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Depression for WIPHL Workers

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Depression for WIPHL Workers Kenneth Kushner, Ph.D. March 27, 2008 – PowerPoint PPT presentation

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Title: Depression for WIPHL Workers


1
Depression for WIPHL Workers
  • Kenneth Kushner, Ph.D.
  • March 27, 2008

2
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

3
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

4
The Significance of Depression
  • Patients with major depressive disorder are more
    likely to become diabetic

5
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

6
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

7
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
  • Depressed mood
  • Diminished interest or pleasure
  • Significant weight loss or weight gain or
    increase or decrease in appetite nearly every day
  • Insomnia or hypersomnia nearly every day

8
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 agitation
  • 6) Fatigue or loss of energy
  • 7) Feelings of worthlessness or excessive or
    inappropriate guilt
  • 8) Diminished ability to think or concentrate or
    indecisiveness
  • 9)Recurrent thought of death or suicidal
    ideation/attempt/plan

9
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

10
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

11
Bipolar Disorder
  • Major depressive symptoms alternating with mania
    or hypomania

12
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.

13
Depression Screening
14
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15
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

16
Two Question Screen
  • Answering no to both questions ruled out
    likelihood of depression when assessed further
    (Negative Predictive Value99.7)
  • Answering yes to either question identified
    most patients with depression (sensitivity97)
    but with many false positive identifications
    (positive predictive value18)
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