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Mental Health Nursing · Chapter 7

The Depression Bench: Count It, Name It, Chart It

Only two of the nine criteria are about feeling. The rest are about how the body runs — sleeping, eating, moving, thinking, wanting. Read each person, mark the criteria their story actually supports, name the differential, then rewrite a note that judged a person into a note that describes one.

Choose a person

Which criteria does this story support?

And what is this?

Chart it: observation, not verdict

The tally

Mark the criteria, then score itThreshold: five or more of nine, present most of the day nearly every day for at least two weeks, and at least one of them must be depressed mood or loss of interest.

Subtract the mimics before you name it

Endocrine and metabolic — hypothyroidism, diabetes, adrenal disease, vitamin B12 and vitamin D deficiency, anaemia.
Neurological — Parkinson disease, stroke, dementia in its early phase, obstructive sleep apnoea.
Occult disease and pain — pancreatic and other cancers, untreated chronic pain.
Medications — interferon, isotretinoin, corticosteroids, some beta blockers, hormonal contraceptives in susceptible people.
Substances — alcohol above all — a depressant that people frequently use to treat the very symptoms it deepens — plus sedatives and stimulant withdrawal.
Presentation is shaped by age and culture. Older adults often present with somatic complaints, memory change and irritability rather than reported sadness. Adolescents often present as irritable rather than tearful. Many people describe fatigue, headache, chest pressure or stomach pain because that is the vocabulary available to them — they are not exaggerating, they are describing depression in another language.

The PHQ-9 is a structure, not a verdict

0–4 5–9 10–14 15–19 20–27 minimal mild moderate mod. severe severe Nine items scored 0 to 3, mapping directly onto the nine criteria. Item 9 asks about thoughts of being better off dead or of self-harm. A positive item 9 is a conversation today — never a number filed in the chart.
A tool structures the interview; it does not replace it. Use the number to track change over time and to hand something concrete to the provider — then ask the person, in plain words, what the score is made of.