Scale-based protocols for the detection and management of depression

Despite evidence for the potential effectiveness of self-rating scales in the detection and management of depressive illness in primary care, they have not been as widely adopted as has been hoped. This may reflect views on their clinical utility when administered in isolation as opposed to being incorporated into a management protocol. More elaborate and sophisticated methods of improving the detection and management of depressive illness in primary care are available, such as educational programmes and management protocols based on clinical practice guidelines and computerized packages. However, these methods are either expensive or may have variable take up, as primary health care staff may not always find it possible to attend training programmes. Hence, there is increasing interest in the use of more widely accessible and possibly briefer approaches to this problem. One potential avenue that deserves further attention is the use of very brief protocols which have self-rated scales as a central part. This approach is discussed in this paper and work in progress with a new self-rating scale for depression, the Brief Depression Scale, is used for illustrating this approach.