Some generaltips when taking a history of depression:
Use the patient’s own language when describing their feelings and use this to get them to expand on their presenting symptoms. Repeating parts of phrases can help develop the consultation and show the patient you are listening and trying to understand.
Be careful with your “active listening” fillers – nodding and making affirmative noises to show engagement may be more appropriate than saying “Okay…”, however, be careful not to accidentally re-affirm some of the patient’s negative beliefs about themselves or their situation.
Don’t be afraid to (sensitively) ask about suicide risk. Screening for risk and asking about suicide does not increase the likelihood of a patient attempting it!
Opening the consultation
Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Ask the patient if they’d be happy to talk with you about their current issues.
You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.
Use open questioning to explore the patient’s presentingcomplaint:
“How are you today?”
“How have you been feeling recently?”
“What’s brought you in to see me today?”
“Tell me about the issues you’ve been experiencing.”
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presentingcomplaint if required:
“Ok, can you tell me more about that?”
Open questions can help the patient to explain how they are feeling, without placing words into their mouth or assuming a specific reason for presentation.
Screening for depression
Depression should be screened for in at-risk individuals (e.g. those with a past history of depression or a chronic health problem with secondary functional impairment).
NICE guidelines recommend the questions below to briefly screen for depression.
“During the past month have you…”
“Felt low, depressed or hopeless?”
“Had little interest or pleasure in doing things?”
If there is an affirmative answer to either of these questions, further evaluation should be performed. It should be noted that a negative response to the questions does not exclude depression.
Exploring symptoms of depression
Sleep cycle disruption
Questions useful for exploring sleepdisruption include:
“How has your sleeping pattern been recently?”
“Have you had any difficulties with getting to sleep?”
“Do you find you wake up early, and find it difficult to get back to sleep?”
Patients with depression typically experience persistentsadness/lowmood on most days.
Explore the patient’s recentmood:
“How has your mood been recently?”
“How often have you felt sad recently?”
“Are there any particular times of day that you notice your mood is worse?”
“Does your mood vary throughout the day?”
The appetite of patients with depression can be significantly altered:
“Have you noticed a change in your appetite?”
“What is your diet like at the moment?”
“What are you eating on a typical day?”
Patients with depression often experience reducedlibido:
“Have you noticed a change in your libido recently?”
“Since you have been feeling this way, have you noticed a difference in your sex drive?”
Screen for, and assess the extent of any cognitivesymptoms of depression.
Patients with depression typically exhibit reduced levels of concentration:
“How are your current levels of concentration?”
“Can you follow TV programmes/ read the newspaper/*insert hobby here* without getting distracted?”
Negative perception of current/future situation
Patients with depression typically demonstrate a negativeperception of their current and futuresituation:
“How do you feel about your current situation?”
“How do you feel about the future?”
Negative perception of self
Patients with depression often exhibit a negativeperception of themselves:
“How do you feel about yourself?”
“Do you often criticise yourself?”
“Do you blame yourself when things go wrong?”
Assess suicide risk
Patients with depression are at an increased risk of suicide and self-harm, therefore assessment of an individuals risk is essential to inform appropriate management.
Questions that can be useful to determine a patient’s risk of suicide include:
“When people feel down and depressed, they can feel that life is no longer worth living. Have you ever felt like this?”
“Have you had any thoughts of taking your life?”
“How often do you think about taking your life?”
“Have you thought about how you would end your life?”
“Have you made any plans to end your life?”
“Have you ever tried to take your own life?”
“Have ever thought about hurting yourself?
“Have you tried to hurt yourself in any way?”
“What things do you have that you feel stop you from ending your life?”
“Are you drinking alcohol or using recreational drugs at the moment?”
“Have you felt able to see your friends and socialise recently?”
Ask the patient if they use recreationaldrugs and if so determine the type of drugs used and their frequency of use. Recreational drugs may be the underlying cause of a patient’s presentation with psychiatric symptoms.
Ask the patient if they gamble and if they feel this is a problem.
Gambling is causative of several decrements to health directly, such as increased sedentary behaviour during the time spent gambling, poor sleep, reduced levels of self-care and anxiety. Patients with a gambling problem are also more likely to have substance misuse issues.1
Insight refers to the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal. Patients with severe depression may demonstrate loss of insight into their illness.
Some examples of questions which can be used to assess insight include:
“What do you think the cause of the problem is?”
“Do you think you have a problem at the moment?”
“Do you feel you need help with your problem?”
Closing the consultation
Ask the patient if they have any questions or concerns that have not been addressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
World Health Organisation. The epidemiology and impact of gambling disorder and other gambling-related harm. Published 26-28 June 2017. Available from: [LINK].