The Challenges of Measuring Symptoms of Depression in Disability Healthcare

Authors

  • Sean Hill Buckinghamshire Healthcare NHS Foundation Trust, Aylesbury
  • Liam Alexander MacKenzie Myles Berkshire Healthcare NHS Foundation Trust, Bracknell

DOI:

https://doi.org/10.13129/2282-1619/mjcp-4885

Keywords:

Assessment, Clinical Psychology, Depression, Disability.

Abstract

Depression is a psychiatric construct, most commonly operationalised as a sustained period of low mood and/or loss of interest/pleasure in activities (APA, 2013). Depression is considerably overrepresented among people living with physical illness, long-term disability and mobility-impairing conditions, with the prevalence of major depressive disorder (MDD) consistently 2-3 times higher than in the general population (Moussavi et al., 2007; Read et al., 2017).

References

Abdulsalam, A. J., & Krassioukov, A. (2025). The two questions we’re not asking: Depression screening in spinal cord injury. Spinal Cord, 1-1. https://doi.org/10.1038/s41393-025-01115-8

Al Syifa, W., & Hadi, E. N. (2023). Determinants of quality of life on persons with physical disability: literature review. Journal of Social Research, 2(6), 1786-1795. https://doi.org/10.55324/josr.v2i6.914

Almeida, J., Mateus, P., & Tomé, G. (2015). Mental health and wellbeing: Situation analysis and recommendations for action — Joint Action on Mental Health and Well-being. European Commission. https://health.ec.europa.eu/document/download/d53b2e54-b019-45a9-8230-510a1fdaa820_en

Alsaleh, M., Videloup, L., Lobbedez, T., Lebreuilly, J., Morello, R., & Thuillier Lecouf, A. (2019). Improved detection and evaluation of depression in patients with chronic kidney disease: validity and reliability of screening (PHQ-2) and diagnostic (BDI-FS-Fr) tests of depression in chronic kidney disease. Kidney Diseases, 5(4), 228-238. https://doi.org/10.1159/000497352

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596

Arnaud, A. M., Brister, T. S., Duckworth, K., Foxworth, P., Fulwider, T., Suthoff, E. D., Werneburg, B., Aleksanderek, I., & Reinhart, M. L. (2022). Impact of major depressive disorder on comorbidities: a systematic literature review. The Journal of Clinical Psychiatry, 83(6), 43390. https://doi.org/10.4088/JCP.21r14328

Bombardier, C. H., Azuero, C. B., Fann, J. R., Kautz, D. D., Richards, J. S., & Sabharwal, S. (2021). Management of mental health disorders, substance use disorders, and suicide in adults with spinal cord injury: clinical practice guideline for healthcare providers. Topics in spinal cord injury rehabilitation, 27(2), 152-224. https://doi.org/10.46292/sci2702-152

Costa, T., Taylor, A., Black, F., Hill, S., McAllister-Williams, R. H., Gallagher, P., & Watson, S. (2023). Autonomic dysregulation, cognition and fatigue in people with depression and in active and healthy controls: observational cohort study. BJPsych Open, 9(4), e106. https://doi.org/10.1192/bjo.2023.68

Diop, M. (2021). Quality of life, health and social costs of patients with spinal cord injury: a systematic review. European Journal of Public Health. https://doi.org/10.1093/eurpub/ckab165.177

Fried, E. I., Flake, J. K., & Robinaugh, D. J. (2022). Revisiting the theoretical and methodological foundations of depression measurement. Nature Reviews Psychology, 1(6), 358-368. https://doi.org/10.1038/s44159-022-00050-2

Gómez-Tabares, A. S., Restrepo, J. E., Aguirre, N. H., González- Pérez, A. (2024). Suicidal risk in young adults: interactions between depression, hopelessness and purpose in life. Mediterranean Journal of Clinical Psychology 12(1). https://doi.org/10.13129/2282-1619/mjcp-4047

Hill, S., & Watts, D. (2024). Googling and health anxiety in older age—A case study of CBT incorporating a single case experimental design. Clinical Case Reports, 12(8), e9316. https://doi.org/10.1002/ccr3.9316

Katon, W. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in clinical neuroscience, 13(1), 7-23. https://doi.org/10.31887/DCNS.2011.13.1/wkaton

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Liu, L., Xu, M., Marshall, I. J., Wolfe, C. D., Wang, Y., & O’Connell, M. D. (2023). Prevalence and natural history of depression after stroke: A systematic review and meta-analysis of observational studies. PLoS Medicine, 20(3), e1004200. https://doi.org/10.1371/journal.pmed.1004200

Merlo, E. M., Martino, G., Tutino, R., Myles, L., Hill, S., Alibrandi, A., Lia, M. C., & Minasi, D. (2025a). Psychological functioning of patients with type I diabetes: the relevant role of alexithymia and intolerance to uncertainty. Frontiers in Psychiatry, 16, 1667103. https://doi.org/10.3389/fpsyt.2025.1667103

Merlo, E. M., Myles, L. A. M., Silvestro, O., Ruggeri, D., Russo, G. T., Squadrito, G., & Martino, G. (2025b). Type 1 Diabetes Mellitus and Alexithymia: A Systematic Review. Healthcare, 13(19), 2402. https://doi.org/10.3390/healthcare13192402

Merlo, E. M., Tutino, R., Myles, L. A. M., Alibrandi, A., Lia, M. C., & Minasi, D. (2024). Type 1 Diabetes Mellitus, Psychopathology, Uncertainty and Alexithymia: A Clinical and Differential Exploratory Study. Healthcare, 12(2), 257. https://doi.org/10.3390/healthcare12020257

Mournet, A. M., Smith, J. T., Bridge, J. A., Boudreaux, E. D., Snyder, D. J., Claassen, C. A., .Jones, D. A., Pao, M., & Horowitz, L. M. (2021). Limitations of screening for depression as a proxy for suicide risk in adult medical inpatients. Journal of the Academy of Consultation-Liaison Psychiatry, 62(4), 413-420. https://doi.org/10.1016/j.jaclp.2021.02.002

Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet, 370(9590), 851-858. https://doi.org/10.1016/S0140-6736(07)61415-9

Myles, L. A. M. (2021). Opinion article: The emerging role of computational psychopathology in clinical psychology. Mediterranean Journal of Clinical Psychology, 9(1). https://doi.org/10.6092/2282-1619/mjcp-2895

Myles, L. A. M. (2025). Learning Disability-Adapted Cognitive Behavioural Therapy for Phobia. Mediterranean Journal of Clinical Psychology, 13(3). https://doi.org/10.13129/2282-1619/mjcp-4581

Myles, L. A. M., & Jones, E. (2024). Single Case Experimental Design Examining Cognitive Behavioural Therapy for Post-Stroke Depression. Journal of Mind and Medical Sciences, 11(1), 30. https://doi.org/10.22543/2392-7674.1470

National Institute for Health and Care Excellence (NICE). (2022). Depression in adults: Treatment and management (NICE guideline NG222). https://www.nice.org.uk/guidance/ng222

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

Read, J. R., Sharpe, L., Modini, M., & Dear, B. F. (2017). Multimorbidity and depression: a systematic review and meta-analysis. Journal of Affective Disorders, 221, 36-46. https://doi.org/10.1016/j.jad.2017.06.009

Scull, A. (2021). American psychiatry in the new millennium: a critical appraisal. Psychological Medicine, 51(16), 2762-2770. https://doi.org/10.1017/S0033291721001975

Senra, H., & McPherson, S. (2021). Depression in disabling medical conditions–current perspectives. International Review of Psychiatry, 33(3), 312-325. https://doi.org/10.1080/09540261.2021.1887823

Silvestro, O., Lund-Jacobsen, T., Ferraù, F., Blanca, E. S., Catalano, A., Sparacino, G., Schwarz, P., Cannavò, S., & Martino, G. (2025). Anxiety, depression and acromegaly: a systematic review. Journal of Endocrinological Investigation, 48(3), 527-546. https://doi.org/10.1007/s40618-024-02483-3

Singh, S., Saini, R., Mathur, R., Sarkar, S., & Sagar, R. (2024). The prevalence of depression in people following limb amputation: A systematic review and meta-analysis. Journal of Psychosomatic Research, 181, 111677. https://doi.org/10.1016/j.jpsychores.2024.111677

Snowdon, D. A., Srikanth, V., Beare, R., Marsh, L., Parker, E., Naude, K., & Andrew, N. E. (2023). A landscape assessment of the use of patient reported outcome measures in research, quality improvement and clinical care across a healthcare organisation. BMC Health Services Research, 23(1), 94. https://doi.org/10.1186/s12913-023-09050-1

Somma, A., De Ciechi, A., Boscaro, L., Arioli, C., Gialdi, G., Mariani, V., & Fossati, A. (2025). Basic Psychometric Properties and Italian Normative Data of the DSM-5 Level 2 Anger, Anxiety, and Depression Scales, and DSM-5 Severity of Dissociative Symptoms Scale. Mediterranean Journal of Clinical Psychology 13(1). https://doi.org/10.13129/2282-1619/mjcp-4664

Van Blarikom, E., Fudge, N., & Swinglehurst, D. (2023). The emergence of multimorbidity as a matter of concern: a critical review. BioSocieties, 18(3), 614-631. https://doi.org/10.1057/s41292-022-00285-5

Vancampfort, D., McGrath, R. L., Dankaerts, W., Van Assche, D., Lambrechts, M., Stubbs, B., & Van Damme, T. (2025). Diagnostic and Clinical Utility of the 2‐Item Patient Health Questionnaire (PHQ‐2) for Screening Depressive Symptoms in Individuals With Persistent Musculoskeletal Pain Attending Physiotherapy. Musculoskeletal Care, 23(2), e70113. https://doi.org/10.1002/msc.70113

Villa Castaño, J. E., Hernández Muñoz, C., & Landínez Martínez, D. (2024). Relationship between Anxiety, Depressive Symptoms and Mild Neurocognitive Disorder in Older Adults: A Systematic Review Mediterranean Journal of Clinical Psychology 12(2). https://doi.org/10.13129/2282-1619/mjcp-4242

Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbassi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelaim, A., Abdollahi, M., Abdollahpour, I., Abolhassani, H., Aboyans, V., Abrams, E. M., Guimarães Abreu, L., Abrigo, M. R. M., Jamal Abu-Raddad, L., Abushouk, A. I., … & Bhutta, Z. A. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204-1222. https://doi.org/10.1016/S0140-6736(20)30925-9

Wei, L., Shang, W., Nan, Y., Liu, Y., Yang, J., & Yang, K. (2025). Evidence map of clinical practice guideline recommendations on stroke rehabilitation. American journal of physical medicine & rehabilitation, 104(2), 193-201. https://doi.org/10.1097/PHM.0000000000002413

Williams, R., & Murray, A. (2015). Prevalence of depression after spinal cord injury: a meta-analysis. Archives of physical medicine and rehabilitation, 96(1), 133-140. https://doi.org/10.1016/j.apmr.2014.08.016

World Health Organization. (2023). Regional framework for the future of mental health in the Western Pacific 2023-2030.

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

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Published

24-12-2025

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