ODQ: Oxford Depression Questionnaire

Reviewed by: Constantin Rezlescu | Associate Professor | UCL Psychology

At a Glance

Items	26 (ODQ-26, for patients taking antidepressants) or 20 (ODQ-20, for those not taking antidepressants), across three sections
Administration time	Brief; most patients completed it within about two minutes (Zhu et al., 2023)
Response format	5-point scale, 1 = Disagree to 5 = Agree; higher scores indicate greater emotional blunting
Scores	Four dimensions (Not Caring, Emotional Detachment, Reduction in Positive Emotions, General Reduction in Emotions), an Antidepressant-as-Cause domain in the ODQ-26, and a total score
Validated ages	Adults (validation samples aged roughly 18-65)
License	Commercial. © Oxford University Innovation Limited
Original citation	Price, Cole, Doll, & Goodwin (2012), Journal of Affective Disorders (published as the OQuESA)

Introduction

The Oxford Depression Questionnaire (ODQ) is a patient self-report measure designed to assess emotional blunting in people with major depressive disorder. Originally published as the Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQuESA), it was developed by Price, Cole, Doll, and Goodwin (2012) at the University of Oxford to capture a phenomenon that standard depression scales measure poorly: the restricted range of emotion that many patients describe during treatment, feeling emotionally “numbed,” detached from the world, or simply “not caring” about things that once mattered.

Understanding Emotional Blunting

Emotional blunting refers to a narrowing of emotional experience rather than to low mood as such. Patients describe their emotions as “toned down” or flattened, reporting neither the peaks of pleasure nor the depths of distress they once felt; diminished capacity for joy, enthusiasm, and love; a sense of detachment, as if watching life from behind a barrier; and a loss of concern for responsibilities and relationships. A recurring clinical question is whether this state reflects a residual symptom of depression itself, a side effect of antidepressant medication, or both, and the ODQ was constructed partly to help separate these possibilities. Emotional blunting is common: in one clinical characterisation, roughly 72% of patients in the acute phase of depression and 25% of those in remission reported severe emotional blunting (Christensen et al., 2022).

Theoretical Foundation

The ODQ is a patient-reported outcome measure built from patients’ own accounts rather than from expert consensus alone. The initial item pool was generated through qualitative interviews with patients who described emotional blunting, then refined by cognitive interviewing so that respondents interpreted the items as intended. Price et al. (2012) reduced the draft through iterative factor analysis and validated the resulting instrument by administering it repeatedly to 207 patients taking antidepressants, with assessments at weeks 0, 1, and 4. Factor analysis identified four dimensions of emotional blunting, which the questionnaire assesses first for the past week (Section 1) and then in comparison with functioning before the illness developed (Section 2). A third section (Section 3), completed only by patients currently prescribed antidepressants, forms the Antidepressant-as-Cause domain and asks how far respondents attribute their emotional difficulties to their medication. This design supports two scoring versions: the ODQ-26 (all three sections) for patients on antidepressants, and the ODQ-20 (Sections 1 and 2 only) for those who are not.

📊 Key insight: The ODQ turns a symptom that ordinary depression scales blur into a measurable, trackable dimension, and it does so from the patient’s own vantage point, including whether they blame the medication.

Key Features

Assessment Characteristics

• 26 items (ODQ-26) or 20 items (ODQ-20 for respondents not on antidepressants), organised into three sections
• Brief to complete; most patients finished within about two minutes in the Chinese validation (Zhu et al., 2023)
• Adult populations with depression (validation samples aged roughly 18-65; Price et al., 2012; Christensen et al., 2021; Kato et al., 2023)
• 5-point response scale, anchored 1 = Disagree to 5 = Agree
• Patient-derived items, generated from interviews and refined by cognitive interviewing (Price et al., 2012)
• Validated translations in Japanese (Kato et al., 2023) and Chinese (Zhu et al., 2023)

Dimensions Assessed

• Not Caring (NC) – loss of concern about responsibilities, activities, relationships, and events that were previously important
• Emotional Detachment (ED) – feeling disconnected from other people and from one’s own emotional experience, as if behind a barrier
• Reduction in Positive Emotions (PR) – diminished capacity for joy, pleasure, enthusiasm, love, and excitement
• General Reduction in Emotions (GR) – overall flattening of both positive and negative emotions, a restricted emotional range
• Antidepressant-as-Cause (AC) – the ODQ-26 adds this domain to gauge how far patients attribute their emotional difficulties to their medication and whether this affects adherence

Versions & Adaptations

• ODQ-26 – the full form, including the Antidepressant-as-Cause section, for patients taking antidepressants (Price et al., 2012)
• ODQ-20 – Sections 1 and 2 only, for respondents not currently on antidepressants; a scoring subset of the same instrument rather than a separate short form (Price et al., 2012)
• Japanese version – validated in employed Japanese outpatients with MDD (Kato et al., 2023)
• Chinese version – validated in patients with mood disorders (Zhu et al., 2023)
• No independent short forms beyond the ODQ-20/ODQ-26 distinction were identified during verification. Translations are produced under linguistic validation by the copyright holder.

Research Applications

• Treatment monitoring – tracking emotional blunting over the course of antidepressant therapy
• Clinical trials – an outcome measure for interventions targeting emotional blunting, and for comparing antidepressant classes
• Differentiating cause from effect – distinguishing medication-related from depression-related emotional change
• Quality-of-life and functioning research – relating emotional blunting to disability and wellbeing (Kato et al., 2023)

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Assess emotional blunting experiences across four dimensions.

Scoring and Interpretation

Response Format

Respondents rate each statement on a 5-point scale from 1 (Disagree) to 5 (Agree); higher item scores (4 or 5) indicate greater emotional blunting (Christensen et al., 2021). The two verified endpoints are labelled Disagree and Agree; the published validation papers do not specify labels for the intermediate points 2 to 4.

Item Content and Structure

Section 1 – Experience during the past week (12 items): three items from each of the four dimensions (NC, ED, PR, GR), assessing current emotional blunting.

Section 2 – Comparison with before the illness (8 items): two items from each dimension, asking respondents to compare their current experience with how they felt before they developed their illness or problem.

Section 3 – Antidepressant attribution (6 items, if applicable): completed only by respondents taking antidepressants; the Antidepressant-as-Cause domain, addressing how far patients attribute their emotional difficulties to their medication and whether this affects adherence.

The full ODQ item wording is copyrighted by Oxford University Innovation Limited and is not reproduced here. Licensed copies of the instrument are available from Oxford University Innovation.

Scoring Procedure

1. Sum Section 1 (12 items): range 12-60.
2. Sum Section 2 (8 items): range 8-40.
3. Sum Section 3 if applicable (6 items): range 6-30.
4. Calculate the total score:
   • ODQ-20 (not on antidepressants): Sections 1 + 2 = 20-100
   • ODQ-26 (on antidepressants): Sections 1 + 2 + 3 = 26-130
5. Compute dimension scores by summing the relevant items.
6. Higher scores indicate greater emotional blunting.

Items are scored 1-5, giving total ranges of 20-100 (ODQ-20) and 26-130 (ODQ-26) (Christensen et al., 2021; Zhu et al., 2023). The published literature validates the ODQ as a change-sensitive measure with a defined minimal clinically important difference (below); it does not define severity classification bands or diagnostic cut-off scores. Zhu et al. (2023) note explicitly that the sensitivity, specificity, and cut-off values for the ODQ remain to be established.

Interpretation: Minimal Clinically Important Difference (MCID)

Because no severity bands exist, interpretation rests on change in score. The minimal clinically important difference was established by anchor- and distribution-based methods in patients switching to vortioxetine, using the Clinical Global Impression-Improvement (CGI-I) scale as the anchor (Christensen et al., 2021):

• ODQ-20: a change of about 16 points represents clinically meaningful improvement
• ODQ-26: a change of about 20 points represents clinically meaningful improvement

Descriptive Sample Values

The values below are descriptive figures from validation samples, not normative cut-offs. They illustrate typical treatment-related change and group differences; they should not be used to classify individuals.

Sample	N	Value (M or change)	Source
Vortioxetine switch, ODQ-20 mean change at 8 weeks	—	−24.8 points	Christensen et al. (2021)
Vortioxetine switch, ODQ-26 mean change at 8 weeks	—	−30.1 points	Christensen et al. (2021)
Mood-disorder patients vs healthy controls (all dimensions and total higher in patients, p < 0.01)	136 vs 95	Group difference	Zhu et al. (2023)

Research Evidence and Psychometric Properties

Reliability Evidence

• Internal consistency (development): α = 0.93 for the total score, with individual dimensions ranging 0.86-0.88 (Price et al., 2012)
• Internal consistency (Chinese version): α = 0.928 (ODQ-20) and 0.945 (ODQ-26) (Zhu et al., 2023)
• Internal consistency (Japanese version): α = 0.912 for the total score; domain alphas ranged 0.756-0.900, with the exception of Not Caring (α = 0.65) (Kato et al., 2023)
• Test-retest reliability: ICC = 0.777 (ODQ-20) and 0.781 (ODQ-26) over a 2-4 week interval (Zhu et al., 2023); the Japanese validation reported ICCs of 0.69-0.82 across total and domain scores (Kato et al., 2023)

Factor Structure

• Development: four factors explained 67.6% of the variance (Not Caring 17.8%, General Reduction 17.4%, Emotional Detachment 16.6%, Positive Reduction 15.9%) (Price et al., 2012)
• Chinese version: the four-dimension structure was supported by confirmatory factor analysis (Zhu et al., 2023)
• Japanese version: exploratory factor analysis extracted three factors accounting for 91.8% of the variance, a structure that differs from the original four-factor solution and reflects sample and translation differences (Kato et al., 2023)

Validity Evidence

• Convergent (depression severity, MADRS): strong in the Japanese validation (total-score r = 0.654 at Week 24 to 0.714 at Week 12; Kato et al., 2023) and moderate in the Chinese validation (ODQ-20 r = 0.480; ODQ-26 r = 0.537; Zhu et al., 2023). Baseline correlation was low (r = 0.27-0.28) in a restricted-range vortioxetine sample, indicating the ODQ captures aspects of experience the MADRS does not (Christensen et al., 2021)
• Convergent (depressive symptoms, BDI-II): ODQ-20 r = 0.647 and ODQ-26 r = 0.719 in the Chinese validation (Zhu et al., 2023)
• Convergent (functioning and quality of life): positive correlation with the Sheehan Disability Scale and negative correlation with EQ-5D quality-of-life scores (Kato et al., 2023)
• Discriminant (clinical vs controls): significantly higher scores in mood-disorder patients than in healthy controls across all dimensions and the total score (p < 0.01; 136 patients vs 95 controls; Zhu et al., 2023)
• Discriminant (acute vs remission): patients in the acute phase score significantly higher than those in remission (Christensen et al., 2022)

Sensitivity to Change

• Treatment response: mean change of −24.8 points (ODQ-20) and −30.1 points (ODQ-26) after 8 weeks of switching to vortioxetine (Christensen et al., 2021)
• Greater change in responders: ODQ-20 changed −27.0 vs −22.6 points, and ODQ-26 changed −32.8 vs −27.5 points, in patients reporting no emotional blunting versus persistent blunting at 8 weeks (Christensen et al., 2021)
• Tracking global improvement: ODQ change graded with CGI-I level (CGI-I 1/2/3/4 = −34.1 / −25.5 / −15.5 / −6.1 for ODQ-20); patients minimally improved on the CGI-I (score 3) changed −15.5 (ODQ-20) and −20.0 (ODQ-26), anchoring the MCID (Christensen et al., 2021)
• Acceptability: 95% of participants completed the questionnaire at each of the three time-points in the development study (Price et al., 2012)

Prevalence and Attribution

• Acute phase: about 72% of patients report severe emotional blunting; remission: about 25% (Christensen et al., 2022)
• Attribution to depression: 56% consider their emotional blunting to be caused by their depression (Christensen et al., 2022; Kato et al., 2023)
• Attribution to medication: 45% believe their antidepressant is negatively affecting their emotions (Christensen et al., 2022; Kato et al., 2023)
• Adherence: over one-third of patients consider stopping, or have stopped, antidepressants because of perceived emotional effects (Christensen et al., 2022)

Relationship to MADRS Items

Kato et al. (2023) examined which MADRS items best approximate emotional blunting when the ODQ is unavailable. In multiple regression, three items were significant predictors of ODQ total score, and a fourth reached significance in correlation:

• Item 6, Concentration difficulties (β = 2.29, p = 0.007)
• Item 8, Inability to feel (β = 2.12, p = 0.028)
• Item 4, Reduced sleep (β = 2.06, p = 0.004)
• Item 7, Lassitude (significant in Spearman correlation with ODQ total)

The sum of these four MADRS items correlated with ODQ total score (ρ = 0.646, p < 0.001), supporting their use as a rough proxy for emotional blunting when a dedicated measure is not available (Kato et al., 2023).

Usage Guidelines and Applications

Primary Applications

• Treatment monitoring throughout antidepressant therapy to detect emerging emotional blunting
• Treatment-switching decisions, providing structured data when patients report emotional side effects
• Remission-quality assessment, evaluating whether remission includes adequate emotional functioning
• Adherence discussion, since a high Antidepressant-as-Cause score flags patients at risk of discontinuing medication

Design Considerations

• Interpret change, not level. Use the MCID (16 points for ODQ-20, 20 points for ODQ-26) to judge meaningful improvement; do not apply severity bands, which the literature does not define (Christensen et al., 2021)
• Track both total and dimension scores to describe the profile of blunting across the four dimensions
• Match the version to the patient: ODQ-26 for patients on antidepressants, ODQ-20 for those who are not
• Anchor the recall window: Section 1 asks about the past week; Section 2 compares with functioning before the illness developed
• Licensing: obtain permission from Oxford University Innovation before reproducing, translating, or hosting the instrument

Cultural Considerations

• Norms of emotional expression vary across cultures, and interpretation should take this into account
• Validated Japanese and Chinese versions exist (Kato et al., 2023; Zhu et al., 2023); the Japanese data extracted a three-factor rather than four-factor structure, so factor-level interpretation should be made against the relevant validation

Limitations and Cautions

• Overlap with depression: emotional blunting correlates with depression severity, so cause and effect can be hard to separate
• Retrospective comparison: Section 2 relies on recall of pre-illness functioning, which may itself be impaired
• Attribution is uncertain: patients may misattribute symptoms to medication rather than illness, or vice versa
• Self-report only: the ODQ does not include a behavioural or performance measure of emotional processing
• No severity thresholds: no validated severity bands or diagnostic cut-off scores exist; the ODQ is a change-sensitive measure, not a classifier (Zhu et al., 2023)

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Legal and Copyright Information

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. Item content is not reproduced here.

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

External Links and Resources

• Oxford University Innovation – ODQ Information
• Emotional Blunting in Depression – PubMed
• University of Oxford Department of Psychiatry

References

Primary 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

Validation, MCID, and Sensitivity to Change:

• Christensen, M. C., Fagiolini, A., Florea, I., Loft, H., Cuomo, A., & Goodwin, G. M. (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, 924-931. https://doi.org/10.1016/j.jad.2021.07.099

Cross-Cultural Validation:

• Zhu, Y., Wu, L., Ye, S., Fu, Y., Huang, H., Lai, J., Shi, C., & Hu, S. (2023). The Chinese version of Oxford Depression Questionnaire: A validation study in patients with mood disorders. Neuropsychiatric Disease and Treatment, 19, 547-556. https://doi.org/10.2147/NDT.S396356
• 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, 2401-2412. https://doi.org/10.2147/NDT.S428443

Prevalence and Clinical Characteristics:

• 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

Related Assessments: The ODQ is often used alongside broad depression-severity measures such as the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory-II (BDI-II), which assess overall depression rather than emotional blunting specifically (links added when their pages go live).