Journal List > J Korean Neuropsychiatr Assoc > v.53(1) > 1017687

Moon, Sakong, Jung, Sung, Lee, Koo, Kim, Shin, Cho, Kim, Kim, Choi, Jung, and Kim: Development of Clinical Guideline for the Diagnosis and Evaluation of Depression: Focused on Evaluation Guideline



The aim of this study is to develop guideline for evaluation of depression.


Development of this guideline was processed according to the ADAPTE manual, which was developed for adaptation of good clinical practice guidelines. Important key questions were determined, and a systematic review of clinical practice guidelines was performed. The contents of guidelines selected by comparison of the methodological quality and currency were evaluated with regard to the applicability and acceptability. Answers to key questions and clinical recommendations were established by peer review.


Careful evaluations on the characteristics of depression, including subtype, severity, suicidality, and psychiatric and physical comorbidities were recommended because these factors can have an influence on course and prognosis in treatment of depression.


The results of this study may contribute to the systematic evaluation of depression, based on clinical importance. However, this guideline did not include systematic reviews regarding useful scales for evaluation of depression. In the future, amendment of this guideline might be needed in order to supplement limitations.

Figures and Tables

Figure 1
Proposed process for diagnosis and evaluation of depression. PHQ : Patients Health Questionnaire, HAMD : Hamilton Depression Rating Scale, MADRS : Montgomery Asberg Depression Rating Scale, BDI : Beck Depression Inventory, MINI : Mini International Neuropsychiatric Interview, ICSI : Institute for Clinical Systems Improvement, PDSQ : Psychiatric Diagnostic Screening Questionnaire, SCID-I : Structured Clinical Interview for DSM-IV Axis I Disorder, ICD-10 : International Statistical Classification of Diseases and Related Health, 10th revision.


1. Chen L, Eaton WW, Gallo JJ, Nestadt G. Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study. J Affect Disord. 2000; 59:1–11.
2. Merikangas KR, Wicki W, Angst J. Heterogeneity of depression. Classification of depressive subtypes by longitudinal course. Br J Psychiatry. 1994; 164:342–348.
3. Terao T. [Diagnosis and severity assessment of patients with depression]. Nihon Rinsho. 2007; 65:1614–1618.
4. Davis LL, Frazier E, Husain MM, Warden D, Trivedi M, Fava M, et al. Substance use disorder comorbidity in major depressive disorder: a confirmatory analysis of the STAR*D cohort. Am J Addict. 2006; 15:278–285.
5. Farabaugh A, Fava M, Mischoulon D, Sklarsky K, Petersen T, Alpert J. Relationships between major depressive disorder and comorbid anxiety and personality disorders. Compr Psychiatry. 2005; 46:266–271.
6. Egede LE. Effect of comorbid chronic diseases on prevalence and odds of depression in adults with diabetes. Psychosom Med. 2005; 67:46–51.
7. Kozhimannil KB, Pereira MA, Harlow BL. Association between diabetes and perinatal depression among low-income mothers. JAMA. 2009; 301:842–847.
8. Hall RC, Dunlap PK, Hall RC, Pacheco CA, Blakey RK, Abraham J. Thyroid disease and abnormal thyroid function tests in women with eating disorders and depression. J Fla Med Assoc. 1995; 82:187–192.
9. Pagliaro LA, Jaglalsingh LH, Pagliaro AM. Cocaine use and depression. CMAJ. 1992; 147:1636–1637.
10. Ros LT. Symptomatic depression after long-term steroid treatment: a case report. Afr J Med Med Sci. 2004; 33:263–265.
11. Bostwick JM, Pankratz VS. Affective disorders and suicide risk: a reexamination. Am J Psychiatry. 2000; 157:1925–1932.
12. Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry. 1960; 1:349–359.
13. Beautrais AL, Joyce PR, Mulder RT, Fergusson DM, Deavoll BJ, Nightingale SK. Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry. 1996; 153:1009–1014.
14. Roy A. Depression, attempted suicide, and suicide in patients with chronic schizophrenia. Psychiatr Clin North Am. 1986; 9:193–206.
15. Kim SY, Kim NS, Shin SS, Jee SM, Lee SJ, Kim SH, editors. Manual for Guideline Adaptation Ver 2.0. Seoul: National Evidence-based Healthcare Collaborating Agency;2011.
16. ICSI Health Care Guideline Working Group. Institude for Clinical System Improvement (ICSI) Health Care Guideline: Major Depression in Adults in Primary Care. 14th ed. Bloomington: Institute for Clinical Systems Improvement, Inc.;2011.
17. Kennedy SH, Lam RW, Parikh SV, Patten SB, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. Introduction. J Affect Disord. 2009; 117:Suppl 1. S1–S2.
18. National Institute for Health and Clinical Excellence. Depression: the Treatment and Management of Depression in Adults. London: National Institute for Health and Clinical Excellence;2009.
19. New Zealand Guidelines Group. Identification of Common Mental Disorders and Management of Depression in Primary Care. An Evidence-based Best Practice Guideline. Wellington: New Zealand Guidelines Group;2008.
20. Uher R, Dernovsek MZ, Mors O, Hauser J, Souery D, Zobel A, et al. Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline. J Affect Disord. 2011; 132:112–120.
21. Fava M, Rush AJ, Alpert JE, Balasubramani GK, Wisniewski SR, Carmin CN, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report. Am J Psychiatry. 2008; 165:342–351.
22. Elkin I, Gibbons RD, Shea MT, Sotsky SM, Watkins JT, Pilkonis PA, et al. Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol. 1995; 63:841–847.
23. Khan A, Leventhal RM, Khan SR, Brown WA. Severity of depression and response to antidepressants and placebo: an analysis of the Food and Drug Administration database. J Clin Psychopharmacol. 2002; 22:40–45.
24. Hirschfeld RM, Russell JM, Delgado PL, Fawcett J, Friedman RA, Harrison WM, et al. Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine. J Clin Psychiatry. 1998; 59:669–675.
25. Schmitt AB, Bauer M, Volz HP, Moeller HJ, Jiang Q, Ninan PT, et al. Differential effects of venlafaxine in the treatment of major depressive disorder according to baseline severity. Eur Arch Psychiatry Clin Neurosci. 2009; 259:329–339.
26. Friedman ES, Davis LL, Zisook S, Wisniewski SR, Trivedi MH, Fava M, et al. Baseline depression severity as a predictor of single and combination antidepressant treatment outcome: results from the CO-MED trial. Eur Neuropsychopharmacol. 2012; 22:183–199.
27. Claassen CA, Trivedi MH, Rush AJ, Husain MM, Zisook S, Young E, et al. Clinical differences among depressed patients with and without a history of suicide attempts: findings from the STAR*D trial. J Affect Disord. 2007; 97:77–84.
28. Kennedy SH, Milev R, Giacobbe P, Ramasubbu R, Lam RW, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies. J Affect Disord. 2009; 117:Suppl 1. S44–S53.
29. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder. 3rd ed. Washington, DC: American Psychiatric Association;2010.
30. Mueller TI, Lavori PW, Keller MB, Swartz A, Warshaw M, Hasin D, et al. Prognostic effect of the variable course of alcoholism on the 10-year course of depression. Am J Psychiatry. 1994; 151:701–706.
31. Fraguas R Jr, Iosifescu DV, Alpert J, Wisniewski SR, Barkin JL, Trivedi MH, et al. Major depressive disorder and comorbid cardiac disease: is there a depressive subtype with greater cardiovascular morbidity? Results from the STAR*D study. Psychosomatics. 2007; 48:418–425.
32. Yates WR, Mitchell J, John Rush A, Trivedi M, Wisniewski SR, Warden D, et al. Clinical features of depression in outpatients with and without co-occurring general medical conditions in STAR*D: confirmatory analysis. Prim Care Companion J Clin Psychiatry. 2007; 9:7–15.
33. Jiang W, Davidson JR. Antidepressant therapy in patients with ischemic heart disease. Am Heart J. 2005; 150:871–881.
34. Austin MP, Mitchell P, Wilhelm K, Parker G, Hickie I, Brodaty H, et al. Cognitive function in depression: a distinct pattern of frontal impairment in melancholia? Psychol Med. 1999; 29:73–85.
35. Schotte CK, Maes M, Cluydts R, Cosyns P. Cluster analytic validation of the DSM melancholic depression. The threshold model: integration of quantitative and qualitative distinctions between unipolar depressive subtypes. Psychiatry Res. 1997; 71:181–195.
36. Yang SJ, Stewart R, Kang HJ, Kim SY, Bae KY, Kim JM, et al. Response to antidepressants in major depressive disorder with melancholic features: the CRESCEND study. J Affect Disord. 2013; 144:42–50.
37. Kim JM, Kim SW, Stewart R, Kim SY, Yoon JS, Jung SW, et al. Predictors of 12-week remission in a nationwide cohort of people with depressive disorders: the CRESCEND study. Hum Psychopharmacol. 2011; 26:41–50.
38. Seo HJ, Jung YE, Kim TS, Kim JB, Lee MS, Kim JM, et al. Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression. J Nerv Ment Dis. 2011; 199:42–48.
39. van der Lem R, van der Wee NJ, van Veen T, Zitman FG. The generalizability of antidepressant efficacy trials to routine psychiatric outpatient practice. Psychol Med. 2011; 41:1353–1363.
40. Brådvik L, Mattisson C, Bogren M, Nettelbladt P. Long-term suicide risk of depression in the Lundby cohort 1947-1997--severity and gender. Acta Psychiatr Scand. 2008; 117:185–191.
41. Isometsä ET, Henriksson MM, Aro HM, Heikkinen ME, Kuoppasalmi KI, Lönnqvist JK. Suicide in major depression. Am J Psychiatry. 1994; 151:530–536.
42. Cho MJ, Chang SM, Hahm BJ, Chung IW, Bae A, Lee YM, et al. Prevalence and correlates of major mental disorders among Korean adults: a 2006 National Epidemiologic Survey. J Korean Neuropsychiatr Assoc. 2009; 48:143–152.
43. Jeon HJ, Lee JY, Lee YM, Hong JP, Won SH, Cho SJ, et al. Lifetime prevalence and correlates of suicidal ideation, plan, and single and multiple attempts in a Korean nationwide study. J Nerv Ment Dis. 2010; 198:643–646.
44. Park MH, Kim TS, Yim HW, Jeong SH, Lee C, Lee CU, et al. Clinical characteristics of depressed patients with a history of suicide attempts: results from the CRESCEND study in South Korea. J Nerv Ment Dis. 2010; 198:748–754.
45. Kim SW, Stewart R, Kim JM, Shin IS, Yoon JS, Jung SW, et al. Relationship between a history of a suicide attempt and treatment outcomes in patients with depression. J Clin Psychopharmacol. 2011; 31:449–456.
46. McIntyre RS, Alsuwaidan M, Goldstein BI, Taylor VH, Schaffer A, Beaulieu S, et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid metabolic disorders. Ann Clin Psychiatry. 2012; 24:69–81.
47. Jung JW, Kim HC, Sakong JK, Sung HM, Jung SW, Lee EJ, et al. Suicidality in major depressive disorder: the impact of psychiatric comorbidity. J Korean Neuropsychiatr Assoc. 2012; 51:85–92.
48. Kim JM, Stewart R, Bae KY, Yang SJ, Yoon JS, Jung SW, et al. Physical comorbidity and 12-week treatment outcomes in Korean patients with depressive disorders: the CRESCEND study. J Psychosom Res. 2011; 71:311–318.
49. Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008; 118:1768–1775.
50. Morris DW, Trivedi MH. Measurement-based care for unipolar depression. Curr Psychiatry Rep. 2011; 13:446–458.
Similar articles