Psychosocial Aspects of Patient Care: Understanding Loss and Depression

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Psychosocial Aspects of Patient Care
Understanding Loss and Depression
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Dealing with Loss

• Self-image
• Home
• Privacy
• Independence

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Privileges of Patients

• Temporary respite
• Financial gain
• Social gain

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Personal Life of the Patient

• Fragility of relationships
• Lack of sustained interest
• Changing relationships
• Uncertainty about the future
• Stigma and support systems
• Depression

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Depression

• A mood state or illness diagnosed according to
  various criteria
• Approximately 17 of all patients seen by primary
  care providers are depressed
• Can be
• Adjustment disorders
• Major depressive disorder
• Dysthymic disorder
• Depressive disorder not otherwise specified (NOS)

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Adjustment Disorders

• Brief periods of depression in response to
  certain events or crises that occur in a persons
  life
• Have a good prognosis

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Major Depressive Disorder

• Characterized by at least four of the following
• Depressed mood and/or loss of interest or
  pleasure in most activities (anhedonia)
• Change in weight or appetite
• Increased or decreased sleep
• Increased or decreased psychomotor activity
• Fatigue or lack of energy (anergia)
• Feelings of worthlessness or guilt
• Decreased ability to think
• Recurrent thoughts of death or suicide

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Dysthymic Disorder

• Chronic or fluctuating form of depression for at
  least a 2-year duration
• Depressed mood or loss of pleasure in activities
  and additional symptoms of depression, but
  insufficient in number or intensity to warrant dx
  of major depression

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Depressive Disorder NOS

• Disorders with depressive symptoms that dont
  meet the criteria for the three previous disorders

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Screening for Symptoms of Depression by Physical
Therapists

• Physical therapists are relatively poor in
  screening for symptoms of depression in their
  patients
• 35 - 47 LBP patients have depressive symptoms
• Haggman S, Maher CG, Refshauge KM. Screening
  for symptoms of depression by physical therapists
  managing low back pain. Phys Ther.
  2004841157-1166.

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Instruments Used to Test for Depression

• Beck Depression Inventory (BDI)
• Beck Anxiety Inventory (BAI)
• Depression Anxiety Stress Scales (DASS)

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A Screening Tool The Two-Question Instrument

• During the past month, have you often been
  bothered by feeling down, depressed, or hopeless?
• During the past month, have you often been
  bothered by little interest or pleasure in doing
  things?
• Whooley MA, Avins AL, Miranda J, Browner WS.
  Case-finding instruments for depression Two
  questions are as good as many. J Gen Intern Med.
  199712439-445.
• Haggman S, Maher CG, Refshauge KM. Screening for
  symptoms of depression by physical therapists
  managing low back pain. Phys Ther.
  2004841157-1166.

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Using the 2-question screening tool

• If the patient answers yes to either or both,
  this is a positive result for moderate to severe
  depression
• Monitor the patient
• If continues to have positive result, refer for
  more intensive testing

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Depression and Rehabilitation

• The longer depression goes undetected, the
  greater the likelihood of
• Increased disability
• Prolonged physical therapy
• Result is
• Increased cost (economic and social) to society
  and the patient
• Possibly recurring cycle of depressive and
  disabling episodes

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Questions for Thought and Discussion

• Purtilo Haddad, pp. 139 - 140