Introduction Depression is a mood disorder affecting the way an individual feels, thinks, behaves and can affect social and occupational functioning (Canadian Medical Association CMA, 2013). Public Health Agency of Canada (PHAC), 2002 reports approximately 8% of Canadian adults will experience major depression at some time in their lives and that it is the leading cause of years lived with disability worldwide. The Patient Health Questionnaire-9 (PHQ-9) was chosen for this critique to improve knowledge and understanding of this tool for practicing and new clinicians working in Primary Care. The goal is to increase confidence in utilizing the PHQ-9, increase diagnostic and monitoring accuracy, and ultimately to improve health outcomes. Description of Tool The PHQ-9 is a widely utilized tool in Primary Care to assist clinicians with the detection, diagnosing, monitoring, and measuring of severity of depression in adults (Kroenke, Spitzer, Williams 2001). It is a nine item self-administered questionnaire based on the Diagnostic Statistic Manual IV (DSM-IV) criteria for diagnosing depression in adults. There is a tenth question at the end regarding effect, if any, on functioning. It has also been used in many medical specialty populations for adults presenting with, or suspicion of depressive symptoms. It may be completed in clinic by the patient and takes two to five minutes (Nease et al. 2003). It is reviewed by the clinician and interpretation of the score is made using the algorithm that accompanies the questionnaire in 1-3 minutes. The expense of the paper is the only cost. The training is simply the clinician becoming familiar with the questions and the scoring. Literature Review The PHQ-9 is a version of the orig... ... middle of paper ... ...ion and diagnosis of depression but does not negate the need for clinician interview and assessment. Gilbert et. al 2007 cautioned that screening procedures alone will not improve client outcomes. One bias is that much of the research regarding the PHQ-9 has been by the developers of the tool and funded by Pfizer, however in view of several other studies supporting that it is evidence- based, this is not an ethical concern. Overall the PHQ-9 has been shown to have a positive effect on health outcomes by aiding clinicians in detection, diagnosing and monitoring depression with a consistent reliable tool. The scope of advanced practice nursing has increased over the last decade and mental health has become a common reason to see a healthcare professional. Nurse practitioners can feel confident in using this tool as an adjunct to their clinical assessment skills.
Included in the treatment of psychiatric patients, differing levels of observation have also been used. These levels of observation include: “routine or general observation, 30- to 15-min checks, and constant or continuous observation” (Manna, 2009, p. 268). While a mental health professional such as a Licensed Professional Counselor, Licensed Clinical Social Worker, Psychiatrist, or Advance...
The Beck Depression Inventory-II (BDI-II) is the latest version of one of the most extensively used assessments of depression that utilizes a self-report method to measure depression severity in individuals aged thirteen and older (Beck, Steer & Brown, 1996). The BDI-II proves to be an effective measure of depression as evidenced by its prevalent use in both clinical and counseling settings, as well as its use in studies of psychotherapy and antidepressant treatment (Beck, Steer & Brown, 1996). Even though the BDI-II is meant to be administered individually, the test administration time is only 5 to 10 minutes and Beck, Steer & Brown (1996) remark that the interpretive guidelines presented in the test manual are straightforward, making the 21 item Likert-type measure an enticing option to measure depression in appropriate educational settings. However it is important to remember that even though the BDI-II may be easy to administer and interpret, doing so should be left to highly trained individuals who plan to use the results in correlation with other assessments and client specific data when diagnosing a client with depression. An additional consideration is the response bias that can occur in any self-report instrument; Beck, Steer & Brown (1996, pg. 1) posit that clinicians are often “faced with clients who alter their presentation to forward a personal agenda that may not be shared.” This serves as an additional reminder that self-report assessments should not be the only assessment used in the diagnoses process.
Zung, W. W. K., (1965). A self-rating depression scale. Arch. Gen. Psychiatry. 12:63-70.[Duke Univ. Med. Ctr., Dept. Psychiatry, Durham, NC]
This paper introduces a 35-year-old female who is exhibiting signs of sadness, lack of interest in daily activities and suicidal tendencies. She has no interest in hobbies, which have been very important to her in the past. Her lack of ambition and her suicidal tendencies are causing great concern for her family members. She is also exhibiting signs of hypersomnia, which will put her in dangerous situations if left untreated. The family has great concern about her leaving the hospital at this time, fearing that she may be a danger to herself. A treatment plan and ethical considerations will be discussed.
The Beck Depression Inventory is a self-report inventory that attempts to understand the severity of depression in adults and or adolescents. The original Beck Depression Inventory was created in 1961 by Aaron Beck and his associates and was revised in 1971. In 1971, the Beck Depression Inventory was introduced at the Center for Cognitive Therapy, CCT, at the University of Pennsylvania Medical School. Much of the research on the Beck Depression Inventory has been done at the University of Pennsylvania Medical School. In the current version, of the Beck Depression Inventory, the subject rates 21 symptoms and attitudes on a 4 point scale depending on severity. Test takers rate the items listed in the inventory according to a one week timeframe, which includes the day the test takers took the test. The items that that the inventory measures covers cognitive, somatic, affective and vegetative dimensions of depression and although it was developed atheoretically, the items correspond with depression symptoms as outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV, American Psychiatric Association, 1994). The Beck Depression Inventory is widely known and is well known by psychiatric populations and clinicians. The BDI can be administered in a group or individual format by oral or written form. The 1993 version targets more trait aspects of depression versus the previous and earlier versions measured state aspects of depression. The test is to be administered with no more than 15 minutes to take the test, regardless of the mode administered. The 21 symptoms that are rated on the 4 point scale are then totaled and the range can vary from 0 to 63. Patients that score...
Kaut, K. P., & Dickinson, J.A. (2007). The mental health practitioner and psychopharmacology. Journal of Mental Health Counseling, 29(3), 204–225.
Depression is an equal opportunity disorder, it can affect any group of people with any background, race, gender, or age. Depression is a sneak thief that slips quietly and gradually into people’s lives - robbing them of their time, and their focus. At first, depression may be undetectable, but in the long run a person could become so weighed down that their life may feel empty and meaningless. Contrary to popular belief, not everyone who commits suicide is depressed, but majority of people who commits suicide do so during a severe depressive episode. There are over 300 million people in the world today who suffer from depression. Depression has affected people for a long as records have been kept. It was first called out by the famous Greek philosopher Hippocrates over 2,400 years ago. Hippocrates called it “melancholia”. Many times we think of depression as one disorder alone, when in fact there are many different types of depression. The different types of depression are major depressive disorder, dysthymic disorder, atypical disorder, adjustment disorder, and depressive personality disorder. All types of depression share at least one common symptom. It is commons from the person who suffers from any form of depression to feel an unshakable sadness, anxious, or empty mood. Major depressive disorder also known as unipolar depression or recurrent depressive disorder is the most severe depressive disorder out of all of the depressive in my estimation. Major depressive disorder is a condition in which affects a person’s family, work or school life, sleeping, eating and general health. It is important to emphasize that we can understand the mechanics of this disorder and how it affects people with major depressive disorder.
Katon, W., and Sullivan, M. D., (1990) Depression and Chronic Mental Illness. Journal of Clinical Psychiatry, v.51. pgs. 8-19
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the comprehensive guide to diagnosing psychological disorders. This manual is published by the American Psychiatric Association (APA) and is currently in its fifth revision. Moreover, the manual is utilized by a multitude of mental health care professionals around the world in the process of identifying individuals with disorders and provides a comprehensive list of the various disorders that have been identified. The DSM serves as the essential resource for diagnosis of mental disorders based off of the various signs and symptoms displayed by individuals while also providing a basic reference point for the treatment of the different disorders. The manual attempts to remain scientific in its approach to identifying the underlying symptoms of each disorder while meeting the needs of the different psychological perspectives and the various mental health fields. The DSM has recently gone through a major revision from the DSM-IV-TR to the DSM-5 and contains many significant changes in both the diagnosis of mental disorders and their classifications.
Clinical depression is very common. Over nine million Americans are diagnosed with clinical depression at some point in their lives. Many more people suffer from clinical depression because they do not seek treatment. They may feel that depression is a personal weakness, or try to cope with their symptoms alone. On the other hand, some people are comfortable with admitting their symptoms and seeking help. Such a discrepancy may account for the differences in reported cases of depression between men and women, which indicate that more than twice the numbers of women than men are clinically depressed. According to the numbers of reported cases of depression, 25% of women and 10% of men will have one or more episodes of clinical depression during their lifetimes.
Williams, J. B. (1988) A structured interview guide for the Hamilton depression rating scale. Arch Gen Psychiatry. 45, 742-747.
Many people feel depression and not know why, they may start to feel like they’re crazy or as if they can’t live a normal life. “ Most mental illnesses go undiagnosed and untreated , screening helps” (Depression Tests, 1). After identifying these illnesses people can finally have a peace of mind and be able to take all the right steps in helping themselves.
National Institute of Mental Health. (2014). “Depression: What Every Woman Should Know”. Pub No. 95-3871.
Simpson, C. (2007) ‘Mental Health part3: Assessment and Treatment of Depression’ British Journal of Healthcare assistants. pp 167-171.
Mental and behavioural disorders (expressed in disability adjusted life years, or DALY'S) represented 11% of the total disease burden in 1990, and this is likely to rise to 15% by 2020. Five of the 10 leading causes of disability worldwide in 1990 were mental or behavioural disorders. Depression was the fourth largest contributor to the disease burden in 1990 and is expected to rank second after ischaemic heart disease by 2020. It is estimated that one in four people will develop one or more mental or behavioural disorders in their life-time and that one in four families has one member suffering from a mental or behavioural disorder (Murray et al., 1996; WHO,