NUR 212 Final test Module 5-7.Depression, Anxiety, and Post-Traumatic Stress Disorder (PTSD) for Primary Care Providers

Depression, Anxiety, and Post-Traumatic Stress Disorder (PTSD) for Primary Care Providers Depression Depression: Significance  Only one-third to one-half of primary care clinicians will detect depression, yet it is a large contributor to death, disability, and pain symptoms across all settings o Of these patients, only about 20-40% get better  Up to 80% of patients with depression have a medical comorbidity  Nearly 70-80% of all antidepressant medications are prescribed by primary care clinicians: It is critical to be comfortable with these medications  In a year, approximately 10% of all adults will have a depressive disorder o 7% major depression o 17% depression in lifetime [Additionally, major depression was second only to back and neck pain for having the greatest effect on disability days, at 386.6 million U.S. days per year. -WHO study of 60 countries showed depression made greatest decrease in quality of life; depression and diabetes are most difficulty combination -Every point increase in the PHQ-9 results in loss of productivity -Concept and treatments of depression vary across cultures (some have not been validated in non-English speaking, caucasian populations)] Depression: Diagnostic Criteria  Depressive symptoms must be present for at least 2 weeks prior to diagnosis. Defined by sadness, hopelessness, loss of interest in activities previously enjoyed; can also be accompanied by somatic symptoms or pain.  Must have either: depressed mood or anhedonia (loss of interest or pleasure)  Must have five or more of the following symptoms in the past two weeks (at the same time) o Depressed mood most of the day, nearly every day o Diminished interest or pleasure in all or nearly all activities most of the day, nearly every day o Weight loss or weight gain, change in appetite-nearly every day o Slowing down of thought and reduction in physical movement (observed) o Fatigue/loss of energy nearly every day o Feelings of worthlessness/inappropriate guilt nearly every day o Decreased ability to think or concentrate, indecisiveness every day o Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, specific plan of completing suicide or suicide attempt [-Criteria based on Diagnostic and Statistical Manual (5th edition) -Routine screening is recommended for the general adult population, pregnant women, and postpartum women -Major depression can be associated with high mortality-it is important to screen for suicidality and refer if needed (will discuss in later slides) -Can also present as somatic symptoms or pain]