I became a nurse in 2004, which was before I became mentally ill. Even then, I wasn’t a fan of using a 1-10 mood rating scale with my patients. It struck me as a bit of a cop-out, and a poor substitute for actually exploring with the person how they were feeling.
Adventures in hospital
And then depression hit, and I ended up in hospital myself. Almost every day, someone was asking me to rate my mood, and I hated it. That feeling I’d had before about it being a cop-out? Quadruple that – at least. It felt like none of them actually cared how I was doing; they just wanted to get in and get out.
There is a wide range of different emotions that we can experience. While we may label some as good and others as bad, they all have their time and place. No one wants to be excited when something bad is happening just like we don’t want to feel angry when we’re getting a relaxing massage.
The arbitrariness of mood rating
Reducing mood to a scale ranging from sad to happy seems very arbitrary. What if I feel anxious? That’s neither sad nor happy, but somehow it has to be slotted in on the scale. What if I’m angry because the professional asking me the question is being a prick? That’s not happy, but telling them to go f*** themselves might be rather satisfying.
The idea of imposing a 0-10 mood rating scale is also arbitrary, since the frame of reference is subject to so many different influences. What’s “normal”? If I was bipolar, maybe 5 would be expected to be my normal. But since I have depression, people might expect me to cruise along at an 8 most of the time.
What’s a zero? If I’d experienced childhood sexual assault, would that be my zero, and anything else is pretty much automatically an 8 or above? My zero before I got depressed was a whole lot different from the zero when I was trying to kill myself, so how’s that supposed to work? And does my zero if I’m suicidal today necessarily correspond to the zero I was when I felt suicidal six months ago?
My own system
I get that it’s helpful to track mood using some form of mood rating scale. I track my mood in my bullet journal with a numerical ranking, but I set zero as the neutral point. For me, a zero neutral makes more sense than something like a 5.
I also use coloured coded letters to record specific emotions. Different days may have the same rating but a very different mix of emotions, but a numerical rating alone wouldn’t capture that. The mix of emotions is just as important as any number I come up with.
I’ve also put together an emotion list PDF here.
Why this matters
What’s really important here is that mental health professionals should be taking the time and effort to dig a little deeper than what a 1-10 mood rating scale can yield. A number that I pull out of my ass has very little meaning on its own if someone doesn’t try to understand the complexity of what’s actually behind that number.
If the person asking is just looking for something to write in my chart so that it looks like they’re doing their job… well, chances are, I’m going to sense that, and whatever I tell them is going to be a load of BS.
Depression symptom rating scales
Depression symptom rating scales are a whole different creature from the 1-10 mood rating. They measure the whole picture of depressive symptoms, and they can be useful for tracking changes over time.
Here are a few examples (you can find more in the Psychology Corner:
- Depression Anxiety Stress Scales (DASS)
- Hamilton Depression Rating Scale (HAM-D)
- Patient Health Questionnaire (PHQ-9)
- Quick Inventory of Depression Symptomatology Self-Report QIDS-SR)
These aren’t a substitute for a professional actually talking to you about how you’re doing. I’ve been handed the PHQ-9 multiple times by GPs who have zero interest in asking about my depression, but they want to make a show of covering their bases. I sometimes wonder if they’re aware of how half-assed it comes across. Either ask me about it or f*** off.
Why this is on my mind
The reason this has come to mind recently is something a friend of mine said. He’s in psychiatric nursing school right now. He tries to be understanding of my illness, but in many ways, he’s clueless. I’ve tried to explain to him what it’s like, and he just doesn’t get it, although not for lack of trying.
I was talking on the phone with him on Boxing Day, and he hadn’t asked how I felt about Christmas. He can’t seem to wrap his head around the concept of anhedonia, and I think he just figured I chose not to do anything for Christmas. When I told him I wasn’t doing very well, there was a pause before he came out with the 1-10 mood rating scale BS. Oh for crying out loud. I told him he could f*** off with his stupid 1-10, and I hung up on him.
He wasn’t trying to be a jerk, but the last thing I need is a friend making a lame-ass attempt to assess me using a crappy assessment tool that pisses me off to begin with. I’m not sure what to do about this whole thing. I’ve tried explaining, and he just seems to be a bit thick when it comes to this issue. So maybe I need to either just put up with it, or back off on the friendship (except he’s my only in-person friend).
I don’t know, but what I do know is that people can take that 1-10 mood rating scale and stick it where the sun don’t shine.
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
I agree, I find it too simplistic, too reductionistic. I had problems with a lot of these types of ratings and scales when I did my psych degree because I didn’t like them. I get why they want things straightforward so numbers can be written and calculations made, but it’s not enough. As you say, “mental health professionals should take the time and effort to dig a little deeper.” xx
Oh God it’s so hard isn’t it … I suspect it’s just more form-filling and a way of covering the professional’s backs if we are under their care. I don’t thing it’s precise enough at all, it’s too general and simplistic. I hope you manage to explain to your friend so that they really understand. We’re nearly at the end of the year … 2019 will be a good year, a fresh start and a happy time for us. Katie xx
Exactly!
I hear you sister xx
The scale is arbitrary, is a five for me good or bad? When I have to do PDQ 9 and GAD 7 questionnaire I always say it’s subjective, it’s slightly better than a straight mood rating number but if I’m answering on a good day my scores are skewed towards the positive and conversely if I’m having a really bad day.
Right now I’m mostly good but I can’t translate that into a single number.
And about Christmas… meh, it was ok but only because it was low key, low peopley-ness and the kids mostly ignored us and me and hubs got to do our own thing.
Just keep doing what’s best for you xx
Yup, that’s pretty much all we can do!
I’ve never saw any value in the chart but know it’s used because the people asking are not trained professionals. Maybe a Med student but no “real” world experience that nails the accountability to their ass. What the Psych sets down to talk, I don’t talk numbers, he trained to listen to spot changes, good or bad, trained to see if meds are working, that I’m improving. His job is to take the conversation and use the training and life experiences assess how you are doing. I’ve only been in three different Psych hospitals, two were a joke, like robots going thru the days, how much money am I getting from insurance, how long can I stretch her stay till the max allowed. The first time I woke up really late the first day, why set an alarm. I went to the glass enclosure to get my meds. Now I need my breakfast in order to cram all these down my that. She yelled at me that I hadn’t laid my ass in bed I could have had breakfast that I had to wait till lunch. I handed the pills back, then she know I wouldn’t kiss her ass, she went and found my something to take my meds with. I’m glad I’ve seen the worst so I can appreciate where I go now when needed. Great topic. Maybe you could explore the topic forward. Have a great day. M
Yes the bad experiences definitely help to appreciate the good.
I’m glad to have the bad experience so I can truly appreciate the hospital where I go when there getting on to me. I will not participate in a groups sessions, that gives a challenge to see who can get me in the room. No. 🙂
I would have expected someone training to be a psychiatric nurse to understand anhedonia and depression a bit better!
I’ve used a 1-10 scale to monitor my depression (and another for anxiety) for well over a decade, but lately I’ve been finding it less helpful. It’s OK for monitoring from day to day, but I get the feeling that my baseline for ‘normal’ has moved over time so I don’t know that I can really compare to earlier episodes of depression. Factor in alexithymia and autism and this can get quite messy. I think I don’t really know what I’m feeling a lot of the time. Plus, I think if I’m doing more, as I have done for the last couple of years, I unconsciously rate my mood higher, even though I’ve become quite capable of a reasonable degree of functionality while very depressed.
That’s a greta point about the baseline of normal shifting. I think that’s happened for me as well.
My care providers ask me how well I feel I’m doing in regards to my functionality on a scale of 0 to 100%. I find that just about as useless as the one to ten scale. Does the 100% signify when I’m manically hyper-functional? Or is this a 0 to 100% scale for a normal person? I just don’t know.
They also have a checklist that helps them to decide whether I’m depressed, functional, manic, experiencing mixed episodes, but sometimes I am not aware of my symptoms, as such. And if I only see my doctor once every four to six weeks, this form does nothing to diagnose rapid cycling.
Verbal communication is key. My provider doesn’t even glance at that form. It’s up to me to let him know what’s been going on with me, special areas of concern, any side effects, and any questions I have about my treatment.
I think that’s definitely think that’s how it should be.
My problem is that the number is good for all of 5 minutes. OK so that’s a bit of an exaggeration, but I can swing from “normal” to “anxious/agitated” to “suicidal” multiple times in the course of a day, and at any given time the emotions are real and complete and feel as if they’ll never end or change. Plus, my mood doesn’t necessarily correlate with my level of functioning. To even come close to being useful I need something that uses a multidimensional scale and summarises the overall feel of the day in retrospect.
Yes that would certainly be a lot more helpful.
I feel that way about mood & pain ratings! You can’t rate these things with numbers.
Absolutely.
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My doctor has asked me to use the 1-10 scale to rate the severity of my depression/feelings, which seems a little more helpful than using it to rate overall mood.
That makes sense
I agree 100%
Hi!
I am a psychiatric nurse and I know EXACTLY what you mean! The only explanation I can come to is that we are trying to quantify patient’s experience and if they come in with an 8 and are now a 4 maybe something is working… but I agree with you wholeheartedly. I don’t think the number thing works in terms of really gauging the individual’s depressive or anxious mood. My way of getting around that is initially I say – “This is just a standard question I have to ask all my patients for documentation purposes, how would you rate your depression and anxiety?”
Generally patient’s are okay with me saying that and depending on how they answer facilitates my response. I prefer the mild, moderate or severe – depression or anxiety rating more than a numerical value as it makes more sense to most people.
Anyways, thanks for this post. I am trying in my own practice to find a solution to this as it has always felt off asking a person to “rate their emotions”. Unfortunately, electronic medical records requires us to ask this question as a part of our assessment question, but I will take into consideration what you have wrote here as well.
Thanks! & Take care.