)\n- [Freedom of information](https:\/\/www.nice.org.uk\/freedom-of-information)\n- [Glossary](https:\/\/www.nice.org.uk\/glossary)\n- [Terms and conditions](https:\/\/www.nice.org.uk\/terms-and-conditions)\n- [Privacy notice](https:\/\/www.nice.org.uk\/privacy-notice)\n- [Cookies](https:\/\/www.nice.org.uk\/cookies)\n\n© NICE 2026. All rights reserved. Subject to [Notice of rights](https:\/\/www.nice.org.uk\/terms-and-conditions#notice-of-rights).","attrs_readable_markdown":"**If a person has a **[suspected](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/diagnosis\/)** diagnosis of depression:**\n\n- **Ask about:**\n  - The onset, duration, pattern, and severity of [symptoms](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/diagnosis\/), including impact on daily functioning at work, on carer role(s), and on relationships including any safeguarding concerns for children or vulnerable adults in their care. See the CKS topic on [Child maltreatment - recognition and management](https:\/\/cks.nice.org.uk\/topics\/child-maltreatment-recognition-management\/) for more information.\n  - Current lifestyle including diet, physical activity, sleep; gambling, alcohol and\/or substance misuse. See the CKS topics on [Alcohol - problem drinking](https:\/\/cks.nice.org.uk\/topics\/alcohol-problem-drinking\/) and [Insomnia](https:\/\/cks.nice.org.uk\/topics\/insomnia\/) for more information.\n  - Any past history of depression and\/or episodes of self-harm. See the CKS topic on [Self-harm](https:\/\/cks.nice.org.uk\/topics\/self-harm\/) for more information.\n  - Any current symptoms or past history of coexisting mental health conditions, including mood elevation or psychotic symptoms suggesting bipolar disorder or psychotic depression, psychosis, anxiety, post-traumatic stress disorder (PTSD), or eating disorders. See the CKS topics on [Bipolar disorder](https:\/\/cks.nice.org.uk\/topics\/bipolar-disorder\/), [Eating disorders](https:\/\/cks.nice.org.uk\/topics\/eating-disorders\/), [Generalized anxiety disorder](https:\/\/cks.nice.org.uk\/topics\/generalized-anxiety-disorder\/), [Post-traumatic stress disorder](https:\/\/cks.nice.org.uk\/topics\/post-traumatic-stress-disorder\/), and [Psychosis and schizophrenia](https:\/\/cks.nice.org.uk\/topics\/psychosis-schizophrenia\/) for more information.\n  - Any learning disability or acquired cognitive impairment including dementia, traumatic brain injury, or Parkinson's disease. See the CKS topics on [Dementia](https:\/\/cks.nice.org.uk\/topics\/dementia\/), [Head injury](https:\/\/cks.nice.org.uk\/topics\/head-injury\/), [Learning disabilities](https:\/\/cks.nice.org.uk\/topics\/learning-disabilities\/), and [Parkinson's disease](https:\/\/cks.nice.org.uk\/topics\/parkinsons-disease\/) for more information.\n  - Any [risk factors](https:\/\/cks.nice.org.uk\/topics\/depression\/background-information\/risk-factors\/) for depression including family history of depression, suicide, or self-harm; chronic physical health conditions; history of domestic violence.\n  - Current or previous supportive relationships including partner, other family, friends, carers; and support from any other statutory or voluntary organisations.\n  - Any recent or past stressful or traumatic life events, including difficult interpersonal relationships or relationship breakdown including divorce; job stress or redundancy; debt or financial difficulties; bereavement or other trauma; housing and living conditions; immigration status; social isolation.\n  - Any current or previous forensic history.\n  - Current medication, any previous treatments for depression, symptom response and any adverse effects.\n  - Always ask about any thoughts, ideas, plans, or intent to self-harm or commit suicide, and any protective factors.\n  - If there is a risk of self-harm or suicide:\n    - Assess the person's level of social support and awareness of sources of help.\n    - Arrange help appropriate to their level of need\n    - Advise the person to seek further help if their situation deteriorates.\n    - See the CKS topic on [Self-harm](https:\/\/cks.nice.org.uk\/topics\/self-harm\/) for more information.\n- **Consider using a validated depression questionnaire** to assess for depression, severity of symptoms, functioning, and response to treatment.\n  - See the section on [Depression questionnaires](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/assessment\/#depression-questionnaires) for more information.\n- **Assess the person's mental state and cognitive function.**\n- **Consider performing a physical examination including neurological examination and arranging additional investigations,** depending on clinical judgement, particularly if a coexisting condition or alternative cause for symptoms is suspected.\n  - See the section on [Differential diagnosis](https:\/\/cks.nice.org.uk\/topics\/depression\/diagnosis\/differential-diagnosis\/) for more information on possible alternative causes for symptoms.\n\n### Depression questionnaires\n- **Depression questionnaires which are validated for use in primary care include:**\n  - **PHQ-9 (Patient Health Questionnaire-9)**\n    - A nine-item, self-administered scale, which reflects the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria.\n    - It classifies current symptoms on a scale of 0 (not at all) to 3 (nearly every day) — the maximum score is 27.\n    - It can be downloaded free of charge from [www.phqscreeners.com](https:\/\/www.phqscreeners.com\/select-screener).\n  - **HADS (Hospital Anxiety and Depression Scale)**\n    - A self-administered scale, with 14 questions in total (seven covering depression and seven covering anxiety).\n    - The maximum score for each subscale is 21.\n    - Scores of 8–10, 11–14, and 15–21 represent cut-off points for mild, moderate, and severe depression respectively.\n    - A paper version is available to purchase from <https:\/\/www.gl-assessment.co.uk\/products\/hospital-anxiety-and-depression-scale-hads\/>.\n  - **BDI-II (Beck Depression Inventory-II)**\n    - A 21-item, self-administered scale that uses DSM-5 criteria.\n    - Each question is rated from 0 to 3 — the maximum score is 63.\n    - Scores of 14–19, 20–28, and 29–63 can be interpreted as mild, moderate, and severe depression respectively.\n    - It is available to purchase from [www.pearsonassessments.com](http:\/\/www.pearsonassessments.com\/).\n- In people who have concerns about gambling the NHS gambling questionnaire may be helpful <https:\/\/www.nhs.uk\/live-well\/addiction-support\/gambling-addiction\/>.\n\n### Basis for recommendation\nThe recommendations for assessment are based on the National Institute for Health and Care Excellence (NICE) guidelines *Depression in adults: treatment and management* \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], the NICE guideline *Gambling-related harms: identification, assessment and management* \\[[NICE, 2025](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\] the British Association for Psychopharmacology (BAP) guidelines *Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines* \\[[Cleare, 2015](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], and expert opinion in review articles on depression \\[[Malhi, 2018](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/); [Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n\n#### Clinical features on history-taking\n- These recommendations are based on the NICE guideline \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], the BAP guidelines \\[[Cleare, 2015](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], expert opinion in review articles \\[[Malhi, 2018](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/); [Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\], and are also pragmatic, based on what CKS considers to be good clinical practice.\n  - The BAP guidelines note that the use of antidepressants in people with undiagnosed bipolar disorder can trigger hypomania\/mania.\n#### Using a validated depression questionnaire\n- This recommendation is based on the NICE guideline \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\] and expert opinion in review articles \\[[Malhi, 2018](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/); [Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n  - The NICE guideline notes that a validated questionnaire can help to assess symptoms, functioning, impairment, and evaluate treatment.\n#### Assessing mental state and cognitive function\n- This recommendation is based on the NICE guideline \\[[NICE, 2022b](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\] and expert opinion in a review article \\[[Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n  - Cognitive testing can help to assess for coexisting or alternative conditions that may present with depressive symptoms, including neurological conditions and dementia \\[[Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\].\n#### Performing a physical examination and arranging additional investigations\n- This recommendation is based on expert opinion in a review article \\[[Ferenchick, 2019](https:\/\/cks.nice.org.uk\/topics\/depression\/references\/)\\]. It is also pragmatic, based on what CKS considers to be good clinical practice.","meta_canonical":null}

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URL	https://cks.nice.org.uk/topics/depression/diagnosis/assessment/
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Meta Title	Assessment \| Diagnosis \| Depression \| CKS \| NICE
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Boilerpipe Text	If a person has a suspected diagnosis of depression: Ask about: The onset, duration, pattern, and severity of symptoms , including impact on daily functioning at work, on carer role(s), and on relationships including any safeguarding concerns for children or vulnerable adults in their care. See the CKS topic on Child maltreatment - recognition and management for more information. Current lifestyle including diet, physical activity, sleep; gambling, alcohol and/or substance misuse. See the CKS topics on Alcohol - problem drinking and Insomnia for more information. Any past history of depression and/or episodes of self-harm. See the CKS topic on Self-harm for more information. Any current symptoms or past history of coexisting mental health conditions, including mood elevation or psychotic symptoms suggesting bipolar disorder or psychotic depression, psychosis, anxiety, post-traumatic stress disorder (PTSD), or eating disorders. See the CKS topics on Bipolar disorder , Eating disorders , Generalized anxiety disorder , Post-traumatic stress disorder , and Psychosis and schizophrenia for more information. Any learning disability or acquired cognitive impairment including dementia, traumatic brain injury, or Parkinson's disease. See the CKS topics on Dementia , Head injury , Learning disabilities , and Parkinson's disease for more information. Any risk factors for depression including family history of depression, suicide, or self-harm; chronic physical health conditions; history of domestic violence. Current or previous supportive relationships including partner, other family, friends, carers; and support from any other statutory or voluntary organisations. Any recent or past stressful or traumatic life events, including difficult interpersonal relationships or relationship breakdown including divorce; job stress or redundancy; debt or financial difficulties; bereavement or other trauma; housing and living conditions; immigration status; social isolation. Any current or previous forensic history. Current medication, any previous treatments for depression, symptom response and any adverse effects. Always ask about any thoughts, ideas, plans, or intent to self-harm or commit suicide, and any protective factors. If there is a risk of self-harm or suicide: Assess the person's level of social support and awareness of sources of help. Arrange help appropriate to their level of need Advise the person to seek further help if their situation deteriorates. See the CKS topic on Self-harm for more information. Consider using a validated depression questionnaire to assess for depression, severity of symptoms, functioning, and response to treatment. See the section on Depression questionnaires for more information. Assess the person's mental state and cognitive function. Consider performing a physical examination including neurological examination and arranging additional investigations, depending on clinical judgement, particularly if a coexisting condition or alternative cause for symptoms is suspected. See the section on Differential diagnosis for more information on possible alternative causes for symptoms. Depression questionnaires Depression questionnaires which are validated for use in primary care include: PHQ-9 (Patient Health Questionnaire-9) A nine-item, self-administered scale, which reflects the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria. It classifies current symptoms on a scale of 0 (not at all) to 3 (nearly every day) — the maximum score is 27. It can be downloaded free of charge from www.phqscreeners.com . HADS (Hospital Anxiety and Depression Scale) A self-administered scale, with 14 questions in total (seven covering depression and seven covering anxiety). The maximum score for each subscale is 21. Scores of 8–10, 11–14, and 15–21 represent cut-off points for mild, moderate, and severe depression respectively. A paper version is available to purchase from https://www.gl-assessment.co.uk/products/hospital-anxiety-and-depression-scale-hads/ . BDI-II (Beck Depression Inventory-II) A 21-item, self-administered scale that uses DSM-5 criteria. Each question is rated from 0 to 3 — the maximum score is 63. Scores of 14–19, 20–28, and 29–63 can be interpreted as mild, moderate, and severe depression respectively. It is available to purchase from www.pearsonassessments.com . In people who have concerns about gambling the NHS gambling questionnaire may be helpful https://www.nhs.uk/live-well/addiction-support/gambling-addiction/ . Basis for recommendation The recommendations for assessment are based on the National Institute for Health and Care Excellence (NICE) guidelines Depression in adults: treatment and management [ NICE, 2022b ], the NICE guideline Gambling-related harms: identification, assessment and management [ NICE, 2025 ] the British Association for Psychopharmacology (BAP) guidelines Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines [ Cleare, 2015 ], and expert opinion in review articles on depression [ Malhi, 2018 ; Ferenchick, 2019 ]. Clinical features on history-taking These recommendations are based on the NICE guideline [ NICE, 2022b ], the BAP guidelines [ Cleare, 2015 ], expert opinion in review articles [ Malhi, 2018 ; Ferenchick, 2019 ], and are also pragmatic, based on what CKS considers to be good clinical practice. The BAP guidelines note that the use of antidepressants in people with undiagnosed bipolar disorder can trigger hypomania/mania. Using a validated depression questionnaire This recommendation is based on the NICE guideline [ NICE, 2022b ] and expert opinion in review articles [ Malhi, 2018 ; Ferenchick, 2019 ]. The NICE guideline notes that a validated questionnaire can help to assess symptoms, functioning, impairment, and evaluate treatment. Assessing mental state and cognitive function This recommendation is based on the NICE guideline [ NICE, 2022b ] and expert opinion in a review article [ Ferenchick, 2019 ]. Cognitive testing can help to assess for coexisting or alternative conditions that may present with depressive symptoms, including neurological conditions and dementia [ Ferenchick, 2019 ]. Performing a physical examination and arranging additional investigations This recommendation is based on expert opinion in a review article [ Ferenchick, 2019 ]. It is also pragmatic, based on what CKS considers to be good clinical practice.
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[NICE](https://www.nice.org.uk/) 2. [CKS](https://cks.nice.org.uk/) 3. [Health topics A to Z](https://cks.nice.org.uk/topics/) 4. [Depression](https://cks.nice.org.uk/topics/depression/) 5. [Diagnosis](https://cks.nice.org.uk/topics/depression/diagnosis/) 6. Assessment # Depression: How should I assess a person with suspected depression? Last revised in April 2025 Print this page Assessment - [Summary](https://cks.nice.org.uk/topics/depression/) - [Have I got the right topic?](https://cks.nice.org.uk/topics/depression/have-i-got-the-right-topic/) - [How up-to-date is this topic?](https://cks.nice.org.uk/topics/depression/how-up-to-date-is-this-topic/) - [Goals and outcome measures](https://cks.nice.org.uk/topics/depression/goals-outcome-measures/) - [Background information](https://cks.nice.org.uk/topics/depression/background-information/) - [Diagnosis](https://cks.nice.org.uk/topics/depression/diagnosis/) - [Diagnosis](https://cks.nice.org.uk/topics/depression/diagnosis/diagnosis/) - [Assessment](https://cks.nice.org.uk/topics/depression/diagnosis/assessment/) - [Differential diagnosis](https://cks.nice.org.uk/topics/depression/diagnosis/differential-diagnosis/) - [Management](https://cks.nice.org.uk/topics/depression/management/) - [Prescribing information](https://cks.nice.org.uk/topics/depression/prescribing-information/) - [Supporting evidence](https://cks.nice.org.uk/topics/depression/supporting-evidence/) - [How this topic was developed](https://cks.nice.org.uk/topics/depression/how-this-topic-was-developed/) - [References](https://cks.nice.org.uk/topics/depression/references/) ## On this page 1. [Depression questionnaires](https://cks.nice.org.uk/topics/depression/diagnosis/assessment/#depression-questionnaires) 2. [Basis for recommendation](https://cks.nice.org.uk/topics/depression/diagnosis/assessment/#basis-for-recommendation-0e7) ## How should I assess a person with suspected depression? If a person has a [suspected](https://cks.nice.org.uk/topics/depression/diagnosis/diagnosis/) diagnosis of depression: - Ask about: - The onset, duration, pattern, and severity of [symptoms](https://cks.nice.org.uk/topics/depression/diagnosis/diagnosis/), including impact on daily functioning at work, on carer role(s), and on relationships including any safeguarding concerns for children or vulnerable adults in their care. See the CKS topic on [Child maltreatment - recognition and management](https://cks.nice.org.uk/topics/child-maltreatment-recognition-management/) for more information. - Current lifestyle including diet, physical activity, sleep; gambling, alcohol and/or substance misuse. See the CKS topics on [Alcohol - problem drinking](https://cks.nice.org.uk/topics/alcohol-problem-drinking/) and [Insomnia](https://cks.nice.org.uk/topics/insomnia/) for more information. - Any past history of depression and/or episodes of self-harm. See the CKS topic on [Self-harm](https://cks.nice.org.uk/topics/self-harm/) for more information. - Any current symptoms or past history of coexisting mental health conditions, including mood elevation or psychotic symptoms suggesting bipolar disorder or psychotic depression, psychosis, anxiety, post-traumatic stress disorder (PTSD), or eating disorders. See the CKS topics on [Bipolar disorder](https://cks.nice.org.uk/topics/bipolar-disorder/), [Eating disorders](https://cks.nice.org.uk/topics/eating-disorders/), [Generalized anxiety disorder](https://cks.nice.org.uk/topics/generalized-anxiety-disorder/), [Post-traumatic stress disorder](https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/), and [Psychosis and schizophrenia](https://cks.nice.org.uk/topics/psychosis-schizophrenia/) for more information. - Any learning disability or acquired cognitive impairment including dementia, traumatic brain injury, or Parkinson's disease. See the CKS topics on [Dementia](https://cks.nice.org.uk/topics/dementia/), [Head injury](https://cks.nice.org.uk/topics/head-injury/), [Learning disabilities](https://cks.nice.org.uk/topics/learning-disabilities/), and [Parkinson's disease](https://cks.nice.org.uk/topics/parkinsons-disease/) for more information. - Any [risk factors](https://cks.nice.org.uk/topics/depression/background-information/risk-factors/) for depression including family history of depression, suicide, or self-harm; chronic physical health conditions; history of domestic violence. - Current or previous supportive relationships including partner, other family, friends, carers; and support from any other statutory or voluntary organisations. - Any recent or past stressful or traumatic life events, including difficult interpersonal relationships or relationship breakdown including divorce; job stress or redundancy; debt or financial difficulties; bereavement or other trauma; housing and living conditions; immigration status; social isolation. - Any current or previous forensic history. - Current medication, any previous treatments for depression, symptom response and any adverse effects. - Always ask about any thoughts, ideas, plans, or intent to self-harm or commit suicide, and any protective factors. - If there is a risk of self-harm or suicide: - Assess the person's level of social support and awareness of sources of help. - Arrange help appropriate to their level of need - Advise the person to seek further help if their situation deteriorates. - See the CKS topic on [Self-harm](https://cks.nice.org.uk/topics/self-harm/) for more information. - Consider using a validated depression questionnaire to assess for depression, severity of symptoms, functioning, and response to treatment. - See the section on [Depression questionnaires](https://cks.nice.org.uk/topics/depression/diagnosis/assessment/#depression-questionnaires) for more information. - Assess the person's mental state and cognitive function. - Consider performing a physical examination including neurological examination and arranging additional investigations, depending on clinical judgement, particularly if a coexisting condition or alternative cause for symptoms is suspected. - See the section on [Differential diagnosis](https://cks.nice.org.uk/topics/depression/diagnosis/differential-diagnosis/) for more information on possible alternative causes for symptoms. ### Depression questionnaires - Depression questionnaires which are validated for use in primary care include: - PHQ-9 (Patient Health Questionnaire-9) - A nine-item, self-administered scale, which reflects the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria. - It classifies current symptoms on a scale of 0 (not at all) to 3 (nearly every day) — the maximum score is 27. - It can be downloaded free of charge from [www.phqscreeners.com](https://www.phqscreeners.com/select-screener). - HADS (Hospital Anxiety and Depression Scale) - A self-administered scale, with 14 questions in total (seven covering depression and seven covering anxiety). - The maximum score for each subscale is 21. - Scores of 8–10, 11–14, and 15–21 represent cut-off points for mild, moderate, and severe depression respectively. - A paper version is available to purchase from <https://www.gl-assessment.co.uk/products/hospital-anxiety-and-depression-scale-hads/>. - BDI-II (Beck Depression Inventory-II)** - A 21-item, self-administered scale that uses DSM-5 criteria. - Each question is rated from 0 to 3 — the maximum score is 63. - Scores of 14–19, 20–28, and 29–63 can be interpreted as mild, moderate, and severe depression respectively. - It is available to purchase from [www.pearsonassessments.com](http://www.pearsonassessments.com/). - In people who have concerns about gambling the NHS gambling questionnaire may be helpful <https://www.nhs.uk/live-well/addiction-support/gambling-addiction/>. ### Basis for recommendation The recommendations for assessment are based on the National Institute for Health and Care Excellence (NICE) guidelines Depression in adults: treatment and management \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\], the NICE guideline Gambling-related harms: identification, assessment and management \[[NICE, 2025](https://cks.nice.org.uk/topics/depression/references/)\] the British Association for Psychopharmacology (BAP) guidelines Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines \[[Cleare, 2015](https://cks.nice.org.uk/topics/depression/references/)\], and expert opinion in review articles on depression \[[Malhi, 2018](https://cks.nice.org.uk/topics/depression/references/); [Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. #### Clinical features on history-taking - These recommendations are based on the NICE guideline \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\], the BAP guidelines \[[Cleare, 2015](https://cks.nice.org.uk/topics/depression/references/)\], expert opinion in review articles \[[Malhi, 2018](https://cks.nice.org.uk/topics/depression/references/); [Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\], and are also pragmatic, based on what CKS considers to be good clinical practice. - The BAP guidelines note that the use of antidepressants in people with undiagnosed bipolar disorder can trigger hypomania/mania. #### Using a validated depression questionnaire - This recommendation is based on the NICE guideline \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\] and expert opinion in review articles \[[Malhi, 2018](https://cks.nice.org.uk/topics/depression/references/); [Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. - The NICE guideline notes that a validated questionnaire can help to assess symptoms, functioning, impairment, and evaluate treatment. #### Assessing mental state and cognitive function - This recommendation is based on the NICE guideline \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\] and expert opinion in a review article \[[Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. - Cognitive testing can help to assess for coexisting or alternative conditions that may present with depressive symptoms, including neurological conditions and dementia \[[Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. #### Performing a physical examination and arranging additional investigations - This recommendation is based on expert opinion in a review article \[[Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. It is also pragmatic, based on what CKS considers to be good clinical practice. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of [Clarity Informatics Limited (trading as Agilio Software Primary Care)](https://agiliosoftware.com/primary-care/). By using CKS, you agree to the licence set out in the [CKS End User Licence Agreement](https://www.nice.org.uk/terms-and-conditions/cks-end-user-licence-agreement). 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All rights reserved. Subject to [Notice of rights](https://www.nice.org.uk/terms-and-conditions#notice-of-rights).
Readable Markdown	If a person has a [suspected](https://cks.nice.org.uk/topics/depression/diagnosis/diagnosis/) diagnosis of depression: - Ask about: - The onset, duration, pattern, and severity of [symptoms](https://cks.nice.org.uk/topics/depression/diagnosis/diagnosis/), including impact on daily functioning at work, on carer role(s), and on relationships including any safeguarding concerns for children or vulnerable adults in their care. See the CKS topic on [Child maltreatment - recognition and management](https://cks.nice.org.uk/topics/child-maltreatment-recognition-management/) for more information. - Current lifestyle including diet, physical activity, sleep; gambling, alcohol and/or substance misuse. See the CKS topics on [Alcohol - problem drinking](https://cks.nice.org.uk/topics/alcohol-problem-drinking/) and [Insomnia](https://cks.nice.org.uk/topics/insomnia/) for more information. - Any past history of depression and/or episodes of self-harm. See the CKS topic on [Self-harm](https://cks.nice.org.uk/topics/self-harm/) for more information. - Any current symptoms or past history of coexisting mental health conditions, including mood elevation or psychotic symptoms suggesting bipolar disorder or psychotic depression, psychosis, anxiety, post-traumatic stress disorder (PTSD), or eating disorders. See the CKS topics on [Bipolar disorder](https://cks.nice.org.uk/topics/bipolar-disorder/), [Eating disorders](https://cks.nice.org.uk/topics/eating-disorders/), [Generalized anxiety disorder](https://cks.nice.org.uk/topics/generalized-anxiety-disorder/), [Post-traumatic stress disorder](https://cks.nice.org.uk/topics/post-traumatic-stress-disorder/), and [Psychosis and schizophrenia](https://cks.nice.org.uk/topics/psychosis-schizophrenia/) for more information. - Any learning disability or acquired cognitive impairment including dementia, traumatic brain injury, or Parkinson's disease. See the CKS topics on [Dementia](https://cks.nice.org.uk/topics/dementia/), [Head injury](https://cks.nice.org.uk/topics/head-injury/), [Learning disabilities](https://cks.nice.org.uk/topics/learning-disabilities/), and [Parkinson's disease](https://cks.nice.org.uk/topics/parkinsons-disease/) for more information. - Any [risk factors](https://cks.nice.org.uk/topics/depression/background-information/risk-factors/) for depression including family history of depression, suicide, or self-harm; chronic physical health conditions; history of domestic violence. - Current or previous supportive relationships including partner, other family, friends, carers; and support from any other statutory or voluntary organisations. - Any recent or past stressful or traumatic life events, including difficult interpersonal relationships or relationship breakdown including divorce; job stress or redundancy; debt or financial difficulties; bereavement or other trauma; housing and living conditions; immigration status; social isolation. - Any current or previous forensic history. - Current medication, any previous treatments for depression, symptom response and any adverse effects. - Always ask about any thoughts, ideas, plans, or intent to self-harm or commit suicide, and any protective factors. - If there is a risk of self-harm or suicide: - Assess the person's level of social support and awareness of sources of help. - Arrange help appropriate to their level of need - Advise the person to seek further help if their situation deteriorates. - See the CKS topic on [Self-harm](https://cks.nice.org.uk/topics/self-harm/) for more information. - Consider using a validated depression questionnaire to assess for depression, severity of symptoms, functioning, and response to treatment. - See the section on [Depression questionnaires](https://cks.nice.org.uk/topics/depression/diagnosis/assessment/#depression-questionnaires) for more information. - Assess the person's mental state and cognitive function. - Consider performing a physical examination including neurological examination and arranging additional investigations, depending on clinical judgement, particularly if a coexisting condition or alternative cause for symptoms is suspected. - See the section on [Differential diagnosis](https://cks.nice.org.uk/topics/depression/diagnosis/differential-diagnosis/) for more information on possible alternative causes for symptoms. ### Depression questionnaires - Depression questionnaires which are validated for use in primary care include: - PHQ-9 (Patient Health Questionnaire-9) - A nine-item, self-administered scale, which reflects the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria. - It classifies current symptoms on a scale of 0 (not at all) to 3 (nearly every day) — the maximum score is 27. - It can be downloaded free of charge from [www.phqscreeners.com](https://www.phqscreeners.com/select-screener). - HADS (Hospital Anxiety and Depression Scale) - A self-administered scale, with 14 questions in total (seven covering depression and seven covering anxiety). - The maximum score for each subscale is 21. - Scores of 8–10, 11–14, and 15–21 represent cut-off points for mild, moderate, and severe depression respectively. - A paper version is available to purchase from <https://www.gl-assessment.co.uk/products/hospital-anxiety-and-depression-scale-hads/>. - BDI-II (Beck Depression Inventory-II) - A 21-item, self-administered scale that uses DSM-5 criteria. - Each question is rated from 0 to 3 — the maximum score is 63. - Scores of 14–19, 20–28, and 29–63 can be interpreted as mild, moderate, and severe depression respectively. - It is available to purchase from [www.pearsonassessments.com](http://www.pearsonassessments.com/). - In people who have concerns about gambling the NHS gambling questionnaire may be helpful <https://www.nhs.uk/live-well/addiction-support/gambling-addiction/>. ### Basis for recommendation The recommendations for assessment are based on the National Institute for Health and Care Excellence (NICE) guidelines Depression in adults: treatment and management \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\], the NICE guideline Gambling-related harms: identification, assessment and management \[[NICE, 2025](https://cks.nice.org.uk/topics/depression/references/)\] the British Association for Psychopharmacology (BAP) guidelines Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines \[[Cleare, 2015](https://cks.nice.org.uk/topics/depression/references/)\], and expert opinion in review articles on depression \[[Malhi, 2018](https://cks.nice.org.uk/topics/depression/references/); [Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. #### Clinical features on history-taking - These recommendations are based on the NICE guideline \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\], the BAP guidelines \[[Cleare, 2015](https://cks.nice.org.uk/topics/depression/references/)\], expert opinion in review articles \[[Malhi, 2018](https://cks.nice.org.uk/topics/depression/references/); [Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\], and are also pragmatic, based on what CKS considers to be good clinical practice. - The BAP guidelines note that the use of antidepressants in people with undiagnosed bipolar disorder can trigger hypomania/mania. #### Using a validated depression questionnaire - This recommendation is based on the NICE guideline \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\] and expert opinion in review articles \[[Malhi, 2018](https://cks.nice.org.uk/topics/depression/references/); [Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. - The NICE guideline notes that a validated questionnaire can help to assess symptoms, functioning, impairment, and evaluate treatment. #### Assessing mental state and cognitive function - This recommendation is based on the NICE guideline \[[NICE, 2022b](https://cks.nice.org.uk/topics/depression/references/)\] and expert opinion in a review article \[[Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. - Cognitive testing can help to assess for coexisting or alternative conditions that may present with depressive symptoms, including neurological conditions and dementia \[[Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. #### Performing a physical examination and arranging additional investigations - This recommendation is based on expert opinion in a review article \[[Ferenchick, 2019](https://cks.nice.org.uk/topics/depression/references/)\]. It is also pragmatic, based on what CKS considers to be good clinical practice.
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