University of Washington

From Swimming in a Tube to Swimming in Laundry:

An Investigation into Alternative Human Depression Metrics

By Blake Delisa and Syd Roy

BIOL 359: Foundations in Quantitative Biology

Dr Jake Cooper

March 5th, 2023

Introduction
Depression is one of the more prevalent mental health disorders in the United States – in
2020, the National Institute of Mental Health estimated 14.8 million adults aged 18 and older
experienced a major depressive episode with severe impairment within that year. Although this
number only makes up 6.0% of the U.S. population, the associated loss of productivity and its
impact on the US economy may have large implications for the future.
The Beck Depression Inventory (BDI) is a famous questionnaire used to evaluate the
severity of one’s depression (Beck et al, 1961). It consists of 21 multiple-choice questions that
allow individuals to rate their symptoms of depression, such as guilt, punishment, and social
withdrawal. Each answer selected has an associated number of points (0-3, where a greater
number of points indicates more severe symptoms), which is then added up to inform a
diagnosis.
In this project, we created our own metric for diagnosing depression, termed the “UW
test.” Like the BDI, the UW test uses a 21-part self-rated scale to accomplish this. The UW test
focused more on daily behaviors or activities that may be impacted by depression rather than
thoughts and feelings associated with depression. For example, participants were asked how
often they submitted late assignments for work or school and how often they did their laundry. It
was hypothesized that there would be a significant difference between a metric using
attitude-based questions rather than quantifiable and observable behaviors. A potentially
significant difference was found between the BDI and a behavior-based metric with greater
average scores on the behavior-based metric, but the usefulness of this difference will require
further exploration.

Quantitative Concept
In this study, a new metric for diagnosing depression was created. This test was designed
drawing inspiration from the forced swim test, which sought to find the correlation between
effort and resilience (time spent swimming to stay afloat) to depression (Can et al, 2012). In
class, students were asked to try to adapt the idea of the forced swim test to human activities. The
researchers responded with answers varying from forcing a subject to sit in a room with a swarm
of flies and measuring how long they would swat at the fly to more humane options such as
inquiring people about how long it has been since they last did laundry. Due to constraints
relating to the complexity of the human model as well as limited funding, the latter format of
surveying that would support this type of metric was chosen. The researchers were also tasked in
section with finding relative strengths and weaknesses with different metrics as no single metric
perfectly characterizes a sample or population. The Beck Depression Inventory (BDI) is an
existing depression metric based on rating impressions rather than observable habits, so this
study focused on comparing these impressions from the Beck Depression Inventory to
quantifiable habits that may be impacted by depression. The thought behind this comparison was
to see how well the existing BDI metric held up in predicting the behaviors affected by
depression. The method for creating this metric was based on guidance from the American
Psychological Association and included self-reported data concerning individuals’ last 6 weeks
of experiences to align with typical psychology metrics (Clay 2007). The test was administered
starting with the 21 BDI questions followed by the 21 UW Test questions. The entirety of the test
can be found in Appendix A.
Main Course
Upon completion of the survey attempt, 58 independent individuals responded to the
survey. Of these 58 individuals, all responded to every required question. Of those 58, 31
self-identified as current UW students while 27 responded that they were not current UW
students. As such, UW students comprised approximately 53.4% of the sample size.
Utilizing the total scores of these 58 individuals in the Beck Depression Inventory (BDI)
and our independent test titled the “UW Test,” a two-tailed T-test was performed in which the
scores for the BDI and UW tests were randomized to create a distribution and produce a p-value.
A two-tailed T-test was performed to better understand whether there was a significant difference
between the scores of individuals in the two tests. A two-tailed test was chosen as the question of
a significant difference was not narrowed to one test being higher on average than the other test
in average score. From the T-test, a p-value of 0.0427 was derived. As such, the test indicates a
4.27% chance of the difference noted between the tests or a more extreme result if there were to
be no real difference in average scores between the two depression inventories. By convention,
this difference would be considered statistically significant (O’Brien et al, 2015). However, the
p-value does not relate to the size of the difference between the two tested groups or its
importance (O’Brien et al, 2015).
To better provide context for the magnitude of the difference between the groups, Graph
1 illustrates the relative mean scores of the BDI and UW inventories across the 58 samples. The
BDI demonstrates a mean score of 15.982 while the UW test data yields a mean score of 19.379.
As such, the relative means would indicate that the difference between the groups appears to be
relatively higher scores for the UW test than for the BDI test. That stated, the error bars on the
graph represent standard deviations of 10.164 for the BDI test and 7.468 for the UW test. There
is considerable overlap noted between the standard deviations of the tests, decreasing confidence
in a considerable difference between the two tests. The lower standard deviation of the UW test
additionally points towards a lower variation of this data with more concentration of the sample
UW scores around the mean of 19.379. An additional interesting interpretation of the difference
between the two means is that, with completely random responses, the average score for a
21-question 0, 1, 2, and 3 options test would be 31.5 points for either the BDI or the UW test. As
such, there is a distinct possibility of more random answering for the UW test than the BDI test
or alternatively a higher mean score with the same level of randomness but less severe options
for the same number value of the response.
 An additional interpretation of the data would focus upon the distribution of the
respondents within the categories associated with scores in the test. Table 1 illustrates the
number of samples placed within each score category for the BDI and UW test. The diagnosis
sourced from the BDI are listed with each score range as well (Beck et al, 1961). As can be noted
from the table, both test results lack respondents who scored over 40 points. Graph 2 can be
more easily interpreted when comparing the two tests.
Table 1:

Score on Test BDI Test UW Test

1-10 21 7
These Ups and Downs are
Considered Normal

11-16 11 13
Mild Mood Disturbance

17-20 11 12
Borderline Clinical
Depression

21-30 6 23
Moderate Depression

31-40 9 3
 Severe Depression

Over 40 0 0
Extreme Depression
In Graph 2 below, the relative trends for BDI and the UW test are separated effectively in
their placement of respondents in different categories. The orange bars representing the BDI test
appear to follow a relatively negative linear slope with fewer respondents in each category. An
exception is the 31-40 category which demonstrates a mild peak deviating from this trend. In
comparison, the purple bars representing the UW test demonstrate a rather different trend.
Instead of a negative linear trend, there appears to be a considerable concentration of respondents
in the 21-30 category with much less respondents in the 1-10 and 31-40 categories than the BDI.
The 11-16 and 17-20 samples are relatively similar between the two tests. As such, it appears
that the UW test may produce less extreme low and high scores, but scores are more
concentrated in the relatively high 21-30 score range than the BDI. The lack of respondents over
40 also points towards a lacking sample size and perhaps a lack of diversity in the sample taken.

Qualitative reviews of the entire survey were additionally included within the survey.
These responses may be found in Appendix B. Due to the relatively small sample of respondents
who chose to provide qualitative reviews as well as the relatively low content within those
collected, these were not analyzed at length. Feedback from these may be incorporated however
into future iterations of the UW test.
Discussion
Based on comparisons of the data from the UW test compared to the Beck Depression
Inventory, the UW test index either overestimates depression or identifies new qualities that are
not reflected in the standard Beck Depression Inventory. Feedback received from our
respondents suggests that more sensitive and specific measures could be implemented in future
questionnaires, which have been reported to be useful for the PH-2 and PH-9 (Sinscalchi et al,
2020). These Patient Health Questionnaires are often used in the medical setting, and as such,
their usefulness in distinguishing symptoms related to depression has been tested rigorously for
both false positives and false negatives. Further, the tests administered were not performed in
comparison to a depression diagnosis from a qualified mental health professional(Sincalchi et al,
2020). Without a diagnosis to which one could compare the test results, it is nearly impossible to
be certain about the sensitivity of the test in identifying depression. Most depression metrics
created today, including the BDI, are created and evaluated through collaboration with mental
health professionals and other established tests (Beck et al, 1988). However, this study lacked the
financial resources required to access a mental health professional to assist in creation of the
procedure used. Additionally, future questionnaires may benefit from more standardized scaling
in the severity of question responses. For example, one question from the Beck Depression
Inventory describes being suicidal as the most severe option while one of our questions describes
never brushing one’s teeth as the most severe option. Finally, it is important to recognize that the
UW Test made multiple cultural assumptions that focused primarily on undergraduate students of
lower-middle to upper-middle class income experience. These assumptions may not be
universally experienced by all of our respondents, such as access to food and laundry, time spent
with loved ones, etc. While the limitations of this study call into question the applicability of this
specific behavior-based depression index, the considerable difference between the UW test and
the BDI does warrant further study to determine whether a behavior-based approach would be a
useful tool for depression screening.

Bibliography:
Beck, A.T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961) An inventory for
measuring depression. Archives of General Psychiatry, 4, 561-571.
Beck, A. T., Steer, R.A., & Garbin, M.G. (1988) Psychometric properties of the Beck Depression
Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77-100.
Can, Adem, et al. “The Mouse Forced Swim Test.” Journal of Visualized Experiments, no. 58,
2011, https://doi.org/10.3791/3638.
Clay, Rebecca. “Finding the Right Tools.” American Psychological Association, American
Psychological Association, 2007, https://www.apa.org/gradpsych/2007/01/tools.
“Major Depression.” National Institute of Mental Health, U.S. Department of Health and Human
Services, Jan. 2022, https://www.nimh.nih.gov/health/statistics/major-depression.
O'Brien, Sheila F., et al. “How Do I Interpret a P Value?” Transfusion, vol. 55, no. 12, 2015, pp.
2778–2782., https://doi.org/10.1111/trf.13383.
Siniscalchi, Kimberly A., et al. “Depression Screening and Measurement-Based Care in Primary
Care.” Journal of Primary Care & Community Health, vol. 11, 2020, p. 215013272093126.,
https://doi.org/10.1177/2150132720931261.
Appendix A:

Note-all questions with an asterisk (*) preceding the question number have the numerical value
of the responses flipped. For example, a 0 score is instead a 3 score. This was done to improve
engagement with the questions and prevent any flow in answering to affect subsequent answers.

1.
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.

2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.

3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.

4.
0 I get as much satisfaction out of things as I used to.
1 I don't enjoy things the way I used to.
2 I don't get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.

5.
0 I don't feel particularly guilty
1 I feel guilty a good part of the time.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.

6.
0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.

7.
0 I don't feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.

8.
0 I don't feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.

9.
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.

10.
0 I don't cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can't cry even though I want to.

11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.

12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.

13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can't make decisions at all anymore.

14.
0 I don't feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look unattractive
3 I believe that I look ugly.

15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can't do any work at all.

16.
0 I can sleep as well as usual.
1 I don't sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.

17.
0 I don't get more tired than usual.
1 I get tired more easily than I used to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.

18.
0 My appetite is no worse than usual.
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.

19.
0 I haven't lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20.
0 I am no more worried about my health than usual.
1 I am worried about physical problems like aches, pains, upset stomach, or constipation.
2 I am very worried about physical problems and it's hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.

21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.

*22.
0 I can’t remember the last time I washed my clothes.
1 I wear my clothes multiple times before washing them.
2 I wear my clothes a couple of times before washing them.
3 I only wear my clothes once before washing them.

*23.
0 I haven’t spent time with my friends in several weeks.
1 In the last 2-3 weeks I haven’t spent time with friends OR I have made plans that I ended up
canceling.
2 In the last 1-2 weeks I haven’t spent time with friends OR I have made plans that I ended up
cancelling.
3 I have spent time with friends sometime within the last week.

24.
0 I brush my teeth regularly twice a day.
1 I brush my teeth at least once a day.
2 I brush my teeth sometimes, but I forget pretty often.
3 I do not brush my teeth often.

25.
0 I wash my clothes regularly.
1 I wash my clothes often enough to wear clean clothes.
2 I have trouble washing my clothes often enough to wear clean clothes.
3 I do not wash my clothes regularly.

26.
0 I sleep the same amount every night.
1 My sleeping habits fluctuate from night-to-night.
2 My sleeping habits are poor so I often nap during the day.
3 My sleeping habits are poor but I do not nap during the day.

*27.
0 I do not drink water regularly and experience moderate to severe signs of dehydration (eg
headache, fatigue, thirst)
1 I do not drink water regularly and experience mild signs of dehydration (eg headache, fatigue,
thirst)
2 I drink water enough that I experience no issues associated with dehydration.
3 I drink the daily recommended amount of water every day.

28.
0 I eat 3-4 full meals every day
1 I eat 1-2 full meals every day
2 I probably eat multiple full meals every day but I mostly snack
3 I eat when I am hungry.

29.
0 I mostly eat when I am hungry.
1 I mostly eat when I feel like I should eat according to an arbitrary schedule.
2 I mostly eat when I am told by others that I should eat.
3 I do not eat when I am hungry.

30.
0 I do something I enjoy every day.
1 I do something I enjoy every other day.
2. I do something I enjoy every few days
3. I do something I enjoy once a week.

*31.
0 I do not remember the last time I ate a fruit or vegetable.
1 I eat fruits and vegetables sometimes, but definitely less than is recommended.
2 I eat fruits and vegetables regularly, but probably less than is recommended.
3 I consume the recommended amount of fruits and vegetables every day (about 1½ to 2 cups per
day of fruit and 2 to 3 cups per day of vegetables)

32.
0 I have an emotional support water bottle that I always have with me.
1 I carry a water bottle with me to class or work.
2 I keep a glass of water near me while I’m at home.
3. I get up and get water if I feel thirsty.

*33.
0 I text or call my friends or family once a week or less.
1 I text or call my friends and family (and have at least one conversation) every few days.
2 I text or call my friends and family (and have at least one conversation) every other day.
3 I text or call my friends and family (and have at least one conversation) every day.

*34.
0 I mostly stay in my home or room.
1 I leave my home or room a few times a week.
2 I leave my home or room most days of the week.
3 I leave my home or room every day of the week.

Appendix B:

Qualitative Feedback-

Insightful questions and wording!

May everyone's suffering be alleviated

Good job :)

Question 19 on losing weight- what time span for losing weight? A few weeks or a month?’

He he he haw

maybe have a trigger warning lol i already know i have depression

N/A

i am pretty driven by a few things (school, roommate) that allow me to be okay despite nonideal
mental state

It was nice to realize what my mental state has been looking like so I can now hopefully do
something about it

There are some spelling mistakes

Questions were very specific but also relatable enough to answer

Some questions were quite redundant but otherwise, it was a nice survey to fill out!
For some of the first questions, a larger range of options may be better.

I feel this is bullshit. Get up do your work, be an adult. Why are we paying taxes for shit like
this? Get a job!