The next step in the DAWN measurement-based approach is to conduct a more detailed assessment to determine if patients meet the criteria for major depression, minor depression, or dysthymia. Physicians need to rule out other potential medical causes of depression such as a side effect to steroids as well as other psychiatric illnesses such as bipolar disorder or alcohol abuse. You could also use structured interviews, such as the MINI that was used in the DAWN study. The MINI 5.0.0, a structured psychiatric interview, was used in the DAWN study because it is a way to verify diagnoses of dysthymia as well as major and minor depression. Once a depression diagnosis is made and it is confirmed that the program is a good fit for the patient, then the intervention can begin.
It is also important to define the indices for improvement: symptom reduction (depression is improved but still present) and symptom remission (symptoms do not meet the criteria for a depressive diagnosis) using the PHQ-9. Effective symptom reduction is measured as a decrease in total score of greater than or equal to 50%. Clinical remission of depression is measured as a score of less than 5.