Understanding Depression: Approaches to Diagnosis

Depression is one of the most common mental health conditions, yet it often goes undetected and untreated. That’s why simple screening tools, like the PHQ-2, are so important. In just two questions, you can take the first step toward understanding your mental health.

Over the last two weeks:

• How often have you been bothered by feeling down, depressed, or hopeless?
  • Not at all
  • Several days
  • More than half the days
  • Nearly every day
• How often have you been bothered by little interest or pleasure in doing things?
  • Not at all
  • Several days
  • More than half the days
  • Nearly every day

If you pondered these questions and answered them honestly, you just took the PHQ-2 (Patient Health Questionnaire-2). This brief, basic assessment is used as an initial depression screening in primary care settings. You can see your results at the end of this article.

Know the Symptoms of Depression

October 9 is National Depression Screening Day, a reminder that we should all be tuned in to our own mental health and that of our loved ones.

The first step is knowing the symptoms of depression. These may include:

• Feeling sad, hopeless, empty or numb and tearing up easily
• Irritability, frustration, and angry outbursts over minor things
• Loss of interest in pleasurable activities such as sports, sex, or your favorite hobbies
• Trouble sleeping or sleeping too much
• Fatigue and lethargy so even the smallest tasks feel like a big effort
• Reduced appetite and weight loss or overeating and weight gain
• Anxiety, agitation, or restlessness
• Slowed thinking, speech, or movement
• Feelings of worthlessness or guilt, fixation on past failures or mistakes
• Trouble concentrating, making decisions, or remembering things
• Suicidal thoughts, frequent thoughts of death
• Unexplained physical problems such as back pain or headaches

Depression symptoms vary from one person to the next. Some people function but feel generally unhappy without knowing why while others are challenged by day-to-day activities and interactions. The duration of a depressive episode depends on the individual and the circumstances. Episodes of Major Depressive Disorder typically last for two weeks or more. However, without effective treatment, they can persist for months and even years. Persistent Depressive Disorder is chronic and lasts for at least two years.

Trends, Risk Factors, and Statistics

According to a 2023 Gallup poll, nearly 30% of U.S. adults are diagnosed with depression at some point in their lives. Between 2013 and 2023, depression rates in Americans 12 and older rose from 8.2% to 13.1%. Several theories have been proposed to account for this increase, including factors such as economic inequality, financial challenges, social isolation, and lifestyle aspects like stress, inadequate nutrition, and insufficient sleep.

Are You at Risk?

Depression can strike anyone at any time, but you may be at increased risk if you have any of the following:

• Biological Risk Factors include a family history of depression, neurochemical imbalances in levels of serotonin or dopamine, and medical conditions such as heart disease or chronic pain.
• Psychological Factors often come down to stressful life events such as loss, abuse, relationship problems, or trauma. People with low self-esteem, poor coping skills, or negative thought patterns are at risk. Individuals with physical or mental disabilities are all more prone to depression.
• Social Factors such as poverty, lack of education, or unemployment often lead to depression.
• Substance Use, including alcohol or drug abuse and cigarette smoking often accompanies depression.
• Age affects how susceptible you are to depression. Teens ages 12-19 and young adults 19-25 have the highest rates of depression. Adults 60 and older tend to report a lower prevalence of depression.
• Gender makes a difference, with recent CDC data indicating that 16.0% of females reported depression compared to 10.1% of males. Hormonal changes that come with pregnancy, childbirth, or menopause can all contribute to depression.
• The time of year can be a trigger for people with SAD, or Seasonal Affective Disorder.

Getting Assessed for Depression

Many people are able to move past depression with therapy and/or medication. The first step is to seek professional help from your primary care physician, a psychologist, or psychiatrist. Early intervention makes a big difference. Below is a list of the most common assessments you may be asked to take:

• PHQ-2 and 9
  PHQ-2 is the simple questionnaire at the beginning of the article. If your screening warrants further investigation, your doctor will give you PHQ-9, nine questions designed to measure depression severity.
• Beck Depression Inventory (BDI)
  This 21-item self-report, widely used in clinical and research settings, evaluates the level of depression from minimal to severe.
• Hamilton Depression Rating Scale (HAM-D or HDRS)
  This questionnaire is given and interpreted by a clinician and generally used in a hospital setting to assess patients with severe depression.
• Zung Self-Rating Depression Scale (SDS)
  Used in clinical and research settings, this 20-item, self-administered survey focuses on both the physical and psychological symptoms of depression.
• Edinburgh Postnatal Depression Scale (EPDS)
  This 10-question screening tool is designed to identify postpartum depression.
• Geriatric Depression Scale (GDS)
  This test is given to adults ages 65 and older to determine whether a person’s symptoms are due to aging or depression.
• Columbia Depression Scale (CDS)
  This test looks for signs of depression in children and teens.

PHQ-2 And You

At the beginning of this article, you were asked two questions. You can score your answers as follows:

• 0 – Not at all
• 1 – Several days
• 2 – More than half the days
• 3 – Nearly every day

Now total your score for both questions. A score of 3 or more suggests the need for further evaluation, often with the PHQ-9. If you score a 3 or above, make an appointment with your doctor as soon as possible.

Understanding your mental health is a courageous first step. Whether your PHQ-2 score was 3 or higher, or you simply recognize the symptoms of depression in yourself or a loved one, please know that effective, compassionate help is available. Don’t dismiss your feelings or think you have to “snap out of it.” With a proper diagnosis and a personalized treatment plan, you can find your way back to feeling like yourself again.

The mental health experts at El Camino Health are here to guide you on your journey to wellness. Learn more.

This article first appeared in the October 2025 edition of the HealthPerks newsletter.