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Assessing for Depression in your clinical counseling practice Deborah Legge PhD CRC LMHC http://www.InfluentialTherapist.com
Poll Question Who are you? Clinical counselor in Private Practice Clinical Counselor in Agency/Hospital/Education/Community setting Counselor Educator Student School Counselor Rehabilitation Counselor
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Assessment Options Observation Self-Report Screening Tools Clinical Interview
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Poll Question… Currently, when do you assess for depression? A. When clients express concern that they feel depressed B. When you first meet the client; in the first session C. When you observe signs that your client may have depression http://www.InfluentialTherapist.com
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Observation Unkempt Flat Agitated Tearful Blunted Distracted
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Self Report I’m feeling down I have no interests or hobbies I have no energy I can’t eat I eat too much I can’t sleep I sleep too much I don’t care if I never wake up http://www.InfluentialTherapist.com
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Poll Question… Do you currently utilize depression screening tools in your clinical work? Yes B. No A.
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Screening Tools Primary Care ◦ Patient Healthcare Questionnaire (PHQ-9) Assesses symptoms and functional impairment to make a tentative depression diagnosis Derives a severity score to help select and monitor treatment Series of 9 questions that are self-rated by the patients according to severity http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495 268/
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PHQ-9 (con’t) Scoring & suggested treatment ◦ If there are 4+ √s, consider depression 5-9 indicates mild depression Monitor symptoms, office check in 30 days
10-14 indicates moderate depression (Minor Depression) Support, watchful waiting (Dysthymia) Antidepressant or psychotherapy (Mild Depression) Antidepressant or psychotherapy
15-19 indicates Major Depression, moderately severe Antidepressant or psychotherapy
20+ indicates Major Depression, severe Antidepressant and psychotherapy, especially if not improved with monotherapy http://www.InfluentialTherapist.com
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Screening Tools Psychiatry ◦ Beck Depression Inventory (BDI)
Most widely used depression inventory in the world Considered to be reliable and valid, except when it is translated (cultural issues with the BDI) 21 questions about symptoms (each worth up to 3 points) 0-9 indicates minimal depressive symptoms 10-16 indicates mild depression 17-29 indicates moderate depression 30+ indicates severe depression
http://www.psychbytes.com/Quizzes/Beck%20Depressio n%20Inventory/Beck%20Depression%20Inventory.htm
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Assessing Depression in the Clinical Interview As part of the initial assessment ◦ Getting to know where the client is “at”, now ◦ Assessing past episodes of depression
As part of the ongoing assessment ◦ Client seems “off” ◦ You observe overt signs of depression
What you need to know: ◦ Major Depressive Episode ◦ Severity, history, duration http://www.InfluentialTherapist.com
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MAJOR DEPRESSIVE EPISODE
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Major Depressive Episode 2 weeks or more Either depressed mood or loss of interest or pleasure PLUS at least 4 more symptoms Symptoms cause significant distress Symptoms are not better accounted for by a medical issue, substance abuse or bereavement http://www.InfluentialTherapist.com
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SIGECAPS Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide
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Criteria for Severity/Psychotic/Remission Specifiers for current episode 296.xx 4th digit indicates: ◦ 2 = first episode ◦ 3 = recurrent
5th digit indicates the current state of the depression ◦ ◦ ◦ ◦ ◦ ◦
1 = mild 2 = moderate 3 = severe without psychotic features 4 = severe with psychotic features 5 = in partial remission 6 = in full remission http://www.InfluentialTherapist.com
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Additional Specifiers for Major Depressive Episode Chronic ◦ When a person meets the criteria for a Major Depressive Episode continuously for the past two years
Catatonic Features ◦ When a person demonstrates one or many unusual movements and mannerisms
Melancholic Features ◦ When the client has depression and cannot feel good (even temporarily) when something good happens
Atypical Features ◦ Mood reactivity, increased appetite, increased sleep, hypersensitivity
Postpartum Onset ◦ When the onset of episode occurs within 4 weeks of childbirth
Seasonal Pattern ◦ When at least 2 of the persons episodes occur regularly and coincide with a specific season of the year
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Seasonal Affective Disorder At this time, it is still a modifier for Major Depressive Disorder NIMH description: Seasonal affective disorder (SAD), is characterized by the onset of depression during the winter months, when there is less natural sunlight.The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy. http://www.InfluentialTherapist.com
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MAJOR DEPRESSIVE DISORDER
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General Criteria of MDD One or more major depressive episodes No history of manic, mixed, or hypomanic episodes Not related to medical or substance issues Not related to psychotic disorder
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Major Depressive Episode
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DYSTHYMIC DISORDER
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General Criteria for Dysthymia Chronic depressed mood for most of the day, for more days than not, for at least 2 years Client describes mood as “down in the dumps” Symptom-free intervals last
