Depression: Screening Questions and Overview

History of Depression

• Onset of depression includes precipitating events and nature of symptoms
• Severity and impact on life, as well as past history of similar symptoms, mood elevation, or other mental health problems
• Previous response to treatment and current life events, including stressors at home and work, are important to consider

Family and Social History

• Quality of interpersonal relationships, living conditions, and social isolation are important factors
• Co-existent medical conditions and current medication, including prescribed and non-prescribed drugs, should be taken into account

Symptoms of Depression

• Symptoms present >50% of the time in the past 2 weeks, with two key features: depressed mood and/or reduced interest or pleasure, which must be disabling to the patient
• Other symptoms include:
  • Change in appetite/weight
  • Insomnia or hypersomnia
  • Fatigue or loss of energy
  • Poor concentration
  • Poor appetite or overeating
  • Low energy or fatigue
  • Low self-esteem
  • Sense of worthlessness or guilt
  • Recurrent thoughts of death/suicide
  • Psychomotor agitation/retardation
  • Feelings of hopelessness
  • Poor concentration or difficulty making decisions

Examination and Assessment

• General appearance, including self-neglect, smell of alcohol, weight loss or weight gain
• Assessment of mood, including depression, tiredness, speech monotone or monosyllabic, avoids eye contact, tearful, anxious or jumpy/fidgety
• Psychotic symptoms, such as hallucinations and delusions, should be considered

Epidemiology of Depression

• 2.3 million people suffer from depression in the UK at any time
• Women are twice as likely to suffer from depression as men
• Around 30-50% of cases are not detected, although most are mild cases that may resolve spontaneously

Screening Questions for Depression

• During the last month, have you often been bothered by feeling down, depressed, or hopeless?
• During the last month, have you often been bothered by having little interest or pleasure in doing things?
• If +ve response to either question, investigate further with PHQ-9

Causes and Co-Morbidity

• Associated with psychiatric disorders, such as anxiety, alcohol abuse, substance abuse, and eating disorders
• Associated with physical disorders, such as PD, MS, dementia, thyroid disorders, Addison's disease, hypercalcaemia, RA, SLE, cancer, HIV, and other chronic infections
• Associated with cardio- and cerebrovascular disease, learning disability, and certain medications that can cause symptoms of depression