• The Zung Self-Rating Depression Scale (SDS) is a well-established self-report screening measure of adult depression severity. It has been used in a variety of mental health areas including primary care, psychiatric, drug trials, and related clinical, institutional, and research settings.
  • In some clinical applications, the Beck Depression Inventory or the PHQ-9 may be preferable as they survey a two-week period and include an item specific to suicidal ideation (this is consistent with DSM–IV criteria for major depression).
  • Some items on the Zung SDS may be sensitive to individuals with SCI.
  • It is easy to administer and score.  The positive and negative item wording may be confusing for some individuals.

ICF Domain

Body Function ▶ Mental Functions

Administration

Approximately 10 minutes to have the person complete 20 items

Number of Items

20

Scoring

  • Symptoms “over the past several days” are rated according to a 4-point (1 to 4) ordinal scale:
  1. Little or none of the time
  2. Some of the time
  3. A large part of the time
  4. Most or all of the time
  • Half the items are worded positively and half are worded negatively (total possible of 80 points). Positive items are reverse-scored.
  • Higher scores indicate increased depressive symptoms.

Equipment

None

Languages

English, Arabic, Azerbaijani, Dutch, German, Portuguese, Spanish

Worksheet

Symptoms “over the past several days” are rated according to a 4-point (1 to 4) ordinal scale:

  1. Little or none of the time
  2.  Some of the time
  3.  A large part of the time
  4.  Most or all of the time

Half the items are worded positively and half are worded negatively (total possible of 80 points). Positive items are reverse-scored.
Higher scores indicate increased depressive symptoms.

Availability

Scale items can be found in the original publication.

Reviewers

Dr. Vanessa Noonan, Matthew Querée

Date Last Updated

3 February 2021

# of studies reporting psychometric properties: 2

Interpretability

MCID: not established for SCI
SEM: not established for SCI
MDC: not established for SCI

  • Scores over 50 suggest depression. Scores over 69 indicating severe depression.
  • No normative data or cut-points have been reported for the SCI population.
  • Published data for the SCI population is available for comparison (see Interpretability section of the Study Details sheet).

Reliability

High

Internal consistency of the Zung Depression scale is High (Cronbach’s a = 0.81).

(Tate et al. 1993)

Validity

Moderate to High

  • Correlation of the Zung total score is High with the Brief Symptom Inventory – global severity index (Pearson’s r = 0.53) and the Brief Symptom Inventory – Depression scale (Pearson’s r = 0.52).
  • Inter-correlations between the Medically-Based Emotional Distress Scale subscales and the Zung scale are Moderate to High (ranging from 0.31 to 0.72).

(Tate et al. 1993, Overholser et al. 1993)

Responsiveness

No values were reported for the responsiveness of the Zung scale for the SCI population.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the Zung scale for the SCI population.

Reviewer

Dr. Vanessa Noonan, Matthew Querée

Date Last Updated

3 February 2021

Overholser JC, Schubert DSP, Foliart R, Frost F. Assessment of emotional distress following a spinal cord injury. Rehabilitation Psychology 1993; 38: 187-198. http://psycnet.apa.org/journals/rep/38/3/187/

Tate D. Alcohol Use Among Spinal Cord Injured Patients. Am J Phys Med Rehabil 1993;72:175-183. http://www.ncbi.nlm.nih.gov/pubmed/8363813

Tate DG, Forcheimer M, Maynard F, Davidoff G, Dijkers M. Comparing Two Measures of Depression in Spinal Cord Injury. Rehabil Psychol 1993;38:53-61. http://psycnet.apa.org/journals/rep/38/1/53/

Zung WWK. A self-rating depression scale. Arch Gen Psychiatry 1965;12:63-70. http://www.ncbi.nlm.nih.gov/pubmed/14221692

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