How Mental Health Clinics Assess Depression Severity

We all have a few days or weeks when we simply feel a bit off. You tell yourself that it’s simply a rough patch – only it’s one in which your sleep is becoming worse, your everyday tasks are becoming tiresome, and you’re losing interest in your hobbies and relationships. If someone asks, you simply say that you’re fine and move on without further elaboration.

But ask yourself: If so much is happening in your life, is this really just a rough patch or something else? Something that may, in fact, warrant a check-in with a mental health clinic? To be honest, you don’t need to answer the first question yourself, as most clinics these days have a rather structured way of working out if you’re facing some mental health condition at the moment. As for how they do it, let’s go a little deeper to figure that out.

The Frameworks and Scales That Investigate Your Mental Health

Every doctor and clinician in the UK has a generally agreed-upon definition of depression – it is a low mood that lasts a long time or keeps returning now and then, affecting your everyday life in the process. These healthcare professionals also have two diagnostic manuals to figure out if what you’ve got is genuinely depression: ICD-11 and DSM-5.

Though they might sound complicated, they’re really just well-developed checklists of symptoms that cover low mood, loss of interest, disrupted sleep and appetite, fatigue, poor concentration, and feelings of worthlessness. What you describe here is also given concrete ratings using a tool called PHQ-9. These are nine additional questions that help you rate the past two weeks, each scored from 0 (not at all) to 3 (nearly every day). Based on the total from the PHQ-9, the doctors are then able to determine the severity of your depression. For reference, a score of 5 would be considered a sign of mild depression, while anything above 20 is considered severe. Five or more symptoms on more than half the days, including low mood or loss of interest, hints that you might be struggling with major depression.

If you’re wondering, this system has actually proven itself to be a pretty accurate one in diagnosing depression. In a large validation study to vouch for it, a score of 10 or higher picked up depression in people with a staggering 88% sensitivity and specificity. But this is just for depression; if your description also points to anxiety, the doctors may hand you another questionnaire called the GAD-7. There are other systems too, like the Hospital Anxiety and Depression Scale, the Beck Depression Inventory, or the Hamilton scale, but these are less common than the ones described before.

The Clinical Interview to Put Things Into Context

The numbers by themselves aren’t enough; they only give the doctor a general idea of how you’re doing. It’s the interview where you describe things in which these numbers really find their weight. How you speak, hold yourself, and describe your experiences will all give more definition to what the forms may have hinted at.

Also, do note that while it is called an interview, it’s really anything but that. It’s not too dissimilar to how conversations with any doctor generally go: they’ll ask about when things started, whether your low mood comes and goes, if you’ve felt this way before, and if someone else in your family has had bouts with depression.

Some comparisons need to be made too, so they’ll ask you to describe how your days have changed from before and if there is a specific event that could have caused the change. They may also ask about your energy levels in particular – whether you’ve had stretches of unusually high energy in between the low periods. This is to screen for bipolar disorder, which is a separate condition with a separate treatment path.

Now, there is also a very good chance that they’ll directly ask you about thoughts of suicide and self-harm too. Don’t be startled, as it is just a part of the process and nothing more – just answer honestly and avoid hiding things here out of guilt or shame.

Checking for Other Symptoms and Factors

There are often times when what people feel is depression may actually be some physical condition in hiding. For one, an underactive thyroid, anaemia, along with low levels of vitamin B12 or folate can all bring about symptoms that may feel like depression. Long-term conditions like diabetes, heart disease, or chronic pain should also be taken into account; although they may not affect your mood, depression can instead make them much harder to manage. While checking for these things initially may seem like a dismissal of what you’re going through, remember that this ensures nothing treatable slips past doctors when they’re trying to create a treatment path for your situation.

As per NICE, the severity of your condition can also be judged by its impact on your personal and social functioning. Consider the following situation: You and one other person ended up with the exact same score on the PHQ-9. While you can still manage work and get through some everyday activities, the other person may not have left their house and may be unable to work at all. That is, doctors must take your social, personal, and work life into account, too – your work, money worries, housing situation, relationships, loneliness, responsibilities, and recent losses.

Another, more frustrating thing about depression is how it tends to travel with certain companions no matter the person. This is called comorbidity, and anxiety is the most common condition here – the reason why GAD-7 is also given to patients. Other conditions include problems with alcohol, drugs, past trauma, obsessive thoughts, eating difficulties, and even ADHD.

Finding the Best Pathway for Depression

In 2022, NICE changed how doctors treat depression by simplifying its categories. Now, people with depression fall either under the less severe category or the more severe one – with a PHQ-9 score of 16 serving as the dividing line. Not that it’s a hard line for how your condition is going to be treated, but it is a good starting point for where to go next.

For people with less severe depression, depression treatment without antidepressants is the standard opening move nowadays – things like guided self-help or working through CBT-based material either with a therapist or a group. For more severe depression, you may be asked to combine your CBT course with an antidepressant or an advanced treatment like rTMS (if you’re resistant to medication). Your care may also be moved to crisis teams if your condition is too complex or there’s a risk to life.

Take a Mental Health Check With Zero Hesitation

If any of the symptoms or feelings described throughout here resonated, then consider it a push to make an appointment with a doctor. Speak to your GP, sign up for NHS talking therapies, or go private, whichever feels most comfortable for you. If you ever have any thoughts that make you feel unsafe, contact a crisis line or emergency services straight away. Just know one thing: you don’t need to be at rock bottom to seek help. The next time you catch yourself saying that you’re just fine, take a brief pause and ask if you’re truly fine. A “no” to this question is a good enough reason to start looking for answers, and it starts with talking to a professional. So, without hesitation or fear, take the first step toward improving your situation. The rest will sort itself out in time.