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$20%prin&0'/appendi(/
Zung Self-Rating Depression Scale (Zung SDS)
). ). *. +un&
,odified from: Rush J, et a-, psychiatric ,easures, #.#, )ashin&ton, /0, 2000.
GOALS
1he +un& %e-f2Ratin& /epression %ca-e 3+un& %/%4 3+un& 1954 6as deve-oped as a
se-f2administered measure of depression severity. 1he author intended the sca-e to be a--2
inc-usive 6ith respect to symptoms of the i--ness but a-so short, simp-e, and 7uantitative.
8tems 6ere se-ected to tap affective, co&nitive, behaviora-, and physio-o&ica- aspects of
depression. 8tems 6ere se-ected on the basis of the dia&nostic criteria for depression and
factor ana-ytic studies avai-ab-e at the time the sca-e 6as deve-oped. #-thou&h there is
covera&e for most /%,289 symptom criteria, no items c-ear-y cover psychomotor
retardation or symptoms that are more common in atypica- depressions, such as increased
appetite, 6ei&ht &ain, or hypersomnia.
DESCRIPTIO
1he ori&ina- form of the +un& %/% 3+un& 1954 contains 20 items, 6ith 10 items keyed
ne&ative-y and 10 positive-y. :or each item, the sub;ect rates 6hether the item occurred 1
< a -itt-e of the time, 2 < some of the time, = < a &ood part of the time, or " < most of the
time. 1he time frame is the present. %amp-e items are provided in >(amp-e 2" ?!.
# revised version that appears in the >ar-y 0-inica- /ru& >va-uation .ro&ram 3>0/>@4
manua- 3Auy 19!54 chan&es the 6ordin& of t6o items, adds a ratin& of 0 < none of the
time, and e(tends the time frame to the past 6eek. # companion intervie6 version of the
+un& %/%, ca--ed the /epression %tatus 8nventory, is a-so &iven in the >0/>@ manua-.
1o obtain a tota- severity score, positive items are reversed, and then a-- items are
summed. +un& %/% scores are interpreted as fo--o6s: B0, 6ithin norma- ran&eC 0?9,
minima- to mi-d depressionC 50?59, moderate to severe depressionC D!0, severe
depression. # severity inde( may be ca-cu-ated by dividin& the tota- score by '0 3the tota-
possib-e4.
PRACTICAL ISS!ES
1he +un& %/% can be comp-eted in minutes by hi&her2functionin& patients, a-thou&h it
may take up to =0 minutes to comp-ete, dependin& on patient patho-o&y. 1he instrument
and instructions for scorin& it appear in the ori&ina- artic-e 3+un& 1954. Eater versions
are inc-uded in the >0/>@ manua- 3Auy 19!54. 1here are no trainin& re7uirements. 1he
+un& %/% has been used in a variety of other countries. 0ross2cu-tura- va-idation studies
are avai-ab-e from /utch, :innish, Fmon&, and Japanese investi&ations. Gther
trans-ations have been used in studies in #ustria, 0Hechos-ovakia, :rance, Aermany, 8ran,
8ta-y, .o-and, %6eden, and 9eneHue-a 3Nau&hton and )ik-und 199=4.
PS"C#O$ETRIC PROPERTIES
Re-iabi-ity
%p-it2ha-f re-iabi-ity studies in a psychiatric popu-ation found a corre-ation 3r4 of 0.!=
3+un& 19!24. 8n a community survey of 1,1!= sub;ects, 0ronbachIs a-pha 6as
satisfactory at 0.!9 3*ni&ht et a-. 19'=4.
9a-idity
8n samp-e of 19 outpatients, there 6ere no si&nificant corre-ations bet6een +un& %/%
tota- score and a&e, se(, marita- status, educationa- -eve-, financia- status, or inte--i&ence
-eve- 3+un& 195!4. # si&nificant corre-ation 6as found 6ith the ,innesota ,u-tiphasic
.ersona-ity 8nventory /epression %ca-e 3,,.82/4 3r < 0.54. 8n a study of "1 depressed
outpatients 3Ji&&s et a-. 19!'4, there 6ere stron& corre-ations bet6een the +un& %/% and
the Fami-ton Ratin& %ca-e for /epression 3Fam2/4 3ran&e of r is 0.5'?0.!54 durin&
treatment 6eeks 2, ", and 5 but not at study intake 3r < 0."4. 0orre-ations 6ere hi&her
6hen Fam2/ scores 6ere be-o6 10 3r < 0.5=4 and -o6est 6hen Fam2/ scores 6ere
above 20 3r < 0."4. #s an indicator of sensitivity to chan&e, +un& 31954 reported that
the mean +un& %/% inde( scores in depressed patients before and after treatment 6ere
0.!= and 0.=9, respective-y. Ji&&s et a-. 319!'4 reported a corre-ation 3r4 of 0.5= bet6een
chan&e on the Fam2/ and chan&e on the +un& %/% in a 526eek treatment tria-. Fo6ever,
in a revie6 of dru& treatment studies, ,oran and Eambert 319'=4 identified five studies
that used the +un& %/% in comparison 6ith another symptom measureC the +un& %/%
6as not found to be more sensitive to chan&e than the comparison too- in any of these
studies. 1hus, sensitivity to chan&e over time is -o6 compared 6ith other avai-ab-e
measures 3inc-udin& the Jeck /epression 8nventory KJ/8 L and the Fam2/. +un& 31954
reported a ran&e of +un& %/% inde( scores from 0.5= to 0.90 6ith a mean of 0.!" 3tota-
score e7uiva-ent of 94 in depressed outpatients, 6hereas hospita- staff contro- sub;ects
sho6ed a ran&e of 0.2?0."= 6ith a mean of 0.== 3tota- score e7uiva-ent of 254. 1hus,
+un& %/% scores discriminated depressed from nondepressed samp-es. 8n a study of
depression sub&roups, ,aes et a-. 319''4 found that patients 6ith minor depression
accordin& to the /%,2888 criteria sho6ed -o6er +un& %/% scores than those 6ith ma;or
depressive disorder, and those 6ith ma;or depressive disorder 6ith me-ancho-ic or
psychotic features sho6ed hi&her +un& %/% scores than either of the other t6o &roups.
,ean tota- scores for five dia&nostic &roups 6ere as fo--o6s 3Auy 19!54: 5 for
depressive disorders 3n < 954, = for an(iety disorders 3n < 224, "' for transient
situationa- disorder 3n < 124, 2 for schiHophrenia 3n < 24, and 5 for persona-ity
disorders 3n < "4. 1hus the +un& %/% is a non?dia&nostica--y specific indicator of
depressive symptomato-o&y.
CLIICAL !TILIT"
1he +un& %/% is a popu-ar too- used to rate the severity of depressive symptoms in
patients 6ith dia&nosed depressive i--nesses. .sychometric data documentin& the
re-iabi-ity of the measure are sparse, but those that e(ist sho6 &ood interna- consistency.
9a-idity studies sho6 that the +un& %/% is sensitive to differences in severity of
symptoms across sub&roups of patients 6ith dia&nosed unipo-ar depression but is -ess
sensitive to chan&e in symptoms over time than other measures. /ifficu-ties in sensitivity
appear more often in the upper ran&es of the sca-eC better resu-ts are obtained at mi-d or
moderate severity -eve-s. #-thou&h deve-oped for use in patient popu-ations, the +un&
%/% has a-so been used in primary care and community settin&s and as a screen for
depression 3,eakin 19924. #s a screenin& too-, the performance of the +un& %/% is
simi-ar to that of the J/8, the Fospita- #n(iety and /epression %ca-e 3F#/%4, and the
Aenera- Fea-th Muestionnaire 3AFM4C none are idea- for this purpose 3,eakin 19924.
1he advanta&es of the +un& %/% are that it is simp-e and easy to use and that it has been
6ide-y used. 1he disadvanta&es are that it -acks covera&e of the symptoms common in
atypica- depressions, such as hyperpha&ia and hypersomnia, and that it may be -ess
sensitive to chan&e than other avai-ab-e sca-es.
RE%ERECES AD S!GGESTED READIGS
Ji&&s J1, )y-ie E1, +ie&-er 9>: 9a-idity of the +un& %e-f2Ratin& /epression %ca-e. Jr J
.sychiatry 1=2:='1?=', 19!'
Auy ): >0/>@ #ssessment ,anua- of .sychopharmaco-o&y NRevised 3/F>) .ub-
No #/, !52=='4. Rockvi--e, ,/, @.%. /epartment of Fea-th, >ducation, and )e-fare,
.ub-ic Fea-th %ervice, #-coho-, /ru& #buse, and ,enta- Fea-th #dministration, N8,F
.sychopharmaco-o&y Research Jranch, /ivision of >(tramura- Research .ro&rams, 19!5
*ni&ht RA, )aa-2,annin& J, %pears A:: %ome norms and re-iabi-ity data for the %tate2
1rait #n(iety 8nventory and the +un& %e-f2Ratin& /epression %ca-e. Jr J 0-in .sycho-
22:2"?2"9, 19'=
,aes ,, /eRuyter ,, %uy >: %e-f2rated depression in re-ation to /%,2888 c-assification:
a statistica- iso-inear mu-tip-e components ana-ysis. #cta .sychiatr %cand !!:2!?=1,
19''
,eakin 0: %creenin& for depression in the medica--y i--. Jr J .sychiatry 150:212?215,
1992
,oran .), Eambert ,J: # revie6 of current assessment too-s for monitorin& chan&es in
depression, in 1he #ssessment of .sychotherapy and Gutcomes. >dited by Eamber ,/,
0hristiensen >R, /e;o-ie %%. Ne6 Oork, )i-ey, 19'=, pp 25=?=0=
Nau&hton ,J, )ik-und 8: # critica- revie6 of dimension2specific measures of hea-th2
re-ated 7ua-ity of -ife in cross2cu-tura- research. Mua- Eife Res 2:=9!?"=2, 199=
+un& ))*: # se-f2ratin& depression sca-e. #rch Aen .sychiatry 12:5=?!0, 195
+un& ))*: :actors inf-uencin& the %e-f2Rated /epression %ca-e. #rch Aen .sychiatry
15:"=?"!, 195!
+un& ))*: 1he depression status inventory: an ad;unct to the %e-f2Ratin& /epression
%ca-e. J 0-in .sycho- 2':=9?"=, 19!2