A century ago, depression wasn't considered to be particularly widespread, with less than 1 percent of the population diagnosed with the condition. But thanks to factors like an improved understanding of mental health, better access to mental healthcare and a growing willingness to seek assessment and treatment, it is now considered by the World Health Organization (WHO) to be a common condition.
The WHO estimates that more than 264 million people are affected worldwide and says depression is "a leading cause of disability worldwide and is a major contributor to the overall global burden of disease". Given how common the condition has become, diagnosing depression accurately and swiftly is key.
However, the assessment and identification of depression can be "quite complex" because mental health conditions can arise from several factors, according to Valorie O’Keefe, Consultant Psychologist at Pearson Clinical.
"The onset of depression can be triggered by a situation or life event for some individuals, while others can experience more chronic mental health issues," Valorie says. "This could be because they have major depression, or they might have co-morbidities such as anxiety or PTSD alongside the depression, or they might have a more complex personality disorder, which adds complexity to the treatment plan."
Depression: A growing concern for Australians
While depression is a global issue and, as the WHO notes is on the rise, in Australia too its impact is being felt around the country. As many as three million adults experience either anxiety or depression in any given year and nearly half the population, it is estimated, will be affected by a mental health condition at some point.
Compounding the problem is the advent of COVID-19, which has changed both the prevalence of, and approach to treating, depression, Valorie says, with the increase in loneliness and anxiety brought on by the drastic changes in our lives – such as social distancing, isolation at home and remote-working measures put in place to limit the coronavirus outbreak – meaning "there's more and more need for assessment and intervention".
And because the pandemic is preventing psychologists and counsellors from assessing clients in person, "there has been a need to develop more and more telehealth assessments", Valorie says.
Assessments: Key tools in the battle against depression
At the same time, because of the complexity of the underlying conditions, the tests for assessing depression need to be comprehensive.
"The most popular assessment tools are ones that are easy to administer and score, are not too difficult or lengthy for the client to complete, and that are affordable for the practitioner," she says. "It is also vital that the diagnosis be made with the help of a “reliable, valid, and well researched tool".
The Beck Depression Inventory (BDI), for example, measures the presence or absence of depression. If present, it grades the severity level of the condition on a scale from mild through moderate and onto severe, Valorie explains. The self-administered questionnaire determines this in about 25 questions, and often an assessor will use the BDI alongside other Beck Scales, such as the Beck Anxiety Inventory, the Beck Hopelessness Scale and the Beck Scale for Suicide Ideation.
According to Valorie, Pearson Clinical provides several tools that mental health professionals can use effectively. These range from quick screeners, which are able to assess "what is most likely a very straightforward depression that requires treatment", but also tools that measure more complex mental health presentations, such as various aspects of psychopathology, which would require in-depth long-term intervention.
Pearson also offers mental health assessments for children and teenagers, including the BASC 3, Beck Youth Inventories and MACI II, and provides the option of digital assessments through its Q-global online platform, allowing assessors to administer these questionnaires online from their office or practice. They can also deliver the tests to their patients via email using a Q-global feature called Remote OnScreen Administration, allowing questionnaires to be completed at home – a feature that has proven hugely beneficial amid the pandemic.
MMPI: A widely used measure of psychopathology
Pearson also offers other, more in-depth assessments that determine depression alongside a range of psychopathologies. The MMPI-2-RF (Minnesota Multiphasic Personality Inventory), for example, is a questionnaire-based assessment developed by Pearson's US-based team, alongside the University of Minnesota. The MMPI is "one of the most widely researched and used psychological assessment instruments", according to the American Psychological Association.
The test is a "very complex measure of psychopathology, which would include depression and anxiety but also things like PTSD and a variety of personality disorders", Valorie says.
On the horizon is the MMPI-3, the updated version of the MMPI-2-RF, which has been redeveloped, modernised and reformed. It will be available for use by psychologists and psychiatrists around September.
To make the assessment more user-friendly for both assessor and the client, the number of questions has been reduced by half from the original version, from around 600 to 300. The rationale is that the smaller number of questions will be less taxing for anyone with mental health issues, Valorie says, but by refining the focus of the questions, the validity and reliability of the measure is retained, while making it quicker and easier to administer.
With improved testing capabilities, psychologists in Australia and the world over can better diagnose mental health issues – and to do so quickly, enabling earlier intervention. This is especially crucial amid the current global health crisis, which provides all the right conditions for exacerbating an already daunting mental health situation.
But with the right tools, a sense of urgency and the compassion that the field of mental healthcare is known for, practitioners can stay one step ahead and mitigate some of its worst effects.
Keeping the black dog at bay: Remaining vigilant against depression
Placing a lens on depression
PODCAST: Episode 2 — Confronting institutional gaps: Investigating mental health policy and depression