Tuesday, June 11, 2024

Zung Self Rating Depression Scale

Taking The Zung Depression Test

What is the Hamilton Depression Scale – Onlymyhealth.com

The test consists of 20 items on a 4-point scale ranging from A little of the time to Most of the time. Based on your score, youll be classified into one of the different depression ranges Normal range, Mildly depressed, Moderately depressed, and Severely depressed.

While answering the items, think about what describes you most accurately for the past several days.

Youll obtain the test results instantly after you finish the questionnaire and hit the Submit button. Your personal information will not be collected and your test results wont be stored in our database. The test takes around 5-10 minutes to complete.

In case the results show that youre depressed, its recommended that you consult with a mental health professional for a more thorough analysis. Results from a battery of tests are always more reliable than from a single test.

Other Depression Tests To Use

There are several types of online tests addressing depressive disorder and its multiple facets. The following three are a selection of what you can find readily available:

The Major depression index calculator screens for presence and severity of disorder by taking into account day to day activities, feelings and most common symptoms. The assessment is based on frequency and the subject needs to recall the past two weeks.

The Depression test by TheCalculator.co is organized in four sections, each addressing different depression symptoms and signs. The result is a likeliness percentage of suffering from a mental disorder.

The Geriatric depression scale test is one of the most reputable and well established methods of evaluation depressive symptoms in elderly patients. There are two versions available, one complete: comprising of 15 questions and one simplified: comprising of 4 direct questions.

Comparison Of Factor Scores By Demographic And Clinical Characteristics

A post-hoc analysis revealed that females had significantly higher scores in factor III than males . The same comparison between age groups showed that patients over the age of 65 presented significantly higher scores in factor I and IV than those under 65 years . Finally, when comparing factor I scores in patients from rural vs. urban settings significantly higher factor scores were observed in patients from a rural or semi-rural setting . There were no other significant differences between factor scores and gender, age, place of residence and severity of depression.

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Exploratory Factor Analysis Of The Zsds

An exploratory factor analysis on the ZSDS scores was used to extract the factor solution. The factor analysis was performed, based on the polychoric correlations matrix between ZSDS items by means of the unweighted least squares method, since the normality supposition was not met , and using promax oblique rotation . After rotation items with a loading of at least 0.25 were considered to load significantly onto a particular factor.

The sample was divided into two sub-samples of 75% and 25%. The first sample was used to perform an exploratory factor analysis and the second was used to validate the results and to perform a confirmatory factor analysis by means of the unweighted least squares method. We used several indexes such as the Goodness of Fit Index , which should be greater than 0.90 for good-fitting models, GFI Adjusted for Degrees of Freedom , with a value of 0.90 as the cut-off value and Root Mean Square Residual , the larger the RMR value the less is the fit between the model and the data .

And finally, a descriptive examination of the 20-item ZSDS was performed at a quantitative level, calculating sample means and standard deviations, and also at a categorical level, providing percentages for each response.

Comparisons Of Predictive And Discriminative Ability

Zung self

The core objective of this research was to assess the ability of the Zung scales to predict diagnoses of depression and anxiety. When employed alongside each other in logistic regression analyses, the respective DASS subscales emerge as making a stronger contribution to accurate prediction of PHQ diagnoses. However, the Zung scales still make a significant contribution. Moreover, when used as solus predictors, as is generally the case in clinical practice, the Zung scales perform in broadly comparable terms, accounting for only slightly less of the variance in PHQ diagnoses and with similar increases in the probability of diagnosis for a standardised unit increase in each scale.

The fact that the SDS emerges as specific to depression, while high scores on the SAS are predictive of both disorders is somewhat surprising, given it was the presence of somatic items on depression scales that Lovibond and Lovibond identified as one of the primary contributors to traditional scales poor discriminative ability. However, it has to be remembered that the PHQ on which these diagnoses are based also contains somatic items .

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Foot Ulceration And Depression: Is There A Link

Depressive symptoms are known to be more common in people with diabetes than in the general population32 and are associated with a range of negative outcomes, including nonadherence to treatment,33 poor glycemic control,34 diminished function, and increased health care costs.35,36 A growing body of evidence suggests that depression is associated with the long-term complications of diabetes,37,38 although the relationship between diabetic foot complications and depression is less clear.

Daniel Cukor PhD, … Paul L. Kimmel MD, MACP, in, 2019

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Dr. William W.K. Zung

Reliability and Validity

The Zung Self-Rating Depression Scale has fairly good reliability. Zung has reported a split-half reliability of 0.73. An alpha coefficient of 0.68 was obtained by DeForge and Sobal , however 0.82 was reported by DeJonghe & Baneke and Leung, Lee, Lue, & Tang . The ZSDS when correlated with the physicians global rating received a correlation of 0.69. In addition, ZSDS has a strong correlation with the Hamiliton Rating Scale and the Beck Depression Inventory in assessing self-criticism, hysteria, hypochondriasis, and paranoia.

Obtaining the ZSDS

Administration, Analysis and Reporting

Statistics Solutions consists of a team of professional methodologists and statisticians that can assist the student or professional researcher in administering the survey instrument, collecting the data, conducting the analyses and explaining the results.

For additional information on these services,


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How Does This Zung Self

This health tool assesses depression in young and adult patients with depressive disorder. It consists of a twenty item self assessment questionnaire based on a Likert scale of answers.

Some of the questions are formulated in a positive manner and the scale is weighted in one direction while other questions are formulated negatively with the scale being weighted in the other direction.

Items 1, 3, 4, 7, 8, 9, 10, 13, 15, 19 are scored:

  • A little of the time
  • Some of the time
  • Good part of the time
  • Most of the time.
  • For items 2, 5, 6, 11, 12, 14, 16, 17, 18, 20 the scale is reversed, as follows:

  • Most of the time
  • Good part of the time
  • Some of the time
  • A little of the time.
  • The items in the Zung Self-rating Depression Scale calculator cover most of the relevant depression symptoms in the four areas: the pervasive effect, the physiological equivalents, psychomotor activities and other disturbances:

    Depressed mood

    Suicidal ideation


    As a test for depression, the Zung SDS has been through several validations and its discriminatory power is reflected in comparison with normal controls, i.e. subjects achieving significantly higher results are often diagnosed with clinical depression. However, the scale should only have indicative and clinical monitoring purposes, for diagnosis other investigations are required.

    How Common Is Postpartum Depression


    At least 80% of all new mothers suffer from postpartum blues. The symptoms of the blues include feelings of sadness and a lack of energy.

    According to Loyola University Health Systems, at least 80% of all new mothers suffer from postpartum blues. The symptoms of the blues include feelings of sadness and a lack of energy. The postpartum blues often fade within the first few weeks and require no medical intervention. Other mother’s, 15 to 20% to be exact, suffer from deeper feelings of sadness which are referred to as postpartum depression.

    The feelings of sadness in postpartum depression deepen to the point of clinical depression. Other symptoms can include a loss of energy and feelings of extreme anger. Some mothers even report feeling angry toward their new baby and/or other children. Postpartum depression can be treated if the mother seeks medical help from their obstetrician or a mental health professional.

    After a mother gives birth, the Edinburgh Postnatal Depression Scale is used to assess whether the new mother could be at risk for postpartum depression, in some hospitals. The test is administered by a nurse and if the mother is found to be a depression risk, the nurse them coordinates care with the obstetrician and psychiatric doctor.

    Medicinal and therapeutic care for postpartum depression could last a year or more after the baby is born.

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    What Is The Zung Self

    The statements to which patients respond in the Zung self-rating depression scale, also known as a mood inventory, are evenly divided between positively and negatively constructed descriptive phrases. For instance, the first statement is “I feel down-hearted and blue.” The next is “Morning is when I feel the best.” This continues until the patient has quantified all 20 statements with his or her level of veracity for each particular sentiment.

    Zung designed his test to gauge four modes of depression in average patients. Some statements attempt to quantify the pervasive effect of the disorder others aim to determine the physiological strain derived from the patient’s depressive state. The other types of statements verify if any psychomotor disturbances or agitation is present, such as wringing the hands or biting the nails. The fourth type of statement is a catch-all to see if other problems may exist.

    Comparison Of Screening Results

    Calculations of sensitivity and specificity for the different scales can be misleading because they depend on the cut-off scores utilised. Using the cut-offs recommended by the scale authors, the DASS scales have superior specificity but the Zung scales have greater sensitivity. However, further investigation revealed that, by modifying the Zung cut-off scores, a similar balance between sensitivity and specificity to that offered by the DASS subscales could be obtained. Specifically, with the cut-off for a depression diagnosis set at an index score of 55 , the SDS has a sensitivity of 80% and a specificity of 82% . Similarly, with the cut-off for an anxiety diagnosis set at an index score of 50 , the SAS has a sensitivity of 72% and a specificity of 84% .

    These results can also be expressed in terms of the numbers of Misses and False Positives that occur with each scale. Using the revised cut-offs for the Zung scales suggested above, the results for depression are as follows: 12 misses and 58 false positives on the SDS, 10 misses and 49 false positives on the DASS depression subscale. For anxiety there are 15 misses and 50 false positives on the SAS, and 14 misses and 50 false positives on the DASS anxiety subscale. Figures and detail the relative overlap between positive diagnoses on the PHQ and positive screens on the DASS and Zung measures using these revised cut offs.

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    Sensitivity And Specificity Of The Norm

    Sensitivity and specificity analyses were conducted for the norm-referenced measures using PHQ criteria for depressive and anxiety disorders. . For the DASS Depression and Anxiety Subscales, analyses used the mild severity levels recommended by Lovibond and Lovibond as the cut-off. For the SDS and SAS, the cut-off points recommended by Zung were used: an index score of 50 and above for depression, and an index score of 45 and above for anxiety.

    With respect to depressive disorders, the DASS subscale recorded 84% for both sensitivity and specifity. The SDS, on the other hand, had a sensitivity of 93% and specificity of 69%. With respect to anxiety disorders, the DASS subscale had 74% sensitivity and 84% specificity, whereas the SAS registered 89% sensitivity and 69% specificity.

    For comparison, calculations were also made using the incorrect cut-off points mistakenly applied in a number of past studies . This reduced the sensitivity of the SDS to 56% and that of the SAS to 31% .

    Effects Of Rls On Patients Mental Health

    Zung Self

    Impact on Mood

    In 2005, Picchietti and Winkelman reviewed studies showing an association between the symptoms of RLS and worsened mental health, particularly symptoms of anxiety and depression. Their review described findings from population-based surveys and studies of patients with RLS. People in a representative population who had the diagnostic symptoms of RLS had a higher prevalence of depressive symptoms and lower self-reported mental health scores on the SF-36. In a survey of men, respondents with the symptoms of RLS were more likely to report depressed mood and to complain of decreased libido in comparison with population norms. In a large survey using standard rating scales â the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale â people with RLS had significantly higher total scores on the HAM-A and HAM-D than matched controls . Scores on most individual items of the HAM-A and HAM-D were also significantly higher in people with RLS symptoms than in controls. Moreover, scores on these two rating scales were positively correlated with the severity of RLS symptoms, whereas the presence of other comorbid diseases had no effect on anxiety and depression scores. It was concluded that the presence of more severe RLS symptoms was the major determinant for the anxiety and depression.

    Diagnoses of Mood Disorders, Including Suicidal Ideation

    Table 1. Symptoms of depression, generalized anxiety, and RLS


    Robin J. Tyacke, … David J. Nutt, in, 2010

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    Depression Scales Developed With Mixed

    The Beck Depression Inventory includes 21 items, each including four alternative statements ranging in order of severity from zero to three. Conventional cutoffs are 0â9 for normal range, 10â18 for mild to moderate depression, 19â29 for moderate to severe depression, and 30â63 for severe depression . For the 13-item short form , 0â4 corresponds to none or minimal depression, 5â7 to mild depression, 8â15 to moderate depression, and 16 or higher to severe depression.

    The BDI has demonstrated test-retest and split-half reliability as well as concurrent validity with older adults . With a cutoff of 10, the BDI has shown good efficiency with older depressed psychiatric outpatients . In a sample seeking outpatient mental health services, Kogan, Kabacoff, Hersen, and Van Hasselt found that a cutoff of 22 maximized efficiency, yielding 64% sensitivity and 73% specificity.

    The BDI has good efficiency in older medical outpatients and medical inpatients . Cognitively impaired individuals have been found to have difficulty comprehending the format and the BDI may be less sensitive to detecting major depression in older men when compared with older women .

    The other conspicuous feature of the BDI lies in its inclusion of somatic symptoms. Zemore and Eames demonstrated that age differences on the BDI could be explained entirely by the somatic symptoms, with no age differences on the more cognitive symptoms.

    P.M. Becker, in, 2013

    Icipants Reaching Diagnostic Criteria On The Phq

    Across the combined sample, 61 participants reached the PHQ diagnostic criteria for some form of depressive disorder and 54 for some form of anxiety disorder. Of those satisfying the criteria for a depressive disorder, 43 met the criteria for a Major Depressive Disorder . Of those satisfying the criteria for an anxiety disorder, 25 met the criteria for Panic Disorder, and 35 the criteria for Other Anxiety Disorder. Levels of comorbidity between anxiety and depressive disorders were considerable with 31 of the above participants suffering from both a depressive and an anxiety disorder. These participants were predominantly from the clinical sample .

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    Assigning Clinical Significance And Symptom Severity Using The Zung Scales: Levels Of Misclassification Arising From Confusion Between Index And Raw Scores

    Debra A. Dunstan

    1School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW 2351, Australia


    Background. The Zung Self-Rating Depression Scale and Self-Rating Anxiety Scale are two norm-referenced scales commonly used to identify the presence of depression and anxiety in clinical research. Unfortunately, several researchers have mistakenly applied index score criteria to raw scores when assigning clinical significance and symptom severity ratings. This study examined the extent of this problem. Method. 102 papers published over the six-year period from 2010 to 2015 were used to establish two convenience samples of 60 usages of each Zung scale. Results. In those papers where cut-off scores were used , up to 51% of SDS and 45% of SAS papers involved the incorrect application of index score criteria to raw scores. Inconsistencies were also noted in the severity ranges and cut-off scores used.. A large percentage of publications involving the Zung SDS and SAS scales are using incorrect criteria for the classification of clinically significant symptoms of depression and anxiety. The most common errorapplying index score criteria to raw scoresproduces a substantial elevation of the cut-off points for significance. Given the continuing usage of these scales, it is important that these inconsistencies be highlighted and resolved.

    1. Introduction


    2. Method

    3. Results




    4. Discussion

    Conflicts of Interest


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