According to the World Health Organization, an estimated 332 million people experience major depressive disorder worldwide. However, diagnosing depression comes with its challenges. While self-report questionnaires are essential, they rely on subjective information when it comes to measuring the diminished ability to think or concentrate that many people with depression experience.
Compared to questionnaires alone, digital cognitive assessments provide a fast, scalable way to measure cognitive symptoms for effective depression screening. By combining subjective input about the core symptoms of depression with objective data about cognition, these assessments can improve screening efficiency, produce reliable data, and enable long-term symptom tracking.
What Is Depression?
Major depressive disorder (MDD), often called depression, is a common but serious mental health disorder marked by persistent feelings of sadness, loss of interest, and a range of physical and cognitive symptoms.
Unlike certain intermittent feelings of sadness or grief, which are natural responses to particular life events, symptoms of clinical depression persist for weeks or months and significantly disrupt daily functioning. About 8.3% of U.S. adults have experienced at least one major depressive episode, but these must be recurring to be considered clinical depression.
While severe depression symptoms are debilitating and associated with crisis, mild or moderate depression can go unidentified without screening. However, when left undiagnosed or untreated, depression is associated with lower quality of life, increased risk of comorbid mental health disorders, and worsened physical symptoms of underlying health conditions like diabetes or hypertension.
It’s important to identify symptoms of mental health conditions like depression early and accurately in order to guide appropriate care and improve patient outcomes.
Common Symptoms of Major Depressive Disorder
Clinical depression has common symptoms that affect mood, cognition, and physical health, like:
- Persistent depressed mood or sadness
- Loss of interest or pleasure in activities
- Significant weight gain or weight loss unrelated to dieting
- Fatigue or loss of energy
- Changes in sleep quality, including trouble sleeping or excessive sleeping
- Feelings of worthlessness or excessive guilt
- Trouble concentrating or making decisions
- Recurrent suicidal thoughts or behaviors
The Cognitive Impact of Depression: How it Impacts Focus and Attention
Depression can have a significant impact on cognition, specifically on the ability to focus. More specific impairments, like response inhibition and attention, can be measured using assessments like the Stroop test or using digital cognitive assessments like those from Creyos.
Patients with major depressive disorder may have difficulty concentrating, making decisions, or remembering details. These cognitive symptoms are characteristic of depression and can cause challenges in professional and personal settings.
What Causes Depression?
Depression is a complex disorder with multiple contributing factors, like biological factors, genetics, and environment. The more risk factors a person has, the more likely they are to develop a depressive disorder at some point in their life.
If an individual has a genetic predisposition to depression, certain lifestyle factors such as sleep, exercise, and social relationships can impact the likelihood of developing a depressive disorder and protect against depression.
Depression Risk Factors
Several biological, psychological, and social risk factors may relate to developing or triggering depression:
- Chronic diseases like chronic pain, diabetes, and cardiovascular conditions.
- Biochemical imbalances in neurotransmitters such as serotonin, norepinephrine, and dopamine.
- Genetic predisposition, especially in cases of severe or major depression.
- Other mental health comorbidities such as OCD, anxiety and panic disorders, and substance use disorder.
- Childhood trauma, particularly emotional and sexual abuse, is reported in the histories of 75.6% of chronically depressed patients.
- Systemic marginalization based on race and ethnicity, gender and sexuality, and more.
- Major life transitions like having children, experiencing loss, and retirement.
- Chronic stress is especially apparent in patients with anxious depression.
- Social isolation has long-term mental and physical health consequences, particularly for senior citizens.
Incorporating patient-centered care during mental health screenings can help uncover the social and environmental factors contributing to patients’ symptoms. By taking time to understand each patient’s story and emotional well-being, providers can get a deeper look at what’s really going on.
What are Some Common Depression Tests?
Diagnosing depression often begins with a screening questionnaire and physical exam. If symptoms are flagged, patients may be referred for a clinical interview, a more comprehensive psychological assessment, or lab tests to rule out underlying medical conditions.
Common mental health screening tools include:
- Patient Health Questionnaire (PHQ-9): This is a nine-question screener widely used to identify the presence and severity of depression symptoms. A score of 10 or above suggests a positive screen, indicating the need for further clinical assessment for depression.
- Generalized Anxiety Disorder (GAD-7) Questionnaire: Because 50-60% of people with depression have comorbid anxiety, this screener may be a useful tool to get a closer look at a patient’s overall mental health.
- Perceived Stress Scale (PSS): This self-report tool measures how individuals perceive stress in their lives—a useful contextual tool when evaluating major depressive disorder symptoms.
In one study about depression in the United States, 31.45% of respondents without a formal diagnosis had scores indicating moderate to severe depression on the PHQ-9, highlighting the need for accessible and sensitive diagnostic aids.
Screening for cognitive symptoms of depression—like slowed thinking, memory issues, or difficulty concentrating—is one way to improve the depression screening process. With digital cognitive assessments, providers can detect subtle cognitive changes that traditional assessments might miss, and speed up the path to treatment.
How Digital Cognitive Tests Support the Depression Diagnosis Process
In mental health care, depression screening often relies on subjective self-reports. While tools like interviews and questionnaires gather valuable insight into patients’ experiences of the mood-related symptoms, they can miss nuances in the cognitive effects of major depressive disorder—particularly when patients underreport or struggle to articulate their symptoms.
That’s where digital cognitive testing comes in.
Depression affects cognition in measurable ways, like impaired reasoning abilities, reduced response inhibition, and memory issues. With cognitive tasks from Creyos, providers can gather real-time data from scientifically validated tasks that objectively measure distinct domains of cognitive function and brain health.
Combining self-report questionnaires and cognitive tests can help:
- Make depression screening more confident and efficient by measuring mood symptoms and cognitive symptoms in one seamless protocol
- Screen for or detect cognitive impairments related to comorbid conditions like dementia, anxiety, or ADHD
- Support more precise treatment planning informed by longitudinal data
- Monitor medication and treatment effectiveness through measurement-based care
Clear, quantified data can make it easier to confidently diagnose major depressive disorder. One study found that nearly 40% of people with major psychiatric disorders were misdiagnosed, with major depressive disorder the second most common misdiagnosis.
By making mental health screenings more precise and accessible, people who experience major depressive disorder can get the help they need for better patient health outcomes.
How Creyos Helped GT Healthcare Make Data-Driven Mental Health Decisions
When GT Healthcare was encountering the limits of subjective self-report screeners for mental health disorders, they began using objective cognitive assessments from Creyos.
This streamlined their process and let clinicians confidently make decisions and begin treatment within just 2–3 visits. As a telehealth service, GT was also able to deliver depression assessments remotely to patients in under ten minutes.
Additionally, EMR integration helped the admin team save up to 1.5 hours daily on session notes, fighting back against administrative burden. And with patient data in one platform, referrals between primary care and mental health specialists were additionally simplified.
The Road to Depression Treatment
Despite the fact that depression is the leading cause of ill health and disability worldwide, it still remains underdiagnosed. Traditional psychological screeners rely heavily on self-reporting, providing essential information about how patients are subjectively feeling, but don't gather objective performance data that can enable more comprehensive and precise depression diagnosis. Digital cognitive tests add that key data to the diagnostic process, allowing clinicians to deliver faster, more effective care for those who need it most.
Reviewed by Sydni Paleczny, Staff Scientist
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.