Handout: Depression Assessment Checklist (50k PDF)

1. General Information:
Name:
Age:
Marital Status:
Children:
Substance Use:
Other Drug Use:
Criteria for Treatment:

2. Interview Skill Elements:
•  Reassure patient that depressed feelings are common.
•  Use commonly understood terms like "sad" or "blue".
•  Ask for recall over short to medium time periods.
•  Ask about history of mental illness and treatment.
•  "Normalize" the questions by drawing parallels to other medical parts of the interview.
•  Use open-ended questions ("how would you describe your mood?").
•  Be ready to give some guidance ("for instance, are you generally.?").
Patient's description of Mood:___________________________________________
___________________________________________________________________.

3. Possible Indications of Depression in the Medical History:
substance abuse problems
sleep disturbances
sexual dysfunction
loss of social supports and/or isolation
difficulty concentrating and poor work or school performance
absenteeism
multiple, vague physical complaints
history of mental illness
family history of mental illness

4. Possible Indicators in the Physical Exam:
weight gain or weight loss
paucity of facial expression or sad looking
poor eye contact
poor grooming or unkempt appearance, poor personal hygiene