11/13/24, 8\:09 PM Guide | Depression history

Depression history

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Tips

Some general tips 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"
appropriate than saying "Okay…
"
, however, be careful not to accidentally re-a
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.
Con
Ask the patient if they'd be happy to talk with you about their current issues.
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Presenting complaint

Use open questioning to explore the patient’s presenting complaint\:
" H o w a r e y o u t o d a y ?"
" H o w h a v e y o u b e e n f e e l i n g r e c e n t l y ?"
" W h a t’ s b r o u g h t y o u i n t o s e e m e t o d a y ?"
" T e l l m e a b o u t t h e i s s u e s y o u’ v e b e e n e x p e r i e n c i n g .
"
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presenting complaint if required\:
" O k , c a n y o u t e l l m e m o r e a b o u t t h a t ?"
Open questions can help the patient to explain how they are feeling, without placing words into their mouth or assuming a
speci

Screening for depression

Depression should be screened for in at-risk individuals (e.g. those with a history of depression or a chronic health problem
with secondary functional impairment).
NICE guidelines recommend the two depression identi
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" D u r i n g t h e p a s t m o n t h , h a v e y o u …
"
" B e e n b o t h e r e d b y f e e l i n g l o w , d e p r e s s e d o r h o p e l e s s ?"
" H a d l i t t l e i n t e r e s t o r p l e a s u r e i n d o i n g t h i n g s ?"
If there is an a
negative response to the questions does not exclude depression.

Exploring symptoms of depression

Biological symptoms

Sleep cycle disruption
Questions useful for exploring sleep disruption include\:
" H o w h a s y o u r s l e e p i n g p a t t e r n b e e n r e c e n t l y ?"
" H a v e y o u h a d a n y d i
" D o y o u
Low mood
Patients with depression typically experience persistent sadness/low mood on most days.
Explore the patient's recent mood\:
" H o w h a s y o u r m o o d b e e n r e c e n t l y ?"
" H o w o f t e n h a v e y o u f e l t s a d r e c e n t l y ?"
" A r e t h e r e a n y p a r t i c u l a r t i m e s o f d a y y o u n o t i c e y o u r m o o d i s w o r s e ?"
" D o e s y o u r m o o d v a r y t h r o u g h o u t t h e d a y ?"
Appetite changes
The appetite of patients with depression can be signi
" H a v e y o u n o t i c e d a c h a n g e i n y o u r a p p e t i t e ?"
" W h a t i s y o u r d i e t l i k e a t t h e m o m e n t ?"
" W h a t a r e y o u e a t i n g o n a t y p i c a l d a y ?"
Reduced libido
Patients with depression often experience reduced libido\:
https\://app.geekymedics.com/osce-guides/history/depression-history/ 2/611/13/24, 8\:09 PM Guide | Depression history
" H a v e y o u n o t i c e d a c h a n g e i n y o u r l i b i d o r e c e n t l y ?"
" S i n c e y o u h a v e b e e n f e e l i n g t h i s w a y , h a v e y o u n o t i c e d a d i
Fatigue
Patients with depression can have fatigue or loss of energy. They can also have slowed thoughts and movements\:
“ H a v e y o u f e l t m o r e t i r e d t h a n u s u a l r e c e n t l y ?”
“ H a v e y o u h a d r e d u c e d e n e r g y l e v e l s ?”
“ H a v e y o u n o t i c e d y o u a r e m o v i n g s l o w e r t h a n u s u a l ?”
“ H a v e y o u r t h o u g h t s b e e n s l o w e r t h a n u s u a l ?”

Cognitive symptoms

Screen for and assess the extent of any cognitive symptoms of depression.
Reduced concentration
Patients with depression typically exhibit reduced levels of concentration\:
" H o w a r e y o u r c u r r e n t l e v e l s o f c o n c e n t r a t i o n ?"
" C a n y o u f o l l o w T V p r o g r a m m e s / r e a d t h e n e w s p a p e r /* i n s e r t h o b b y h e r e*
w i t h o u t g e t t i n g d i s t r a c t e d ?"
Negative perception of current/future situation
Patients with depression typically demonstrate a negative perception of their current and future situation\:
" H o w d o y o u f e e l a b o u t y o u r c u r r e n t s i t u a t i o n ?"
" H o w d o y o u f e e l a b o u t t h e f u t u r e ?"
Negative perception of self
Patients with depression often exhibit a negative perception of themselves\:
" H o w d o y o u f e e l a b o u t y o u r s e l f ?"
" D o y o u o f t e n c r i t i c i s e y o u r s e l f ?"
" D o y o u b l a m e y o u r s e l f w h e n t h i n g s go w r o n g ?"
Depression questionnaires
A validated depression questionnaire may also be considered to assess the severity of depression and its impact on
functioning. A patient health questionnaire-9 (PHQ-9), hospital anxiety and depression scale (HADS), and Beck
depression inventory-II (BDI-II) are all validated for use in primary care.
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Assess suicide risk

Patients with depression are at an increased risk of suicide and self-harm. Therefore, assessment of an individual's risk is
essential to inform appropriate management.
Questions that can be useful to determine a patient's risk of suicide include\:
" W h e n p e o p l e f e e l d o w n a n d d e p r e s s e d , t h e y c a n f e e l t h a t l i f e i s n o l o n ge r w o r t h l i v i n g. " H a v e y o u h a d a n y t h o u g h t s o f t a k i n g y o u r l i f e ?"
" H o w o f t e n d o y o u t h i n k a b o u t t a k i n g y o u r l i f e ?"
" H a v e y o u t h o u g h t a b o u t h o w y o u w o u l d e n d y o u r l i f e ?"
" H a v e y o u m a d e a n y p l a n s t o e n d y o u r l i f e ?"
" H a v e y o u e v e r t r i e d t o t a k e y o u r o w n l i f e ?"
" H a v e y o u e v e r t h o u g h t a b o u t h u r t i n g y o u r s e l f ?
" H a v e y o u t r i e d t o h u r t y o u r s e l f i n a n y w a y ?"
" W h a t t h i n g s d o y o u f e e l s t o p y o u f r o m e n d i n g y o u r l i f e ?"
" A r e y o u d r i n k i n g a l c o h o l o r u s i n g r e c r e a t i o n a l d r u gs a t t h e m o m e n t ?"
" H a v e y o u f e l t a b l e t o s e e y o u r f r i e n d s a n d s o c i a l i s e r e c e n t l y ?"
H a v e y o u e v e r f e l t l i k e t h i s ?"
https\://app.geekymedics.com/osce-guides/history/depression-history/ 3/611/13/24, 8\:09 PM Guide | Depression history
See our suicide risk assessment guide for more details.

Other psychiatric diagnoses

It's important to consider other psychiatric diagnoses which may also present with depression, including\:
Bipolar disorder
Schizophrenia
Screen for features of mania suggestive of bipolar disorder\:
" H a v e y o u e v e r e x p e r i e n c e d p e r i o d s o f f e e l i n g p a r t i c u l a r l y h i gh , Screen for features of schizophrenia\:
e n e r g e t i c o r e u p h o r i c ?"
" H a v e y o u e v e r h e a r d v o i c e s s p e a k i n g w h e n t h e r e s e e m s t o b e n o o n e a r o u n d ?" (auditory hallucinations)
" D o y o u e v e r f e e l t h a t p e o p l e a r e d i s c u s s i n g y o u n e ga t i v e l y ?"
" D o y o u f e a r t h a t p e o p l e m a y b e o u t t o g e t y o u ?" (paranoia)
" H a v e y o u e v e r f e l t t h a t s o m e t h i n g o r s o m e o n e c a n p u t t h o u gh t s i n t o y o u r h e a d ?" (thought insertion)
" H a v e y o u e v e r f e l t t h a t s o m e t h i n g o r s o m e o n e c a n r e m o v e t h o u g h t s f r o m y o u r b r a i n ?" (thought withdrawal)
" H a v e y o u e v e r f e l t t h a t s o m e t h i n g o r s o m e o n e c a n h e a r y o u r t h o u g h t s ?" (thought broadcasting)
" H a v e y o u n o t i c e d a n y s e n s a t i o n s t h a t s e e m o d d o r i n e x p l i c a b l e ?" (tactile hallucinations)

Past psychiatric history

Previous episodes of depression\:
" H a v e y o u e v e r h a d a n y o t h e r p e r i o d s o f f e e l i n g p a r t i c u l a r l y l o w ?"
" H a v e y o u e v e r b e e n t o l d y o u h a v e d e p r e s s i o n i n t h e p a s t ?"
" H a v e y o u e v e r r e c e i v e d a n y t r e a t m e n t ( s ) f o r d e p r e s s i o n i n t h e p a s t a n d i f s o , General psychiatric history\:
" H a v e y o u p r e v i o u s l y h a d a n y p r o b l e m s w i t h y o u r m e n t a l h e a l t h ?"
" H a v e y o u e v e r b e e n d i a g n o s e d w i t h a p s y c h i a t r i c c o n d i t i o n ?"
" W h a t t r e a t m e n t ( s ) d i d y o u r e c e i v e f o r t h i s d i a g n o s i s , a n d d i d t h e y s e e m t o h e l p ?"
" H a v e y o u e v e r b e e n a d m i t t e d t o t h e h o s p i t a l b e c a u s e o f y o u r m e n t a l h e a l t h ?"
d i d t h e y h e l p ?"

Past medical history

Ask if the patient has any medical conditions\:
“ D o y o u h a v e a n y m e d i c a l c o n d i t i o n s ?”
“ A r e y o u c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e gu l a r l y ?”
Note any medical conditions which may directly cause mood disturbance through physiological mechanisms (e.g.
hypothyroidism).
Chronic illness is also a major risk factor for depression (e.g. chronic pain, cancer, etc).
Allergies
anaphylaxis).
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to the substance (e.g. mild rash vs

Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies\:
“ A r e y o u c u r r e n t l y t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s o r o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
https\://app.geekymedics.com/osce-guides/history/depression-history/ 4/611/13/24, 8\:09 PM Guide | Depression history
If the patient is taking prescribed or over the counter
medications, document the medication name, dose, frequency, form and route.
Ask the patient if they’re currently experiencing any side e
“ H a v e y o u n o t i c e d a n y s i d e e

Family history

Ask the patient if there is any family history of psychiatric disease in
" H a v e a n y o f y o u r p a r e n t s o r s i b l i n g s h a d p r o b l e m s w i t h t h e i r m e n t a l h e a l t h i n t h e p a s t ?"
" D o y o u k n o w w h a t t y p e o f m e n t a l h e a l t h p r o b l e m s t h e y h a d ?"
It may be useful to draw a genogram displaying this information.

Explore the patient’s social history to both understand their social context and identify potential psychiatric risk factors.
General social context
Explore the patient’s general social context, including\:
the type of accommodation they currently reside in (e.g. house, bungalow, homelessness) and if there are any adaptations to
assist them (e.g. stairlift)
who else the patient lives with and their personal support network
what tasks they can carry out independently and what they require assistance with (e.g. self-hygiene, housework, food
shopping)
Assess the impact of patient's depressive symptoms on their relationships and work\:
" H a s y o u r m o o d a
" A r e y o u a b l e t o s o c i a l i s e r e g u l a r l y w i t h o t h e r s ?"
" A r e y o u i n a r e l a t i o n s h i p a t t h e m o m e n t ? H a s t h i s b e e n a
" H a v e y o u t o l d a n y f r i e n d s / f a m i l y / a n y o n e h o w y o u f e e l ?"
" H a s y o u r m o o d a
" A r e y o u a b l e t o c o n c e n t r a t e o n t a s k s a t w o r k ?"
" H a s y o u r m o o d c a u s e d y o u t o t a k e a n y t i m e o
Ask about their s u p p o r t n e t w o r k . This is particularly important if the patient has expressed thoughts of self-harm/suicide\:
“ H a v e y o u s p o k e n t o a n y o n e a b o u t y o u r m e n t a l h e a l t h ?”
“ I f y o u d i d f e e l o v e r w h e l m e d o r v e r y l o w , i s t h e r e a n y o n e y o u f e e l y o u c o u l d g o t o o r t a l k t o ?”
Smoking
Record the patient’s smoking history, including the type and amount of tobacco used.
Patients with depression are twice as likely to smoke than patients without depression.
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Alcohol
Record the frequency, type and volume of alcohol consumed on a weekly basis.
This is important as alcohol can cause low mood, and there are interactions between alcohol and some antidepressants.
See our alcohol history taking guide for more information.
Recreational drug use
Ask the patient if they use recreational drugs, 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.
Gambling
Ask the patient if they gamble and if they feel this is a problem.
https\://app.geekymedics.com/osce-guides/history/depression-history/ 5/611/13/24, 8\:09 PM Guide | Depression history
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.
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Problematic gambling can be assessed via the Problem Gambling Severity Index (PGSI).

Insight

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 a loss of insight into their illness.
Some examples of questions which can be used to assess insight include\:
“ W h a t d o y o u t h i n k t h e c a u s e o f t h e p r o b l e m i s ?”
“ D o y o u t h i n k y o u h a v e a p r o b l e m a t t h e m o m e n t ?”
“ D o y o u f e e l y o u n e e d h e l p w i t h y o u r p r o b l e m ?”

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.

References

1. NICE. W h e n s h o u l d I s u s p e c t a d i a g n o s i s o f d e p r e s s i o n ? Revised June 2024. Available from\: [LINK].
2. NICE. H o w s h o u l d I a s s e s s a p e r s o n w i t h s u s p e c t e d d e p r e s s i o n ? Revised June 2024. Available from\: [LINK].
3. Action on Smoking and Health. S m o k i n g a n d m e n t a l h e a l t h . Published August 2019. Available from\: [LINK].
4. World Health Organisation. T h e e p i d e m i o l o g y a n d i m p a c t o f g a m b l i n g d i s o r d e r a n d o t h e r ga m b l i n g-r e l a t e d h a r m . 26-28 June 2017. Available from\: [LINK].
Published

Reviewer

Dr Katie Sissons
General Practitioner
Source\: geekymedics.com
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