Depression for WIPHL Workers

Kenneth Kushner, Ph.D.March 27, 2008

The Significance of Depression

• According to the W.H.O. Global Burden of Disease Project (GBD 2000), worldwide– Depression was ranked #1 among leading

causes of years of life lived with disability, accounting for 12% of the total.

– 5.8% of men and 9.5% of women experience depression in a given year

– Estimated that 121 million people world wide currently experiencing major depression

The Significance of Depression

• The prevalence of major depression in adults in the U.S. is 5.3% with an estimate of 17 million cases

• Up to 15% of people with major depressive disorder will eventually commit suicide

• Death rates (from all causes) of people with major depressive disorder over 55 are 4 times those in the general population

• In medical settings, patients with major depressive disorder have more pain and physical illness and decreased physical, social functioning

The Significance of Depression

• Patients with major depressive disorder are more likely to become diabetic

The Nosology of Depression

• DSM-IV lists multiple diagnoses that may be referred to as “depression”– Major Depressive Disorder (MDD)– Dysthymic Disorder– Bipolar Disorder– Adjustment Disorder (with Depressed

mood)– Schizoaffective Disorder

The Nosology of Depression

• Other conditions may have significant mood symptoms similar to depression– Post-traumatic Stress Disorder (PTSD)– Schizophrenia

• Depression might arise secondary to other conditions– Ie panic disorder– Diabetes

DSM Major Depressive Disorder

A. A minimum of 5 symptoms during the same 2-week period and represent change in previous functioning. One symptom must be #1 or #2 below:

1) Depressed mood2) Diminished interest or pleasure3) Significant weight loss or weight gain or

increase or decrease in appetite nearly every day

4) Insomnia or hypersomnia nearly every day

DSM Major Depressive Disorder

A. A minimum of 5 symptoms during the same 2-week period and represent change in previous functioning (Cont).5) Psychomotor retardation or agitation6) Fatigue or loss of energy7) Feelings of worthlessness or excessive or

inappropriate guilt8) Diminished ability to think or concentrate or

indecisiveness9)Recurrent thought of death or suicidal

ideation/attempt/plan

DSM Major Depressive Disorder

B. The symptoms do not meet criteria for a mixed episode (bipolar disorder)

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

D. The symptoms are not due to direct effects of a substance or general medical condition

E. The symptoms are not better accounted for by bereavement

Dysthymic Disorder

• Characterized as chronic, but less severe depression as compared to MDD

• Standard is 2 symptoms, majority of days for 2 years, never absent for more than 2 months

Bipolar Disorder

• Major depressive symptoms alternating with mania or hypomania

Adjustment Disorder

• An adjustment disorder is a debilitating reaction, usually lasting less than six months, to a stressful event or situation. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

• These symptoms or behaviors are clinically significant as evidenced by either of the following: – Distress that is in excess of what would be expected

from exposure to the stressor.– Significant impairment in social, occupational or

educational functioning.

• The symptoms are not caused by Bereavement.

Depression Screening

Two Question Verbal Screen

• Two questions were shown to be good at ruling out depression and identifying most of those who were depressed in general practices in New Zealand (Arroll, Khin & Kerse, 2003)– “During the last 2 weeks have you been often been

bothered by feeling down, depressed or hopeless”?– “During the past month have you been bothered by

little interest or pleasure in doing things”?

• Questions were delivered by physicians verbally to 476 general practice

• Answers were recorded as “yes” or “no”

Two Question Screen

• Answering “no” to both questions ruled out likelihood of depression when assessed further (Negative Predictive Value=99.7%)

• Answering “yes” to either question identified most patients with depression (sensitivity=97%) but with many false positive identifications (positive predictive value=18%)