The Perfect Scale for the Depression Diagnosis in the Athletes
A Comparison of the Clinical Tools – Review
DOI:
https://doi.org/10.12775/JEHS.2025.81.66604Keywords
anxiety and depressive disorders, Athlete, assessment methodsAbstract
Background: This review provides a critical analysis of selected clinical assessment instruments for depression, with emphasis on their utility in everyday medical practice and their adaptability to individual patient profiles. Given the multifactorial etiology and diverse symptomatology of depressive disorders, appropriate diagnostic tool selection is essential for accurate evaluation and monitoring.
Aim: The paper reviews widely used depression assessment scales, including the Hamilton Depression Rating Scale (HDRS), Montgomery-Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ), Zung Self-Rating Depression Scale (ZSDS), Center for Epidemiologic Studies Depression Scale (CES-D), Depression Anxiety Stress Scales (DASS), and others, analyzing their relevance to various clinical populations, including athletes.
Materials and Methods: A structured literature review was conducted using PubMed and Web of Science databases. Keywords included: major depressive disorder, psychometric assessment, screening tools, diagnostic evaluation, and mood disorders.
Results: The examined tools differ in structure, scoring methods, and clinical applicability. Their utility varies depending on age, comorbidities, and context. Some instruments are better suited for older adults, postpartum women, or adolescents, while others may offer better sensitivity in athletic populations. Matching the tool to the individual's clinical and psychosocial profile improves diagnostic accuracy and treatment outcomes.
Conclusions: Selecting depression assessment scales based on psychometric quality and population specificity—particularly in underrepresented groups such as athletes—can optimize diagnosis and facilitate effective, personalized treatment strategies.
References
1. Beck, C. T., & Gable, R. K. (2001). Comparative analysis of the performance of the Postpartum Depression Screening Scale with two other depression instruments. Nursing Research, 50(4), 242–250. https://doi.org/10.1097/00006199-200107000-00008
2. Carleton, R. N., Thibodeau, M. A., Teale, M. J. N., Welch, P. G., Abrams, M. P., Robinson, T., & Asmundson, G. J. G. (2013). The Center for Epidemiologic Studies Depression Scale: A Review with a Theoretical and Empirical Examination of Item Content and Factor Structure. PLoS ONE, 8(3), e58067. https://doi.org/10.1371/JOURNAL.PONE.0058067
3. Costantini, L., Pasquarella, C., Odone, A., Colucci, M. E., Costanza, A., Serafini, G., Aguglia, A., Belvederi Murri, M., Brakoulias, V., Amore, M., Ghaemi, S. N., & Amerio, A. (2021). Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of Affective Disorders, 279, 473–483. https://doi.org/10.1016/J.JAD.2020.09.131
4. Cox, J. (2019). Thirty years with the Edinburgh Postnatal Depression Scale: voices from the past and recommendations for the future. The British Journal of Psychiatry : The Journal of Mental Science, 214(3), 127–129. https://doi.org/10.1192/BJP.2018.245
5. Demyttenaere, K., & Jaspers, L. (2020). Trends in (not) using scales in major depression: A categorization and clinical orientation. European Psychiatry, 63(1), e91. https://doi.org/10.1192/J.EURPSY.2020.87
6. Dozois, D. J. A. (2010). Beck Depression Inventory-II. The Corsini Encyclopedia of Psychology, 1–2. https://doi.org/10.1002/9780470479216.CORPSY0113
7. Dunstan, D. A., & Scott, N. (2019). Clarification of the cut-off score for Zung’s self-rating depression scale. BMC Psychiatry, 19(1). https://doi.org/10.1186/S12888-019-2161-0
8. Evins, G. G., Theofrastous, J. P., & Galvin, S. L. (2000). Postpartum depression: a comparison of screening and routine clinical evaluation. American Journal of Obstetrics and Gynecology, 182(5), 1080–1082. https://doi.org/10.1067/MOB.2000.105409
9. Gloster, A. T., Rhoades, H. M., Novy, D., Klotsche, J., Senior, A., Kunik, M., Wilson, N., & Stanley, M. A. (2008). Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. Journal of Affective Disorders, 110(3), 248–259. https://doi.org/10.1016/J.JAD.2008.01.023
10. HAMILTON, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56–62. https://doi.org/10.1136/JNNP.23.1.56
11. Khan, A., Khan, S. R., Shankles, E. B., & Polissar, N. L. (2002). Relative sensitivity of the Montgomery-Asberg Depression Rating Scale, the Hamilton Depression rating scale and the Clinical Global Impressions rating scale in antidepressant clinical trials. International Clinical Psychopharmacology, 17(6), 281–285. https://doi.org/10.1097/00004850-200211000-00003
12. Krishnamoorthy, Y., Rajaa, S., & Rehman, T. (2020). Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: Systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 87. https://doi.org/10.1016/J.ARCHGER.2019.104002
13. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16(9), 606. https://doi.org/10.1046/J.1525-1497.2001.016009606.X
14. Leontjevas, R., Van Hooren, S., & Mulders, A. (2009). The Montgomery-Asberg Depression Rating Scale and the Cornell Scale for Depression in Dementia: a validation study with patients exhibiting early-onset dementia. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 17(1), 56–64. https://doi.org/10.1097/JGP.0B013E31818B4111
15. Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12(2), 277–287. https://doi.org/10.1037//0882-7974.12.2.277
16. Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: Screening and Diagnosis. American Family Physician, 98(8), 508–515. https://www.aafp.org/pubs/afp/issues/2018/1015/p508.html
17. Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134(4), 382–389. https://doi.org/10.1192/BJP.134.4.382
18. Osman, A., Wong, J. L., Bagge, C. L., Freedenthal, S., Gutierrez, P. M., & Lozano, G. (2012). The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. Journal of Clinical Psychology, 68(12), 1322–1338. https://doi.org/10.1002/JCLP.21908
19. Paiva-Medeiros, P. F. rancielle, Duarte-Guerra, L. S. evero, Santo, M. A. urélio, Lotufo-Neto, F., & Wang, Y. P. (2015). Psychometric Properties of the Montgomery-Åsberg Depression Rating Scale in Severely Obese Patients. The Spanish Journal of Psychology, 18, E69. https://doi.org/10.1017/SJP.2015.072
20. Pereira, A. T., Bos, S. C., Marques, M., Maia, B. R., Soares, M. J., Valente, J., Gomes, A. A., MacEdo, A., & De Azevedo, M. H. P. (2011). The postpartum depression screening scale: is it valid to screen for antenatal depression? Archives of Women’s Mental Health, 14(3), 227–238. https://doi.org/10.1007/S00737-010-0178-Y
21. Poole, H., Bramwell, R., & Murphy, P. (2009). The utility of the Beck Depression Inventory Fast Screen (BDI-FS) in a pain clinic population. European Journal of Pain (London, England), 13(8), 865–869. https://doi.org/10.1016/J.EJPAIN.2008.09.017
22. Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
23. Shaw, T., Campbell, M. A., Runions, K. C., & Zubrick, S. R. (2017). Properties of the DASS-21 in an Australian Community Adolescent Population. Journal of Clinical Psychology, 73(7), 879–892. https://doi.org/10.1002/JCLP.22376
24. Shin, C., Park, M. H., Lee, S. H., Ko, Y. H., Kim, Y. K., Han, K. M., Jeong, H. G., & Han, C. (2019). Usefulness of the 15-item geriatric depression scale (GDS-15) for classifying minor and major depressive disorders among community-dwelling elders. Journal of Affective Disorders, 259, 370–375. https://doi.org/10.1016/J.JAD.2019.08.053
25. Szabo, M., & Lovibond, P. F. (2022). Development and Psychometric Properties of the DASS-Youth (DASS-Y): An Extension of the Depression Anxiety Stress Scales (DASS) to Adolescents and Children. Frontiers in Psychology, 13, 766890. https://doi.org/10.3389/FPSYG.2022.766890/BIBTEX
26. Wang, Y. P., & Gorenstein, C. (2013). Assessment of depression in medical patients: a systematic review of the utility of the Beck Depression Inventory-II. Clinics (Sao Paulo, Brazil), 68(9), 1274–1287. https://doi.org/10.6061/CLINICS/2013(09)15
27. Wood, B. M., Nicholas, M. K., Blyth, F., Asghari, A., & Gibson, S. (2010). The utility of the short version of the Depression Anxiety Stress Scales (DASS-21) in elderly patients with persistent pain: does age make a difference? Pain Medicine (Malden, Mass.), 11(12), 1780–1790. https://doi.org/10.1111/J.1526-4637.2010.01005.X
28. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17(1), 37–49. https://doi.org/10.1016/0022-3956(82)90033-4
29. Zimmerman, M., & McGlinchey, J. B. (2008). Why don’t psychiatrists use scales to measure outcome when treating depressed patients? The Journal of Clinical Psychiatry, 69(12), 1916–1919. https://doi.org/10.4088/JCP.V69N1209
30. Zung, W. W. K. (1965). A SELF-RATING DEPRESSION SCALE. Archives of General Psychiatry, 12(1), 63–70. https://doi.org/10.1001/ARCHPSYC.1965.01720310065008
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Copyright (c) 2025 Monika Olszanska, Aleksandra Jurczuk, Adam Rafałowicz, Bartosz Łuniewski, Angelika Macko, Kamil Klaudiusz Lauko, Maria Łuniewska, Iga Nowicka, Urszula Justyna Wojciechowska, Kinga Marciniak

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