The Zung self-rating depression scale is a tool to measure a person’s level of depression. Psychologists and psychiatrists may use the scale to assess people who may be experiencing this condition.

The Zung self-rating depression scale is a 20-item questionnaire that people complete themselves. It screens for symptoms that commonly relate to depression.

In the United States, depression is one of the most common mental health disorders.

In this article, we examine the Zung self-rating depression scale and how it works. We also look at its accuracy, how widely people use the scale, and other diagnostic tools for depression.

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Duke University psychiatrist Dr. William W. K. Zung was the inventor of the Zung depression scale, which he founded in 1965. The scale has not received an update since Zung’s original design.

It is a scale that health professionals may use to determine an adult’s level of depression.

A person completing the Zung self-rating scale will answer 20 statements about how often they feel a certain way. They can respond with:

  • a little of the time
  • some of the time
  • a good part of the time
  • most of the time

Some examples of the statements in the scale requiring a response include:

  • I feel downhearted and blue.
  • I have trouble sleeping at night.
  • My mind is as clear as it used to be.
  • I find it easy to do the things I used to do.
  • I feel hopeful about the future.
  • I am more irritable than usual.
  • I feel that I am useful and needed.
  • I feel that others would be better off if I were dead.
  • I eat as much as I used to.
  • I have crying spells or feel like it.

A person receives an overall score according to their responses to the statements. The scores and corresponding results are as follows:

  • less than 50: typical range
  • 50–59: mild depression
  • 60–69: moderate to marked depression
  • 70+: severe depression

A 2019 study assessed the validity of the Zung self-rating depression scale in an older Finnish population. The researchers concluded that the scale is effective in identifying severe depression.

However, a 2020 study looking at patients with psoriatic arthritis concluded that the Zung self-rating depression scale might not be the most effective form of assessing depression levels. The researchers determined that another method — the Hospital Anxiety and Depression Scale — may be the most efficient.

It seems as though the scale has worked better in certain populations and worse in others. If the scale suggests that a person might have depression, a health professional can then use tests and continued contact with them to make a diagnosis.

It is not clear how widely people use the Zung self-rating depression scale. However, there are translations of the scale into several languages, so it may be a tool that various countries use worldwide.

Additionally, the scale is available in multiple languages, including:

  • Arabic
  • Spanish
  • German
  • Dutch
  • Azerbaijani
  • Portuguese

In 2020, approximately 66% of individuals with major depressive episodes in the U.S. received treatment for the condition.

A doctor diagnoses depression after asking questions about a person’s symptoms and feelings. They will likely ask them to complete a self-assessment questionnaire such as the Zung self-rating depression scale.

Additionally, there are many different assessments besides this scale to determine someone’s level and severity of depression. Some examples of alternative assessments include:

  • Beck Depression Inventory: A self-assessment tool with 21 questions. People can choose between four responses, and a shorter 13-question version is also available.
  • Hamilton Rating Scale for Depression: This scale is not a self-assessment. A clinician will rate a person according to where they think they sit on the scale. It contains 17 questions.
  • Montgomery-Asberg Depression Rating Scale (MADRS): This includes 10 questions, and a person answers on a scale of 0–6. It determines the severity of a depressive episode.
  • Children’s Depression Inventory (CDI): This assessment is suitable for children aged 7–17 years. It has 27 questions, and a person can rate them on a scale from 0 to 2.

A person may have depression if they feel low for long periods. This feeling of sadness may also interfere with their day-to-day activities.

Some possible symptoms of depression may include:

  • a frequent or constant feeling of sadness or anxiety
  • a lack of motivation to partake in activities they previously enjoyed
  • irritability
  • feeling easily frustrated or restless
  • sleeping difficulties
  • excessive sleeping or waking early
  • eating habit changes or having a lack of appetite
  • pain, headache, aches, or stomach problems
  • concentration difficulties
  • memory issues
  • feeling tired, even after sleeping well
  • feelings of guilt, worthlessness, or helplessness
  • thoughts of suicide or self-harm

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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A person should contact a doctor if they think they may have depression. If feelings of sadness or hopelessness get in the way of daily activities, individuals can schedule an appointment with a doctor.

Many helplines are available if a person is in emotional distress or has concerns for their safety.

A person who thinks they might have depression may complete the Zung self-rating depression scale. It contains 20 questions, of which someone can choose from four responses. The responses determine an individual’s overall score, providing a potential depression severity level.

It is not clear how popular this scale is. There are also various other alternative assessment methods that doctors may recommend and use.

Depression may result in persistent feelings of sadness or hopelessness. If a person experiences symptoms of depression, they can contact a doctor.