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Revisiting the theoretical and methodological foundations of depression measurement

Nature Reviews Psychology volume 1, pages 358–368 (2022)Cite this article

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Abstract

Depressive disorders are among the leading causes of global disease burden, but there has been limited progress in understanding the causes of and treatments for these disorders. In this Perspective, we suggest that such progress depends crucially on our ability to measure depression. We review the many problems with depression measurement, including the limited evidence of validity and reliability. These issues raise grave concerns about common uses of depression measures, such as for diagnosis or tracking treatment progress. We argue that shortcomings arise because the measurement of depression rests on shaky methodological and theoretical foundations. Moving forward, we need to break with the field’s tradition, which has, for decades, divorced theories about depression from how we measure it. Instead, we suggest that epistemic iteration, an iterative exchange between theory and measurement, provides a crucial avenue for progressing how we measure depression.

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Fig. 1: Co-occurrence of 52 depression symptoms across 7 depression rating scales.
Fig. 2: Expected and empirical distributions of depressive symptoms.
Fig. 3: Simulated impact of low inter-rater reliability on diagnostic outcomes.

Data availability

Data underlying Figs 1,2 and 3 can be found at https://osf.io/7dp5s/.

Code availability

Code to reproduce Figs 1 and 2 (minus graphical edits performed by the journal art editor), and run the simulation underlying Fig. 3, can be found at https://osf.io/7dp5s/.

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Acknowledgements

The authors thank M.G. Wolf, N. Butcher and Z. Cohen for comments on earlier versions of this manuscript. E.I.F. is supported by funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant no. 949059). D.J.R. was supported by funding from the National Institute for Mental Health (K23 MH113805). The content is solely the responsibility of the authors and does not necessarily represent the views of any funding agency.

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Authors and Affiliations

  1. Department of Clinical Psychology, Leiden University, Leiden, The Netherlands

    Eiko I. Fried

  2. Department of Psychology, McGill University, Montreal, Québec, Canada

    Jessica K. Flake

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Donald J. Robinaugh

  4. Department of Applied Psychology, Northeastern University, Boston, MA, USA

    Donald J. Robinaugh

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  3. Donald J. Robinaugh
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E.I.F and D.J.R. developed the idea and outline for the manuscript, E.I.F. and D.J.R. conducted background research for the manuscript and all authors contributed to writing and revision of the manuscript.

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Fried, E.I., Flake, J.K. & Robinaugh, D.J. Revisiting the theoretical and methodological foundations of depression measurement. Nat Rev Psychol 1, 358–368 (2022). https://doi.org/10.1038/s44159-022-00050-2

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