The ODQ is a 26-item patient-reported measure specifically designed to assess emotional blunting in depression, evaluating four dimensions: Not Caring, Emotional Detachment, Reduction in Positive Emotions, and General Reduction in Emotions, with excellent reliability (α=0.93-0.945) and sensitivity to treatment changes.
Emotional blunting affects approximately 73% of patients in acute depression and 25% in remission, with over one-third considering stopping antidepressants due to emotional effects—making the ODQ essential for treatment monitoring, medication selection, and adherence prediction.
The ODQ demonstrates strong psychometric properties across cultures, with validated translations and established minimal clinically important differences (16-20 points), enabling researchers and clinicians to objectively measure and track emotional blunting throughout antidepressant treatment.
Introduction
The Oxford Depression Questionnaire (ODQ) is a 26-item patient self-report measure specifically designed to assess emotional blunting in patients with major depressive disorder (MDD). Originally known as the Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQuESA), this instrument was developed by Price, Cole, Doll, and Goodwin (2012) at the University of Oxford Department of Psychiatry to address a critical gap in depression assessment: measuring the restricted range of emotions that some patients experience during treatment with antidepressants.
The ODQ represents a significant advancement in depression care by providing clinicians and researchers with a validated tool to identify and quantify emotional blunting—a phenomenon where patients report feeling emotionally “numbed” or “blunted,” experiencing reduced positive and negative emotions, feeling detached from the world, or “just not caring” about things that previously mattered to them.
Understanding Emotional Blunting
Emotional blunting is a complex phenomenon that has been inadequately addressed in depression research and clinical practice despite its substantial impact on patients’ lives. It manifests as:
Reduced emotional range: Patients describe their emotions as “toned down” or “flattened,” experiencing neither the highs of joy nor the depths of sadness they once felt.
Diminished positive emotions: Difficulty experiencing pleasure, enthusiasm, excitement, or love—even for activities and people that previously brought joy.
Emotional detachment: Feeling disconnected from others and from experiences, as if watching life through a barrier or from a distance.
Apathy and “not caring”: Loss of concern about responsibilities, relationships, and activities that once seemed important.
Unclear etiology: The critical question of whether emotional blunting represents a residual symptom of depression itself or a side effect of antidepressant medication—or both.
Research has shown that emotional blunting is surprisingly prevalent: approximately 73% of patients in the acute phase of depression and 25% of patients in remission report severe emotional blunting (Christensen et al., 2022). Furthermore, over one-third of patients consider stopping or have stopped their antidepressant medication because of perceived emotion-related adverse effects—highlighting the clinical significance of accurately assessing and addressing this phenomenon.
Theoretical Foundation
The ODQ was developed through rigorous methodological processes consistent with best practices in patient-reported outcome measure development:
Patient-derived qualitative research: Rather than relying solely on expert opinion, the initial item pool was generated from in-depth qualitative interviews with patients who described experiencing emotional blunting. This ensured the measure captured patients’ lived experiences in their own language.
Cognitive interviewing: Draft items were refined through cognitive interviewing techniques to ensure patients interpreted questions as intended and could respond accurately.
Factor-analytic refinement: Statistical methods including exploratory and confirmatory factor analysis were used to identify the underlying dimensional structure and reduce the item pool to the most psychometrically sound 26 items.
Validation studies: The instrument was validated through repeated administration to 207 patients taking antidepressants, with assessments at multiple time points (weeks 0, 1, and 4).
Four-dimensional structure:
The ODQ assesses emotional blunting through four core dimensions that emerged from factor analysis:
1. Not Caring (NC) – Loss of interest and concern about responsibilities, activities, and matters that were previously important. Patients endorse items indicating they no longer care as much about day-to-day responsibilities, relationships, or events.
2. Emotional Detachment (ED) – Feeling disconnected or detached from others and from emotional experiences. This dimension captures the sense of being behind a barrier, watching life rather than fully participating in it.
3. Reduction in Positive Emotions (PR) – Diminished capacity to experience positive feelings such as joy, pleasure, enthusiasm, love, and excitement. This goes beyond anhedonia to encompass the full range of positive emotional experience.
4. General Reduction in Emotions (GR) – Overall emotional flattening affecting both positive and negative emotions. Patients describe emotions as “toned down,” experiencing a restricted emotional range.
Three-section structure:
The 26-item ODQ is organized into three distinct sections with different purposes:
Section 1 (12 items): Assesses emotional experiences during the past week, with 3 items from each of the 4 dimensions (NC, ED, PR, GR). This provides the core assessment of current emotional blunting severity.
Section 2 (8 items): Compares respondents’ experiences during the previous week with their experiences before they developed their illness/problem, with 2 items from each dimension. This retrospective comparison helps distinguish emotional blunting from pre-existing emotional patterns.
Section 3 (6 items): Completed only by respondents currently prescribed antidepressants. This “Antidepressant-as-Cause” (AC) domain addresses the extent to which participants attribute their emotional difficulties to their antidepressant medication and possible impact on treatment adherence.
This design allows for two scoring versions: ODQ-26 (all items including the AC domain) for patients on antidepressants, and ODQ-20 (excluding the AC domain) for those not currently taking antidepressants.
💊 Clinical Significance: Over one-third of patients consider stopping antidepressants due to emotional blunting, making accurate assessment essential for treatment adherence.
Key Features
Assessment Characteristics
26 items (or 20 items for those not on antidepressants) providing comprehensive assessment
5-10 minutes administration time
Ages 18+ through adult populations with depression
5-point Likert scale for nuanced response capture
Three-section structure addressing different aspects of emotional experience
Patient-derived items ensuring clinical relevance and face validity
Available translations validated in multiple languages
Four Core Dimensions Assessed
Not Caring (NC):
Loss of concern about responsibilities
Diminished interest in previously important activities
Reduced care about relationships and events
Emotional Detachment (ED):
Feeling disconnected from others
Sense of being behind an emotional barrier
Detachment from emotional experiences
Reduction in Positive Emotions (PR):
Diminished joy, pleasure, and enthusiasm
Reduced capacity for love and excitement
Inability to experience positive feelings
General Reduction in Emotions (GR):
Overall emotional flattening
“Toning down” of both positive and negative emotions
Restricted emotional range
Additional “Antidepressant-as-Cause” Domain
Attribution assessment – Extent to which emotions are attributed to medication
Adherence impact – How emotional effects influence medication continuation
Treatment decisions – Role in considering medication changes
Clinical and Research Applications
Treatment monitoring – Tracking emotional blunting throughout antidepressant therapy
Medication decision-making – Informing antidepressant selection and switching
Clinical trials – Outcome measure for interventions targeting emotional blunting
Differential diagnosis – Distinguishing medication effects from residual depression
Patient-clinician communication – Facilitating discussion of emotional experiences
Quality of life research – Assessing impact on functioning and wellbeing
“I think my antidepressant is affecting my emotions”
“I believe my medication is making me feel emotionally numb”
“I have considered stopping my antidepressant because of emotional effects”
Scoring Procedure
Sum Section 1 items (12 items): Range 12-60
Sum Section 2 items (8 items): Range 8-40
Sum Section 3 items if applicable (6 items): Range 6-30
Calculate total score:
ODQ-20 (no antidepressants): Sections 1+2 = 20-100
ODQ-26 (on antidepressants): Sections 1+2+3 = 26-130
Calculate dimension scores by summing relevant items
Higher scores indicate greater emotional blunting
Score Interpretation
ODQ-26 Total Score Ranges:
Total Score
Severity Level
26-52
Minimal emotional blunting
53-78
Mild emotional blunting
79-104
Moderate emotional blunting
105-130
Severe emotional blunting
ODQ-20 Total Score Ranges:
Total Score
Severity Level
20-40
Minimal emotional blunting
41-60
Mild emotional blunting
61-80
Moderate emotional blunting
81-100
Severe emotional blunting
Minimal Clinically Important Difference (MCID)
Treatment response thresholds (Christensen et al., 2021):
ODQ-20: Change of 16 points represents clinically meaningful improvement
ODQ-26: Change of 20 points represents clinically meaningful improvement
These MCID values were established through anchor- and distribution-based methods in patients switching to vortioxetine treatment.
Dimension Score Interpretation
Domain scores (each range 5-25 for Section 1):
Low (5-10): Minimal difficulties in this dimension
Moderate (11-17): Some emotional blunting present
High (18-25): Significant emotional blunting in this dimension
Profile analysis:
High PR + High NC: Prominent anhedonia with apathy
High ED: Particularly concerning for social relationships
High AC: Patient attributes emotions to medication; adherence risk
Elevated across all dimensions: Pervasive emotional blunting requiring attention
Research Evidence and Psychometric Properties
Reliability Evidence
Internal consistency: α = 0.93 for total score in original development showing excellent reliability (Price et al., 2012)
ODQ-20 internal consistency: α = 0.928 in Chinese validation (Chen et al., 2023)
ODQ-26 internal consistency: α = 0.945 in Chinese validation (Chen et al., 2023)
Japanese version: α = 0.912 for total score demonstrating cross-cultural reliability (Kato et al., 2023)
Domain reliability: α = 0.756-0.900 for individual dimensions except NC (α = 0.65) (Kato et al., 2023)
Test-retest reliability: ICC = 0.888 (ODQ-20) and 0.911 (ODQ-26) over 2-4 week interval (Chen et al., 2023)
Validity Evidence
Construct validity:
Four-factor structure: Consistently replicated in original development explaining 68% of variance (Price et al., 2012)
Chinese validation: Four factors explaining 58% of variance (Chen et al., 2023)
Japanese validation: Three factors explaining approximately 90% of variance (Kato et al., 2023)
Confirmatory factor analysis: Good model fit for four-factor structure across cultures
Convergent validity:
Depression severity: Moderate to strong positive correlation with MADRS demonstrating association with depression (r = 0.40-0.60) (Kato et al., 2023)
Depressive symptoms: Positive correlation with BDI-II (r = 0.45-0.65) (Chen et al., 2023)
Functional impairment: Positive correlation with Sheehan Disability Scale indicating impact on functioning (Kato et al., 2023)
Quality of life: Negative correlation with wellbeing measures (Price et al., 2012)
Discriminant validity:
Clinical vs. healthy controls: Significantly higher scores in mood disorder patients across all dimensions (p < 0.01) (Chen et al., 2023)
Acute vs. remission: Patients in acute phase score significantly higher than those in remission (Christensen et al., 2022)
Sensitivity to Change
Treatment response:
Vortioxetine switching study: Mean change of -24.8 points (ODQ-20) and -30.1 points (ODQ-26) after 8 weeks demonstrating sensitivity (Christensen et al., 2021)
Greater improvement in responders: ODQ-20 changed -27.0 vs -22.6 points in no blunting vs. persistent blunting groups (Christensen et al., 2021)
Correlation with global improvement: Changes in ODQ correlate with Clinical Global Impression-Improvement scores (Christensen et al., 2021)
Longitudinal tracking:
Completion rate: 96% of patients completed the ODQ on three separate occasions showing acceptability (Price et al., 2012)
Stable measurement: Consistent psychometric properties across repeated assessments
Clinical Group Differences
Prevalence of emotional blunting:
Acute phase depression: 73% report severe emotional blunting (Christensen et al., 2022)
Remission phase: 25% continue experiencing severe emotional blunting (Christensen et al., 2022)
Overall prevalence: 44% of depressed patients rate emotional blunting as extremely severe (Christensen et al., 2022)
Attribution patterns:
Depression-attributed: 56% consider emotional blunting caused by depression (Christensen et al., 2022)
Copyright and Usage Responsibility: Check that you have the proper rights and permissions to use this assessment tool in your research. This may include purchasing appropriate licenses, obtaining permissions from authors/copyright holders, or ensuring your usage falls within fair use guidelines.
The Oxford Depression Questionnaire is copyrighted by Oxford University Innovation Limited. Commercial use, translation, or adaptation requires authorization from the copyright holder.
Proper Attribution: When using or referencing this scale, cite the original development:
Price, J., Cole, V., Doll, H., & Goodwin, G. M. (2012). The Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQuESA): Development, validity, reliability and sensitivity to change. Journal of Affective Disorders, 140(1), 66-74. https://doi.org/10.1016/j.jad.2012.01.030
For licensing information: Contact Oxford University Innovation Limited at innovation.ox.ac.uk
Price, J., Cole, V., Doll, H., & Goodwin, G. M. (2012). The Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQuESA): Development, validity, reliability and sensitivity to change. Journal of Affective Disorders, 140(1), 66-74. https://doi.org/10.1016/j.jad.2012.01.030
Validation and MCID Studies:
Christensen, M. C., Loft, H., & McIntyre, R. S. (2021). Validation of the Oxford Depression Questionnaire: Sensitivity to change, minimal clinically important difference, and response threshold for the assessment of emotional blunting. Journal of Affective Disorders, 294, 456-462. https://doi.org/10.1016/j.jad.2021.07.020
Cross-Cultural Validation:
Chen, Z., Wang, J., Zhang, Y., et al. (2023). The Chinese version of Oxford Depression Questionnaire: A validation study in patients with mood disorders. Neuropsychiatric Disease and Treatment, 19, 539-549.
Kato, M., Kikuchi, T., Watanabe, K., Sumiyoshi, T., Moriguchi, Y., Åström, D. O., & Christensen, M. C. (2023). Assessing reliability and validity of the Oxford Depression Questionnaire (ODQ) in a Japanese clinical population. Neuropsychiatric Disease and Treatment, 19, 2579-2589.
Prevalence and Clinical Impact:
Christensen, M. C., Ren, H., & Fagiolini, A. (2022). Emotional blunting in patients with depression. Part I: Clinical characteristics. Annals of General Psychiatry, 21(1), 10. https://doi.org/10.1186/s12991-022-00387-1
Goodwin, G. M., Price, J., De Bodinat, C., & Laredo, J. (2017). Emotional blunting with antidepressant treatments: A survey among depressed patients. Journal of Affective Disorders, 221, 31-35.
A pangolin curled into an armored ball — symbolizing withdrawal, emotional shutdown, and protective isolation assessed by the ODQ (Oxford Depression Questionnaire)
Frequently Asked Questions
What does the ODQ measure?
The Oxford Depression Questionnaire (ODQ) measures emotional blunting in patients with major depressive disorder. It assesses four dimensions: Not Caring, Emotional Detachment, Reduction in Positive Emotions, and General Reduction in Emotions. The ODQ also evaluates whether patients attribute emotional blunting to their antidepressant medication and its impact on treatment adherence.
How long does the ODQ take to complete?
The ODQ takes approximately 5-10 minutes to complete. It consists of 26 items for patients taking antidepressants (ODQ-26) or 20 items for those not on antidepressants (ODQ-20), organized into three sections with straightforward 5-point Likert scale responses.
Is the ODQ free to use?
No, the ODQ is not free to use. It is copyrighted by Oxford University Innovation Limited. Commercial use, translation, or adaptation requires authorization from the copyright holder. Researchers should contact Oxford University Innovation Limited for licensing information and permissions.
How is the ODQ scored?
The ODQ is scored by summing items from three sections. Section 1 (12 items, range 12-60) assesses current emotional experiences. Section 2 (8 items, range 8-40) compares with pre-illness functioning. Section 3 (6 items, range 6-30) assesses antidepressant attribution. Total scores range from 20-100 (ODQ-20) or 26-130 (ODQ-26), with higher scores indicating greater emotional blunting.
What's the difference between the ODQ and the MADRS?
The ODQ specifically measures emotional blunting across four dimensions, while the Montgomery-Åsberg Depression Rating Scale (MADRS) is a broader clinician-rated measure of overall depression severity. The ODQ is patient-reported and focuses exclusively on emotional numbing and detachment. Research shows moderate correlation (r=0.40-0.60) between ODQ and MADRS, indicating they measure related but distinct constructs.
How reliable is the ODQ?
The ODQ demonstrates excellent reliability. Internal consistency is high (α=0.93-0.945 for total score) across multiple validation studies. Test-retest reliability is strong (ICC=0.888-0.911 over 2-4 weeks). The measure shows consistent psychometric properties across cultures, including validated Japanese and Chinese versions, with domain reliability ranging from α=0.65-0.90.
