A diagnostic test of eight short questions designed by Jaclene Zauszniewski from the Frances Payne Bolton School of Nursing at Case Western Reserve University can be used to detect depressive thinking patterns that lead to clinical depression in women who care for an adult family member with a serious mental illness.

Issues in Mental Health Nursing recently published Zauszniewski’s findings from the study, “Psychometric Assessment of the Depressive Cognition Scale in Women Family Members of Adults with Serious Mental Illness.” Working with Zauszniewski on this study funded by the Frances Payne Bolton School of Nursing was co-investigator Jane Suresky, assistant professor of nursing at FPB.

Zauszniewski, a psychiatric nurse researcher, has tested the Depressive Cognition Scale (DCS) she developed on a number of different populations and groups to test whether the short questionnaire and scale can detect cognitive symptoms of early depression.

Each of the DCS’s questions targets a symptom of depression and measures negative thinking.

Negative thoughts related to self-worth, power and hope can be precursors to the development of clinical depression. Thus, early detection of negative thinking patterns can lead to prevention of serious depressive illness.

The DCS tested for negative thinking patterns in the study’s 60 women, who cared for an adult family member with a serious mental illness such as depression, schizophrenia or bipolar disorder. The average age of the participants was 46 years old and almost half lived in the same household as the adult with the mental illness.

The idea is if the caregiver—who is under stress and encounters the stigma of having a family member with a mental illness—becomes depressed, it can impact the quality of life for both the person being cared for who might go off their medications and miss doctor appointments, and quality of life for the caregiver.

“Detecting depression early can be helpful for everyone, “Zauszniewski said.

Zauszniewski designed the DCS in 1995 as a way to detect depressive thoughts in the elderly. It is based on Developmental Psychologist Erik Erikson’s eight stages of human development that lead to building character strengths.

The successful completion of each stage of life identified by Erikson from birth through old age helps individuals develop and master characteristics that allow them to function and have healthy relationships with other people, Zauszniewski said. On the other hand, less than successful resolution of a developmental stage, can result in the evolution of unfavorable characteristics, such as depressive thought patterns.

Based on the ideas of those developmental stages, DCS has been found valid for diagnosing depressive thoughts through the responses to questions that look at an individual’s sense of purposelessness, meaninglessness, emptiness, helplessness, hopelessness, powerlessness, loneliness and worthlessness.

Not only has the DCS test been found valid in a number of different groups from the elderly to young adults, it has been validated when used by people in cultures that speak Arabic, Portuguese, and Chinese languages.

Zauszniewski is the nursing school’s Kate Hanna Harvey Professor of Community Health Nursing and associate dean for doctoral education.