BackgroundWhile the gold standard for the diagnosis of mental disorders remains the structured clinical interview, self-report measures continue to play an important role in screening and measuring progress, as well as being frequently employed in research studies. Two widely-used self-report measures in the area of depression and anxiety are Zung’s Self-Rating Depression Scale (SDS) and Self Rating Anxiety Scale (SAS). However, considerable confusion exists in their application, with clinical cut-offs often applied incorrectly. This study re-examines the credentials of the Zung scales by comparing them with the Depression Anxiety Stress Scale (DASS) in terms of their ability to predict clinical diagnoses of anxiety and depression made using the Patient Health Questionnaire (PHQ).MethodA total sample of 376 adults, of whom 87 reported being in receipt of psychological treatment, completed the two-page version of the PHQ relating to depression and anxiety, together with the SDS, the SAS and the DASS.ResultsOverall, although the respective DASS scales emerged as marginally stronger predictors of PHQ diagnoses of anxiety and depression, the Zung indices performed more than acceptably in comparison. The DASS also had an advantage in discriminative ability. Using the current recommended cut-offs for all scales, the DASS has the edge on specificity, while the Zung scales are superior in terms of sensitivity. There are grounds to consider making the Zung cut-offs more conservative, and doing this would produce comparable numbers of ‘Misses’ and ‘False Positives’ to those obtained with the DASS.ConclusionsGiven these promising results, further research is justified to assess the Zung scales ability against full clinical diagnoses and to further explore optimum cut-off levels.

Background: Zung's Self-rating Anxiety Scale (SAS) is a norm-referenced scale which enjoys widespread use a screener for anxiety disorders. However, recent research Scott N, Depress Res Treat 2018:9250972, 2018) has questioned whether the existing cut-off for identifying the presence of a disorder might be lower than ideal. Method: The current study explored this issue by examining sensitivity and specificity figures against diagnoses made on the basis of the Patient Health Questionnaire (PHQ) in clinical and community samples. The community sample consisted of 210 participants recruited to be representative of the Australian adult population. The clinical sample consisted of a further 141 adults receiving treatment from a mental health professional for some form of anxiety disorder. Results: Mathematical formulas, including Youden's Index and the Receiver Operating Characteristics Curve, applied to positive PHQ diagnoses (presence of a disorder) from the clinical sample and negative PHQ diagnoses (absence of a disorder) from the community sample suggested that the ideal cut-off point lies between the current and original points recommended by Zung.Conclusions: Consideration of prevalence rates and of the potential costs of false negative and false positive diagnoses, suggests that, while the current cut-off of 36 might be appropriate in the context of clinical screening, the original raw score cut-off of 40 would be most appropriate when the SAS is used in research.

Background Zung’s Self-rating Depression Scale (SDS) is an established norm-referenced screening measure used to identify the presence of depressive disorders in adults. Despite widespread usage, issues exist concerning the recommended cut-off score for a positive diagnosis. First, confusion arising from the conversion of raw scores to index scores had resulted in a considerably higher cut-off score than that recommended being used by many researchers. Second, research in China [Chin J Nervous Mental Dis. 12:267-268; 2009] and Australia [BMC Psychiatry. 17:329; 2017] had suggested that the current recommended cut-off is lower than ideal, at least in those countries. Method To explore these matters further, sensitivity and specificity figures for alternative cut-off points were examined in positive clinical and negative community samples respectively. The positive clinical sample ( n = 57) consisted of adults receiving treatment from a medical professional for some kind of depressive disorder, whose diagnosis was positively confirmed using the Patient Health Questionnaire (PHQ). The negative community sample ( n = 172) was derived from a representative sample of adults whose absence of any depressive disorder was similarly confirmed by the PHQ. Results Mathematical models, including Youden’s Index and the Receiver Operating Characteristics Curve, suggest that the recommended cut-off (a raw score of 40) is indeed too low. More detailed comparisons, including consideration of the likely numbers of false positives and negatives given prevalence rates, confirm that, ironically, the incorrect SDS cut-off score mistakenly applied by many researchers (a raw score of 50) would appear to provide far greater accuracy. Conclusions Research in China [Chin J Nervous Mental Dis. 12:267-268; 2009] has resulted in an elevated SDS cut-off score of 42 being used in many Chinese studies. Research by Dunstan and Scott [BMC Psychiatry. 17:329; 2017] in an Australian context, suggested that a greater increase, to a raw score of 44 might be required. Based on this study, an even larger adjustment is required. Specifically, we recommend the use of an SDS raw score of 50 as the cut-off point for clinical significance.

Background The Zung Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) are two norm-referenced scales commonly used to identify the presence of depression and anxiety in clinical research. Unfortunately, several researchers have mistakenly applied index score criteria to raw scores when assigning clinical significance and symptom severity ratings. This study examined the extent of this problem. Method 102 papers published over the six-year period from 2010 to 2015 were used to establish two convenience samples of 60 usages of each Zung scale. Results In those papers where cut-off scores were used (i.e., 45/60 for SDS and 40/60 for SAS), up to 51% of SDS and 45% of SAS papers involved the incorrect application of index score criteria to raw scores. Inconsistencies were also noted in the severity ranges and cut-off scores used. Conclusions A large percentage of publications involving the Zung SDS and SAS scales are using incorrect criteria for the classification of clinically significant symptoms of depression and anxiety. The most common error—applying index score criteria to raw scores—produces a substantial elevation of the cut-off points for significance. Given the continuing usage of these scales, it is important that these inconsistencies be highlighted and resolved.

Eating disorders have proved resistant to therapy with high relapse rates. Enhanced cognitive behavior therapy (CBT-E) is the favored treatment of choice but has been criticized for placing a similar emphasis on controlling eating behavior as the psychopathology it seeks to counter. In contrast, narrative therapy focuses on the development of an anti-eating disorder lifestyle and values. Evidence for this approach primarily consists of informal case study material. This case study describes a 28-year-old woman with a recurring history of anorexia nervosa, who selfreferred to a university psychology clinic, due to fears of imminent relapse. The client received 10 sessions of narrative therapy and made significant progress in externalizing her eating disorder, in lessening her adherence to the ascetic values underpinning it, and in developing/ expressing her non-eating disorder character and values. This case study provides evidence of the potential effectiveness of narrative therapy and contains valuable learning for clinicians regarding its implementation.