Understanding Depression: DSM Criteria and the Role of the Mental Status Examination

Depression is a common mental health condition affecting millions worldwide, including one in seven Australians at some stage in life. It’s more than just feeling sad; depression is a complex illness with emotional, cognitive, and physical symptoms that can interfere with daily life. Recognising depression’s criteria and understanding tools like the Mental Status Examination (MSE) can be crucial in identifying and managing this condition effectively.

DSM-5 Criteria for Depression

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) outlines specific criteria for diagnosing Major Depressive Disorder (MDD), the most recognised form of depression. For a diagnosis, at least five of the following symptoms must be present for a minimum of two weeks, with at least one of the symptoms being a depressed mood or loss of interest in activities:

  1. Depressed Mood: Feeling sad, empty, or hopeless most of the day.

  2. Anhedonia: A marked loss of interest or pleasure in all, or nearly all, activities.

  3. Significant Weight Change or Appetite Disturbance: Noticeable weight loss or gain, or decrease/increase in appetite.

  4. Sleep Disturbances: Insomnia or hypersomnia (excessive sleeping) nearly every day.

  5. Psychomotor Changes: Agitation or retardation observed by others (e.g., restlessness or slowed movements).

  6. Fatigue or Loss of Energy: Persistent tiredness and lack of energy.

  7. Feelings of Worthlessness or Excessive Guilt: Negative self-view or irrational guilt.

  8. Impaired Concentration or Indecisiveness: Difficulty thinking, concentrating, or making decisions.

  9. Recurrent Thoughts of Death or Suicide: Suicidal ideation, plans, or attempts.

These symptoms must cause significant distress or impairment in social, occupational, or other areas of functioning and should not be attributable to substance use or another medical condition.

What is a Mental Status Examination (MSE)?

The Mental Status Examination (MSE) is a key clinical tool that helps clinicians assess a patient’s current mental state. It provides a structured way to evaluate a range of mental functions, giving insights that go beyond verbal reports. An MSE is typically conducted as part of a diagnostic interview to observe and note symptoms objectively, often complementing DSM criteria when diagnosing depression.

Key areas assessed in an MSE include:

  1. Appearance: Observing grooming, clothing, and hygiene, as they can indicate changes in self-care often seen in depression.

  2. Behavior: Includes mannerisms, eye contact, and psychomotor activity, which may reveal agitation or retardation.

  3. Speech: Tone, rate, volume, and fluency are examined. Depression may slow speech or result in low, soft-spoken communication.

  4. Mood and Affect: Mood is the patient’s self-reported emotional state, while affect is the clinician’s observation of their emotional expression, often restricted or flat in depression.

  5. Thought Process and Content: Checking for coherent thought processes and whether thoughts are negative, hopeless, or preoccupied with guilt or death.

  6. Cognition: Brief assessment of memory, attention, and concentration, which can be impaired in depression.

  7. Insight and Judgment: Reflects the patient’s understanding of their condition and ability to make safe decisions.

Why Both DSM Criteria and MSE are Important

The DSM criteria offer a standardized way to diagnose depression, but the MSE provides a real-time, nuanced understanding of a patient's mental state. Together, they guide effective treatment planning by ensuring an accurate diagnosis and a deeper comprehension of the patient’s day-to-day functioning. For individuals experiencing symptoms of depression, early intervention through these assessments can be a powerful step toward recovery, offering insights that inform therapy and medication options.

If you or someone you know is struggling with depression, seeking help through a GP, psychologist, or mental health service can lead to support, assessment, and tailored care.