Depression Intensity Scale Circles (DISCs)
The tool is a six-point visual scale and consists of a sequence of black circles increasing in size to denote “no depression” to “most severe depression”. The patient can indicate the circle which best indicates their mood by either using a pen or pointing to the circle. The score range is 0-5 but for comparison with the Numbered graphic rating scale (NGRS) a multiplier of 2 can be used.
The DISCs has three main uses:
- To screen and document in-patients mood following an acquired brain injury (including patients with either cognitive or communicative limitations)
- To identify the severity of the change in mood (i.e sad or depressed)
- To use serially to monitor change in mood
Depression Intensity Scale Circles (DISCs) booklet with pictures
This tool incorporates words and pictures to assist in assessing mood for patients with communicative/cognitive impairment following an acquired brain injury.
The patient is asked to indicate which picture reflects their current mood using “Yes sad/depressed” with a sad face picture, or “No sadness/depression” with a happy face picture.
An understanding of the faces is obtained prior to using the faces alongside the DISCs circles.
Guidance on administering the tool is also incorporated for the assessor.
DISCs can be used as part of the Depression protocol and Integrated Care Pathway.
Anxiety Intensity Scale circles (AISCs)
The tool is a six-point visual scale and consists of a sequence of yellow/black circles increasing in size to denote “no anxiety” to “most severe anxiety”. The patient can indicate the circle which best indicates their anxiety level by either using a pen or pointing to the circle. The score range is 0-5 but for comparison with the Numbered graphic rating scale (NGRS) a multiplier of 2 can be used.
The AISCs has three main uses:
- To screen and document in-patients level of anxiety following an acquired brain injury (including patients with either cognitive or communicative limitations)
- To identify the severity of the change in anxiety
- To use serially to monitor change in anxiety
Depression Intensity Scale Circles (DISCs)
The DISCs tool is based on the same design as the Scale of Pain Intensity (SPIN) screen, except the colour of the circles are dark grey for an association with low mood. It is a simple intuitive tool providing a graded assessment of mood. It is particularly designed for use by the cognitively impaired population that find standardised tools difficult to complete.
The six-point circles are presented in a vertical line to make it user-friendly. The grey circles increase in size to represent the scale of “no depression” to “most severe depression.”
The tool also includes the Yale Single question screen “Do you often feel sad or depressed?”
Following development, the tool was tested for validity, reliability and responsiveness in the assessment of depression for those with severe complex disability following an acquired brain injury.
Source References
- Turner-Stokes L, Kalmus M, Hirani D, Clegg F. The depression Intensity Circles (DISCs). A first evaluation of a simple assessment tool for depression in the context of brain injury. Journal of Neurology, Neurosurgery and Psychiatry Medicine 2005; 76 (9): 1273-1278. DOI: 10.1136/jnnp.2004.050096
Guidelines
The Royal College of Physicians guidance on depression following acquired brain injury recommends DISCs as part of the screening tool for depression.
- Turner-Stokes L, MacWalter R, Guideline Development Group of the British Society of Rehabilitation M, British Geriatrics S, Royal College of Physicians L. Use of antidepressant medication following acquired brain injury: concise guidance. Clinical Medicine 2005;5(3):268-74.
- Mahoney J, Drinka TJK, Abler R, Gunter-Hunt G, Matthews C, Gravenstein S, et al. Screening for depression: Single question versus GDS. J Am Geriatr Soc 1994;42(9):1006-1008.
- Hammond MF, O'Keeffe ST, Barer DH. Development and validation of a brief observer-rated screening scale for depression in elderly medical patients. Age Ageing. 2000 Nov;29(6):511-5
Anxiety Intensity Scale circles (AISCs)
The AISCs is based on the same design as the DISCs and SPIN using different coloured circles to denote level of anxiety.
A joint project is in progress to validate the AISC
Exemplar depression management protocol
Administering the tool
An explanation of the tool should be provided using the questions on the tool.
Before completing the DISCs the Yale question is asked- “Do you often feel sad or depressed”. The response is recorded in addition to any further information provided by the patient.
The patient is informed:
- This is a scale to measure sadness or depression
- The grey circles show how sad or depressed you feel
- The bottom circle shows no sadness or depression
- The top circle shows sadness or depression as bad as it can be
- (Whilst pointing to each circle) As you go from the bottom circle to the top circle you can see that the sadness or depression is becoming more and more severe
The patient is asked:
- Please point to each of the circles in turn
- Please point to the circle that shows how sad or depressed you feel today.
If the administrator is confident that the patient understood the scale, then the results are used to direct further input as required.
If the patient indicated that they were not sad or depressed the tool is presented again in 4 weeks (or sooner if the treating team think there is a change in the patient’s mood). If at 4 weeks there is no change in mood and the patient is still reporting no sadness or depression, then the Depression pathway is closed (it can be re-commenced at any time if the patient’s mood changes)
If the patient indicated that they were depressed, then the Depression Integrated Care Pathway is commenced.
Administering the tool
An explanation of the tool should be provided using the questions on the tool.
Before completing the AISCs the screening question is asked- “Do you often feel worried or anxious”. The response is recorded in addition to any further information provided by the patient.
The patient is informed:
- This is a scale to measure anxiety
- The yellow/black circles show how anxious you feel
- The bottom circle shows no anxiety
- The top circle shows anxiety as bad as it can be
- (Whilst pointing to each circle) As you go from the bottom circle to the top circle you can see that anxiety is becoming more and more severe
The patient is asked:
- Please point to each of the circles in turn
- Please point to the circle that shows how anxious you feel today.
If the administrator is confident that the patient understood the scale, then the results are used to direct further input as required.
If the patient indicated that they were not anxious the tool is presented again in 4 weeks (or sooner if the treating team think there is a change in anxiety levels). If at 4 weeks there is no change in anxiety and the patient is still reporting anxiety, then the pathway is closed (it can be re-commenced at any time if the patient’s anxiety levels changes)
If teams would like further clarification, please email LNWH-tr.ukroc@nhs.net
The DISC screen is routinely used for all in-patients on a Specialist Level 1a neurorehabilitation unit to inform further need for the use of the Depression Management integrated Care Pathway.
The DISC screen has acceptable convergent validity, reliability and responsiveness as a simple screening tool for patients with complex disabilities following an acquired brain injury.
Source References
- Turner-Stokes L, Kalmus M, Hirani D, Clegg F. The depression Intensity Circles (DISCs). A first evaluation of a simple assessment tool for depression in the context of brain injury. Journal of Neurology, Neurosurgery and Psychiatry Medicine 2005; 76 (9): 1273-1278. DOI: 10.1136/jnnp.2004.050096
The AISC screen is used for any in-patient on a Specialist Level 1a neurorehabilitation unit that is observed by the treating team to be anxious to inform further management.