Summary

The Depression Thermometer (from the Emotion Thermometers) is a simple single item visual analogue screening tool for detection and monitoring of depression in clinical practice and research. It was created by Dr Alex Mitchell and is easy for most patients to understand, quick  to administer and score. It is currently royalty free for (departmental) clinical use and for unfunded research (but please request permission via email to ajm80@le.ac.uk).

Background

In 1998 the Distress Thermometer (DT) was developed and validated for evaluation of distress (and anxiety and depression) in cancer [NCCN c/oRoth et al, 1998]. In 2007 we piloted and validated an extension of the DT called the Emotion Thermometers Tool. This is a new five dimensional tool retaining the convenience of the innovative DT but with superior accuracy. It comprises five visual analogue scales in the form of four predictor domains (distress, anxiety, depression, anger) and one outcome domain (need for help).

Following several requests we now make available the single item DepT visual-analogue tool. This is rated on an 11 point (0 to 10) Likert scale in a visual thermometer. We found that the tool takes about 20 seconds (compared to about 20 seconds for the DT) for most patients. Validation is included in our papers of the ET here

Mitchell AJ, Baker-Glenn EA, Symonds P.

Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool. Psychooncology. 2010 Feb;19(2):125-33

Mitchell AJ, Baker-Glenn EA, Park B, Granger L, Symonds P.

Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers? Psychooncology. 2010 Feb;19(2):134-140

Tool Download

Download PDF Original Version

Validation (based on the ET full version)

In our study in the Leicester Cancer Centre, 11.5% of people scored three or below on all ET domains and 69.3% scored four or above on at least one domain. Against the HADS depression scale, the optimal thermometer was the depression thermometer (sensitivity 60% specificity 78%). Finally, against the DSM-IV diagnosis of major depression the optimal thermometer was the depression thermometer sensitivity 80% specificity 79%) but no single method had good positive predictive value (PPV). Further improvements can be made by adjusting the cut-offs particularly for detection of anxiety (AnxT ROC = 0.867 at a cut-off of 5v6) and detection of depression (DepT ROC = 0.751 at a cut-off 4v5).

Validation Posters

We have published a series of posters on the ET at the IPOS and APOS conferences 2010-2012.

IPOS2010 Poster 130 (defining ET thresholds) | IPOS2010 Poster 131 (defining ET reliability) | IPOS2010 Poster 131 (ET re-validation) | APOS2011 Poster 153 (ET Re-validation vs depression)

Copyright

The tool is subject to copyright (c) Alex J Mitchell but freely available (royalty free) for non-commercial and clinical use.

If this (or related) tools are useful please consider donating to help with our research

Current Research on the DepT

We welcome collaborations with other groups who are interested in using the ET for research. The following groups have sought permission to study the ET in various settings

FAQ on the Dep

Q. Has the DepT been validated?

A. Yes in cancer (incl small palliative subsample), neurology (epilepsy) and misc cardiovascular disease

Q. Can the DepT be used clinically without permission?

A. Yes, it is royalty free for clinical use at the current time

Q. Can the DepT be used for research without permission?

A. No, please write to me with the title and duration of your proposed project. It is likely I will grant permission.

Q. Is the DepT available with addition thermometer domains?

A. Yes there is a modular ET (ET_mod) which optionally adds customised assessments of QoL, function, pain.

Q. Is the DepT sensitive to change?

A. Usually VAS are sensitive to change, but this requires formal study

Q. What is the best cut off on the DepT ?

A. Please refer to the validation papers, but be aware fixed cut-offs are somewhat arbitrary, and may require study in your setting

Q. How long does the DepT take to administer

A. Usually about 20-30seconds

Q. Has the DepT been translated into.....my language?

A. Probably not, please consider doing this and sending us your version

Q. Can the DepT be read out for those with visual (or other) impairment?

A. Yes but this really requires separate validation

Q. What should happen when someone scores above threshold?

A. We recommend a further assessment for clinical depression is made along with clarification of unmet needs, but this is a local decision

Q. How does the DepT compare to  the HADS

A. We have the data on this for analysis

Q. How easy is it to adopt the DepT into a screening programme delivered by cancer clinicians?

A. Please feel free to use our screening programme form and see our new paper on this (submitted)

Q. Can the DepT be computerised to automated screening?

A. Certainly, but no one has done this yet