Depression Evaluation

The following are all elements of the Depression Evaluation and can be complete in one or more visits depending on the patient’s needs. Clinicians may have some of the information from prior office visits.

Suicide/Homicide Safety Risk

Complete the following:	Screen and/or assess for presence of harm to self or others which includes suicidal / homicidal ideation, suicide attempts, and non-suicidal self-injury   Examples of Screening Tools include: Columbia Suicide Severity Rating Scale Screener – Since Last Contact Columbia Suicide Severity Rating Scale Pediatric Quick Screen     Learn more about suicide screening and assessment with the CHOP pathway Suicide Risk Assessment and Care Planning, Outpatient Specialty Care
	Complete Columbia Suicide Severity Rating Scale (C-SSRS)   when suicide screen is positive. Suicide risk assessment gathers information related to current and past history of suicidal ideation, suicidal behavior, and self-injurious behavior. The widely used Columbia Suicide Severity Rating Scale (C-SSRS; Posner, Brent, Lucas, Gould, Stanley, Brown, Fisher, Zelazny, Burke, Oquendo, & Mann, 2009) is a standardized, evidenced-based instrument that guides a thorough and reliable suicide risk assessment. A standardized approach to assessment, using the C-SSRS, supports reliability and clear communication across clinicians and clinical teams using specific definitions of suicidal ideation and behavior, as well as ratings of intensity and severity of ideation and behavior. The C-SSRS is applicable across multiple settings in the health care environment (e.g., inpatient, outpatient, ED) and does not require a mental health clinician to administer. The C-SSRS can be used for both initial encounters with patients, as well as in the context of follow-up care of established patients to track changes over time. The completion of the C-SSRS will assist with the development of a risk formulation and plan of care to address the patient’s immediate and ongoing needs. C-SSRS — Very Young Child/Cognitively Impaired – Lifetime Recent C-SSRS — Very Young Child/Cognitively Impaired – Since Last Contact Columbia Protocol for Communities and Healthcare
	Safety Plan using the Safety Plan Intervention when indicated
	Assess for presence of guns in the home, access to weapons, and general safety of the home and/or neighborhood environment

Depressive Symptoms (Including Severity)

Current and Past Depressive Symptoms should be obtained by use of Clinical Interview assessing DSM-5 or ICD-10 diagnostic criteria and/or Structured or Semi-Structured Interview Instruments.

Structured and Semi-Structured Diagnostic Interviews

Diagnostic Interview Schedule for Children (DISC-IV)

Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS)

Anxiety Disorders Interview Schedule (ADIS-IV) Child and Parent Interview Schedules

Symptoms of Major Depression: DSM-5 Classification Criteria

1	Depressed or irritable mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
2	Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
2	Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3	Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month), or decrease in appetite nearly every day or failure to make expected weight gain)
4	Insomnia or hypersomnia nearly every day
5	Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6	Fatigue or loss of energy nearly every day
7	Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8	Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9	Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Psychiatric Review of Symptoms

Current and Past Psychiatric Review of Systems Obtained (based on clinical history, use of structured or semi-structured interviews, use of symptom check-lists, and/or parent and self-report measures) to assess for the following:

Mental Health Treatment History

Providers should obtain past mental health treatment history including history of mental health diagnoses, outpatient treatment, partial hospitalization treatment, inpatient treatment, and medication management.

Assessment Rating Scales

Examples of screening and assessment tools are provided in Depression Screening Tools and Assessment Rating Scales section.

Psychosocial History (Current and Past)

Providers should specifically assess for history and/or presence of psychosocial risk and protective factors across multiple domains.
These may include:

Risk	Examples
History of trauma	Abuse Neglect Traumatic loss, etc.
Personal/interpersonal variables	Self-esteem Cognitive style Same-sex attraction/LGBTQIA identification
Family-level variables	Parent’s mental health and competence Presence of a supportive adult family/school/community member Family cohesion vs. high conflict Financial/occupational strain or stability Recent changes in family system Housing stability
Peer relationships	Peer conflict or history of bullying/victimization by peers Presence of a supportive peer group Recent loss of friendship or romantic relationship
Societal/community variables	Access/connection to community resources Exposure to community violence Exposure to prejudice/racism

Family Medical and Mental Health History

Providers should specifically assess for a family history of mood disorders, anxiety disorders, substance use disorders, psychotic disorders, psychiatric hospitalizations and suicidal behaviors.

Medical History

Medical history should include past and current medical illness, hospitalizations, surgeries, medications, and allergies. It should assess for history of cardiac disease, head injury, or seizures.

Academic History

Providers should obtain information regarding the patient’s academic history, including past and current academic performance, history of early intervention, history of school accommodations (e.g., 504 plans, IEP’s, GIEP’s), and results of psychological testing.

Level of Functioning, Impairment, and Distress

Providers should assess level of functioning and impairment as well as symptom distress to aid in diagnosis and severity. These concepts refer to the patient’s ability to interact with others, form relationships and handle day-to-day tasks as well as the impact of psychiatric symptoms on a patient’s day-to-day life. Psychosocial functioning can be assessed using the Clinical Global Assessment of Functioning Scale (CGAS) and The Columbia Impairment Scale (CIS), Youth and Parent versions.

Medical Evaluation and Drug Screening, as Clinically Indicated

Baseline vital signs (BP, HR, Height, Weight, BMI) and review of growth charts are recommended. Consider Lab Work (Complete Blood Count, Comprehensive Metabolic Panel, Thyroid Function Tests, Liver Function Tests, Urine Drug Screen, and pregnancy test), physical examination, or referral to medical provider if clinically indicated.