Assessment Of Depression, Part 1
Depression is a psychological disorder that involves all functions of an individual’s existence. It affects the way a person behaves, thinks and feels. Depression is not merely a passing “blue mood”. People who have depression could not simply get over it and get better. Without treatment, usually medication, symptoms last for weeks, months, even years.
Usually the first step in getting appropriate treatment is a physical examination by the medical doctor and later a thorough psychiatric assessment. A good evaluation will include Psychiatric Assessment with Suicide Risk Assessment (more on suicide in Chapter VI), Mental State Examination, Symptoms Checklist, DASS (Depression Anxiety Stress Scale) and BDI (Beck Depression Inventory).
The Psychiatric Assessment (done by medical professionals) is a standard component of assessments for all mental disorders (WHO Collaborating Centre for Mental Health and Substance Abuse, 2000).
The aim of this assessment is to identify diagnosis and other existing problems, assess suicide risk, highlight areas that require intervention so that goals can be set and management plan devised, and identify the baseline against which improvement or deterioration can be measured. Questions are devised to obtain information needed to help mental health teams appropriately match client with treatment.
Data is collated from answers to following enquiries:
- Identify the presenting problem
- History of the present problem
- Personal history
- Previous medical history
- Drug history
- Premorbid personality (what was the person like before the problems)
- Family history
The Mental State Examination (MSE) is also done by health professionals. It includes an assessment of the current or actual state of the client. The MSE is designed to obtain specific aspects of the individual’s mental experiences and behaviour at the time of interview. Sometimes it is not possible to organise immediate assessment with a specialist.
Other mental health workers with more basic knowledge should also be able to assess mental state and to use the same professional terminology in order to devise the best management plan. The MSE should be also used routinely with clients who might experience relapse. Following aspect of client’s experiences and behaviours are assessed.
- Appearance and behaviour
- Speech
- Mood and affect
- Form of thought
- Content of thought
- Perception
- Sensorium and cognition
- Insight
Symptoms Checklist
Symptoms of depression could be grouped into three clusters – physical, cognitive and behavioural. Each symptom cluster requires emphasis on different treatment options. This checklist may be helpful if used regularly throughout treatment.
Here are some of examples of the checklist (WHO Collaborating Centre for Mental Health and Substance Abuse, 2000):
- Physical symptoms – sleep disturbance; appetite disturbance, weight change, loss of energy etc.
- Cognitive symptoms – excessive self-criticism or guilt, feelings of hopelessness, suicidal thoughts, decreased pleasure etc.
- Behavioural symptoms – loss of motivation, apathy, impaired ability to make decision, difficulty setting goals etc.
In Part 2 we’ll look at the DASS (Depression Anxiety Stress Scale) and BDI (Beck Depression Inventory).