Depression in adults
Depression or feelings of depression occur in
10% of all people
20% of people with a chronic physical health problem
20% of Aboriginal and Torres Strait Islander people
Assessment
Screening
“During the past month, have you been bothered by feeling down, depressed or hopeless?”
“During the past month, have you been bothered by little interest or pleasure in doing things?”
If yes to either
“Is this something that you would like help with?”
If answer is either 1 or 2 AND yes to 3 then sensitivity is 96% and specificity is 89% for depression
Consider screening in pregnant / post-partum, chronically ill, new patients, multiple physical symptoms
History
Symptoms - Concentration, decrease energy, guilt, worthlessness, helplessness, hopelessness, sleep changes, iritability, loss of interest, low mood, sadness, emptiness, thoughts of suicide, psychosis
Functional impairment - Grief, psychosocial distress, decrease ability to do ADLs, relationships
Personal + Family History - Mental health, Previous medication or therapy, substance use, chronic health problems, life circumstance changes, trauma, social supports, domestic violence
Mania + Hypomania
Risk of harm
Are you think of suicide?
Consider risk to dependants through neglect
Risk of violence
Medical
Thyroid, Parkinson’s, Insomnia, CV disease, Diabetes, Dementia, Steroids, COCP, Champix
Consider testing physical causes (more useful if > 45 and sudden onset)
FBC TSH Ferritin CMP LFT B12 Folate UEC
Tool
K10 / DASS21
MSE
Appearance - Contact, dress, grooming, manner, attentiveness, prominent physical abnormalities, emotional facial expression, alertness
Motor - Agitation, retardation, abnormal movements, gait
Speech - Rate, rhythm, volume, amount, articulation, spontaneity
Affect - Stability, range, appropriateness, intensity, mood
Thought content - Suicidal ideation, depressive cognitions, obsessions, paranoid ideation, delusions
Thought process - Associations, perseveration, neologism, blocking, attention
Perception - Hallucinations, illusions, déjà vu, depersonalisation
Intellect - Global impression
Insight - Awareness of illness
Diagnostic criteria
5 or more of the following during 2 weeks with one of 1) depressed mood 2) loss of interest
Depressed mood
Loss of interest
Weight change
Sleep change
Psychomotor
Fatigue
Worthlessness
Poor concentration
Thoughts of death
And
Symptoms cause distress or impairment
Not attributable to other cause
Not explained by other mental health illness
No mania
Management
Red Flags
Escalate
Suicidality
Follow the Suicide Ideation and Intent pathway
Stepped care model
For self-management (level 1):
For low intensity services (level 2):
For moderate intensity services (level 3):
For high intensity services and acute and specialist community mental health services (level 4 and 5):
E mental health
Black Dog Institute – myCompass – An interactive self‑help program designed to address mild to moderate symptoms of stress, anxiety, and depression. Includes two specific psychoeducational activities:
e-couch – Provides information about emotional problems, what causes them, how to prevent them and how to treat them for patients aged 15 years and older.
Mental Health Online – Is a treatment based online service for people (aged 18 years and older) with mental health problems, designed to support people to improve their health and overcome mental health difficulties.
MindSpot – Offers a number of online treatment courses for people (aged 18 years and older) with symptoms of stress, worry, anxiety, low mood and depression, including MindSpot Indigenous Wellbeing Course.
MoodGYM – Is an online self-help program designed to help users prevent and manage symptoms of depression and anxiety using cognitive behavioural therapy techniques.
OnTrack – Depression – A free online treatment program designed to help people aged ≥ 18 years recover from depression and to stop depression from coming back.
This Way Up – Offers online courses including depression, anxiety, OCD, and PTSD that patients (aged 15 years and older) can enrol in or general practitioner's can prescribe to their patients. Cost involved – see website.
Mandatory reporting
Young person at harm
Therapeutic relationship
Essential
Crisis Intervention
Safety Plan
Crisis numbers
13YARN: 13‑92‑76 (24 hours, 7 days, crisis support for Aboriginal and Torres Strait Islander patients)
Lifeline – phone 13‑11‑14
eHeadspace (patients aged ≤ 25 years) – phone 1800‑650‑890
Beyond Blue – phone 1300‑224‑636
Suicide Call Back Service – phone 1300‑659‑467
Healthy Living Strategies
GPMHTP
Develop a GP Mental Health Care Plan in collaboration with the patient and family or carer