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J Affect Disord. 2017 Jan 15;208:191-197. doi: 10.1016/j.jad.2016.10.019. Epub 2016 Oct 21.

The 52 symptoms of major depression: Lack of content overlap among seven common depression scales.

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University of Amsterdam, Department of Psychology, Nieuwe Achtergracht 129-B, room G0.28, 1001NK Amsterdam, The Netherlands. Electronic address:



Depression severity is assessed in numerous research disciplines, ranging from the social sciences to genetics, and used as a dependent variable, predictor, covariate, or to enroll participants. The routine practice is to assess depression severity with one particular depression scale, and draw conclusions about depression in general, relying on the assumption that scales are interchangeable measures of depression. The present paper investigates to which degree 7 common depression scales differ in their item content and generalizability.


A content analysis is carried out to determine symptom overlap among the 7 scales via the Jaccard index (0=no overlap, 1=full overlap). Per scale, rates of idiosyncratic symptoms, and rates of specific vs. compound symptoms, are computed.


The 7 instruments encompass 52 disparate symptoms. Mean overlap among all scales is low (0.36), mean overlap of each scale with all others ranges from 0.27 to 0.40, overlap among individual scales from 0.26 to 0.61. Symptoms feature across a mean of 3 scales, 40% of the symptoms appear in only a single scale, 12% across all instruments. Scales differ regarding their rates of idiosyncratic symptoms (0-33%) and compound symptoms (22-90%).


Future studies analyzing more and different scales will be required to obtain a better estimate of the number of depression symptoms; the present content analysis was carried out conservatively and likely underestimates heterogeneity across the 7 scales.


The substantial heterogeneity of the depressive syndrome and low overlap among scales may lead to research results idiosyncratic to particular scales used, posing a threat to the replicability and generalizability of depression research. Implications and future research opportunities are discussed.


Content analysis; Major depression; Measurement; Scales; Symptom overlap

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