Beyond the Burns Depression Checklist

I’ve continued tracking my depression symptoms using the Burns checklist for another month. The oscillations have been a bit less extreme: There was a period of higher (worse) scores near the end of August when we had to put Trouble (our 2-year-old pet rat) to sleep. This was followed by lower (better) scores at the beginning of September when I got to spend some time with Banji and had my first in-person session with Wakana in about a month. Then I started a new game in The Sims 3 (my current family) and, well, I think the scores pretty much speak for themselves. I’m noticing that I tend to have much better (lower) scores when I go out and socialize; this is in part because some of the items on the checklist are basically asking “Did you interact with other people today?” but I think it tends to help my overall mood, too. My average for this month is 32.

Ziya’s scores on the Burns Depression Checklist August 17, 2014 to September 15, 2014

The items on the checklist are organized into 4 categories: Thoughts and Feelings, Activities and Personal Relationships, Physical Symptoms, and Suicidal Urges.

Thoughts and Feelings

The first category consists of 10 items describing one’s subjective experience, including: “feeling unhappy or blue,” “feeling hopeless,” “criticizing yourself or blaming yourself,” and “difficulty making decisions.” I’ve been scoring fairly high in this category (relative to the others), with no particular items standing out as more or less problematic than the others.

Activities and Personal Relationships

The second category consists of 7 items that describe behavior and subjective experience related to work/hobbies and social life. Although I feel worse on days when I withdraw from my social network, the items I struggle with most consistently with are “motivation” and “avoiding work or other activities.”

Physical Symptoms

There are 5 items related to sleep, appetite, sex, and “worrying about your health.” This is the category I seem to consistently score the highest in. Even on really good days when my thoughts, feelings, and behavior would suggest otherwise, my body seems to be depressed. Hopefully soon I’ll learn whether that’s (in part?) because of a sleep disorder.

Suicidal Urges

The final category asks 3 questions: thoughts? desire? plan? Fortunately this is the category I score the lowest in – usually.

Instead of tracking each item separately, I decided to look at my scores for overall categories. To standardize the scores, I divided the total score for each category by the number of items in said category. As a result, all the scores represented on the graph below are between 0 and 4. (Well, 0 and 3, but they could go up to 4. I really hope they don’t!)

Ziya’s (standardized) scores on the subcategories of the Burns Depression Checklist from August 17, 2014 to September 15, 2014.

Unlike the month I tracked last year, there seems to be a disconnect among my subjective experience, behavior, physical symptoms, and suicidal ideation; the lines don’t move with any kind of pattern that would suggest they have anything to do with each other (correlation?). One thing I do notice is that my Suicidal Urges are the worst (highest) when my Thoughts and Feelings are as painful as or worse than my Physical Symptoms. I can deal with having low physical energy, but when I feel really sad, hopeless, and hating on myself on top of that, it becomes pretty tempting to just stop existing. I think it’s way past time for me to start engaging in cognitive behavioral therapy (CBT)!

Finally, as I wrote when I first posted about this in Measuring Recovery: Part One, the Burns Depression Checklist doesn’t include everything I believe is important to consider when assessing my mental health (such as symptoms of anxiety). My goal is to eventually develop a way to keep track of changes in various indicators of mental health, including signs that I am becoming more healthy and not just less mentally ill.

I’ve started tracking other symptoms that concern me, rating them on the same scale: 0 = “not at all”, 1 = “somewhat”, 2 = “moderately”, 3 = “a lot” and 4 = “extremely”. Some of them are symptoms of anxiety, others have to do with depression … it’s actually kind of confusing. I’ve heard irritability described as a symptom of depression, anxiety, and mania/hypomania! I guess the point isn’t so much to associate them with the correct disorder as to be aware of how much they’re affecting me. This is an imperfect numerical representation of my recent subjective internal experiences.

I put the symptoms into categories that sort of mirror the ones on the Burns, but I haven’t done the kind of empirical testing that’s necessary to determine whether my “checklist” measures anything meaningful. For that reason I have decided to track each item separately, even though it makes for fairly messy charts. Here’s what I have for the first half of September:

Ziya’s scores on anxiety-related symptoms September 1 – 15, 2014

Ziya’s scores on physical symptoms September 1 – 15, 2014

Ziya’s scores on irritability-related symptoms September 1 – 15, 2014

Ziya’s difficulty concentrating and communicating September 1 – 15, 2014

I’m inclined to see my tracking method for the additional symptoms as a work in progress, but I do like using one graph per category and graphing each symptom separately. I think I’ll stick with it as-is for a while, and make changes as I feel inspired. For example, I originally had 10 items; I added “excessive or out-of-control worrying” and “difficulty relaxing” on September 3rd. Though the graphs don’t reflect this, I also needed to re-arrange the items to create the existing categories.

The new items use the same scoring as the Burns specifically so I can compare them. Is there any relationship (correlation?) between my scores on the Burns Depression Checklist / its subcategories and the additional symptoms I’ve chosen to track? Honestly, I have no idea.

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