Health care dana bartlett, bsn, msn, ma, cspi

Depression

Depression is a significant public health problem in the U.S. and the most common psychiatric disorder.²⁷ The National Institute of Mental Health estimated that in 2014, 15.7 million American adults had one episode of major depression²⁸ and the lifetime prevalence of depression of Americans is estimated to be 7% to 16.6%.^29,30

Depression is a major cause of disability, mental and physical impairment from mild to major, and lost productivity, and it is one of the most important causes of suicide.³¹ Risk factors for depression include (but are not limited to) childbirth, family history, female gender, serious medical illness, stressful life occurrences, and substance use.^5,27,31

The USPSTF recommends screening for depression in non-pregnant adults 18 years and older “… when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.”⁵

In 2009, the USPSTF recommended screening all adults when staff-assisted depression care supports are in place and selective screening based on professional judgment and patient preferences when such support is not available. In recognition that such support is now much more widely available and accepted as part of mental health care, the current recommendation statement has omitted the recommendation regarding selective screening, as it no longer represents current clinical practice. The current statement also specifically recommends screening for depression in pregnant and postpartum women, subpopulations that were not specifically reviewed for the 2009 recommendation.⁵

The criteria for major depressive disorder are listed in the section below.¹¹³

The diagnostic criteria for major or depressive disorder include that five or more of the following symptoms have been present during a two-week period, are a significant change from the patient’s previous mood and functioning, at least one of the symptoms is depressed mood or loss of pleasure or interest, and the symptoms are not caused by a medical condition. The criteria include:

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  Depressed mood most of the day, nearly every day. The depressed mood can be subjective (i.e., the patient reports feeling sad, hopeless) or can be observed by others. In children or adolescents, irritation is often present.
  
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  Markedly diminished interest or pleasure in daily activities. This happens nearly every day and is reported by the patient or by others.
  
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  Significant weight loss (> 5% of body weight) when not dieting or a decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
  
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  Insomnia or hypersomnia nearly every day.
  
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  Psychomotor agitation or retardation nearly every day: this should be observable by others and not just the patient’s feelings of restlessness or feeling lethargic.
  
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  Fatigue or loss of energy nearly every day.
  
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  Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  
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  Diminished ability to think or concentrate, or indecisiveness, nearly every day, reported by the patient or observed by others.
  
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  Recurrent thoughts of death; recurrent suicidal ideation without a specific plan; a suicide attempt or a specific plan for committing suicide.
  

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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  The episode is not attributable to a substance or another medical condition.
  

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  The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
  

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  There has never been a manic episode or a hypomanic episode.
  

The incidence of major depressive disorder in children and adolescents has been estimated as between 3.9% to 12.8%, depending on the age group that was surveyed and how the data was collected.¹¹⁴

Depression in children is often undertreated and it can cause serious impairment of psycho-social functioning.¹¹⁵ Risk factors for depression in children and adolescents include:^5,115

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  Abuse, neglect
  
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  ADHD
  
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  Anxiety disorder
  
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  Bullying
  
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  Chronic illness
  
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  Family conflict
  
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  Family history of depression
  
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  Gender dysphoria
  
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  Learning disabilities
  
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  Oppositional defiance disorder
  
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  Substance use disorder
  
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  Traumatic brain injury
  

The USPSTF advises that adolescents age 12-18 should be screened for depression when there are resources in place for diagnosis, treatment, and follow-up.⁵ The Patient Health Questionnaire for Adolescents (PHQ-A) and the Beck Depression Inventory Primary Care Version (BDI-PC) have been shown to useful for assessment of adolescents for depression.⁵