Depression and DPN are closely associated with each other. Based on the clinical measures of DPN, the neuropathy disability score (NDS) and the vibration perception threshold (VPT), it has been associated with the Hospital Anxiety and Depression Scale (HADS). A separate screening instrument, the Patient Health Questionnaire 9 (PHQ-9), also showed connections between depression and DPN. The symptoms of DPN that have been associated with depression are reduced foot sensation, pain, and unsteadiness.