Depression is among the biggest contributors to the global disease burden and affects individuals from virtually all corners of the world. The World health organization in 2012 estimated that the worldwide depression prevalence is at 350 million people. A research performed by the World mental Health Survey in 17 countries found out that about 1 in 20 people have depression (Depression, W. H. O. 2012). Depressive symptoms are recurring and have significant, far-reaching consequences on the health of an individual. The WHO further categorizes WHO as a primary cause of disability. As such, this has called upon various stakeholders including health professionals, governmental, and non-governmental authorities to come together to curb depression and its comorbid aspects. The case study features a 28-year-old woman by the name Jessica. She demonstrates depressive symptoms that have functionally affected her life and the ability to develop positive interpersonal relationships with the family. As illustrated in her story, depression is a prevalent and highly debilitating mental health condition. Thus, understanding its epidemiology, manifestations, clinical interventions, resources and limitations form the basis of appropriate treatment.
Epidemiology
Depression has been ranked as the most significant cause of disability and a contributor to the growing disease burden across the world. The global prevalence of depression has been on the rise. Wang et al. (2017) say, “The lifetime prevalence of depression ranges from 20% to 25% in women and 7% to 12% in men.” Almost half of the psychiatric consultations today revolve around the problem of depression. However, it is essential to note that the prevalence of depression is higher in the patient population compared to the general population. The authors further assert that depression is a significant comorbid factor chronic conditions such as asthma, stroke, and arthritis among others. In the United States, the prevalence of depression was at 7.4% as of 2016 (Elflein, 2016). The rates of depression are higher among a given segment of the demographic. First, based on the statistics shown, women are more prone to depression. Although the actual reasons are not known, it is assumed that they are exposed to more risk factors for depression, such as childbirth coupled with poor coping skills. Also, depression is relatively common among adolescents and college students.
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Manifestations
The case of Jessica provides several insights into some of the most common symptoms associated with depression. She has little interest in sex and also experiences difficulties in falling asleep. She seemingly has familial problems, as shown by her inability to open up to her husband. Jessica is generally dissatisfied with her life. Also, she has recently developed suicidal ideations. Lim et al. (2018) assert that depression is characterized by symptoms such as sadness, disturbed sleep, and lack of appetite. Other symptoms include poor concentration, sadness, and a feeling of low self-worth. Depression is also associated with suicidal ideation, which could lead to cases of mortality. As illustrated in the case of Jessica, “Depression often runs a chronic course and substantially impairs an individual’s occupational potential and quality of life” (Lim et al., 2008). The WHO estimates that by the end of 2020, depression will be a leading cause of disease burden across the world. The American Disability Act (ADA) has recently revised its regulations by including mental health conditions such as depression as part of what entails a disability. Depression, especially major depression, could have a significant disability on an individual’s ability to perform at the highest professional level.
Clinical Interventions
The clinical interventions for Jessica will begin by diagnosis. The caregiver will largely rely on the clinical history of the patient. Physical assessment can be performed to establish whether she meets the criteria for depression, as illustrated in the DSM-5 manual. Laboratory tests should be done for Jessica to rule out any other medical condition. The treatment available for Jessica can broadly be classified as pharmacological and non-pharmacological treatment. The pharmacological interventions for treatment include medications and drugs such as the antidepressants. According to Gartlehner et al., (2017), the second-generation antidepressant drugs are preferred to the treatment of depression. They include selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitors. The authors further opined that these medications should be regarded as first-step therapy. Most non-pharmacological treatments for depression are based on various psychological models and theories. The first theory in the treatment of depression is known as the psychodynamic theory. Here, the underlying assumption is that the actions of individuals are determined by the experiences they witness in life. For instance, Jessica’s depression could be as a result of the high demanding and high stressing nature of her work.
The Psychodynamic theory was postulated by philosophers such as Carl Jung and Sigmund Freud. Psychodynamic therapy is, therefore, an essential strategy in mitigating the long-term sources of depression. Gartlehner et al. (2017) assert that it involves mitigating the painful emotions and resolving any conflicts that an individual might be holding. Another theoretical model for treatment is cognitive theory. The cognitive theory places the cognitive processes at the helm of thoughts, emotions, and behaviors. It, therefore, focuses on what people do rather than what they think. An example of a strategy in this category is cognitive behavioral therapy (CBT). Gartlehner et al. (2017) assert that CBT challenges the negative and unhelpful thoughts and instead replaces them with more positive ones. It focuses on emotional regulation and also ensures that an individual develops coping skills. Throughout the treatment model, Jessica can be assessed with a model such as the stepped-approach system. Depending on her manifestations, treatments will be adjusted to meet her mental health needs better.
Resources and Limitations
The management of depression significantly relies on the resources found in primary care. The Family Nurse Practitioner, in diagnosing Jessica, will need to follow the Diagnostic Statistical Manual of mental Disorders (DSM-5). Ng, How, & Ng (2017) assert that approximately two-thirds of individuals with depression do not seek help. It is, therefore, the role of the nurse to identify some of the barriers that could negatively impact the patient from seeking mental care. Some of these limiting factors as identified by the authors include stigma, financial means, and a lack of awareness. Jessica might not be aware that she has depression. It is for this reason that he is adamant about opening up to her husband. Some of the resources for the treatment of depression include a mental health facility, nurse practitioner, psychiatrist, and the guidelines availed by the WHO among others. Ng et al. (2017) assert that the nurse should ensure that the treatment is holistic and strictly follows the biopsychosocial model. In this regard, Jessica will be taken through a rigorous treatment regime that focuses on medication, social treatment, psychological treatment, lifestyle changes, and addressing the potential sources of stressors such as her work. Also, the nurse will need to develop a therapeutic relationship with the patient. Since Jessica is a reserved individual, developing a close therapeutic relationship backed with empathic listening could improve her outcomes.
Conclusion
Depression is a highly debilitating mental condition that affects millions of people across the world. As illustrated in the case study, Jessica cannot live a normal life due to the depression that continues to destroy her personal life. Thus, she should receive mental health guidance that will begin with diagnosis and treatment. The role of the nurse will remain crucial throughout the treatment process. They will form strong interpersonal relationships, avail resources, mitigate the limitations, and work with the patient throughout their recovery.
References
Depression, W. H. O. (2012). A Global Public Health Concern Developed by Marina Marcus, M. Taghi Yasamy, Mark van Ommeren, and Dan Chisholm, Shekhar Saxena. WHO Department of Mental Health and Substance Abuse.
Elflein, J. (2019). Depression in the U.S. - Statistics & Facts https://www.statista.com/topics/4569/depression-in-the-us/
Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L. ... & Lohr, K. N. (2017). Pharmacological and non-pharmacological treatments for major depressive disorder: a review of systematic reviews. BMJ Open , 7(6), e014912.
Lim, G. Y., Tam, W. W., Lu, Y., Ho, C. S., Zhang, M. W., & Ho, R. C. (2018). Prevalence of Depression in the Community from 30 Countries between 1994 and 2014. Scientific Reports, 8(1), 2861.
Ng, C. W. M., How, C. H., & Ng, Y. P., (2017). Managing depression in primary care. Singapore Medical Journal, 58(8), 459.
Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W. ... & Wang, D. (2017). Prevalence of depression and depressive symptoms among outpatients: A systematic review and meta-analysis. BMJ Open, 7(8), e017173.
