Major depression in primary care: making the diagnosis

Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

doi:10.11622/smedj.2016174

Cited by 30 publications

(23 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our previous article illustrated the approach to diagnosis of major depression in primary care. (36) The physician should make an effort to look out for any comorbid illnesses, such as chronic physical illnesses, anxiety, substance misuse or personality disorders, which may complicate management. To prevent harmful overdosing, adherence to medication should be checked and strictly supervised, if deemed necessary.…”

Section: Optimising Treatment Of Underlying Depressive Disordermentioning

confidence: 99%

Depression in primary care: assessing suicide risk

Ng¹,

How²,

Ng³

2017

smedj

Self Cite

View full text Add to dashboard Cite

Major depression is a risk factor for suicide, accounting for up to 60% of suicides.(1-4) The literature has shown that a large proportion of patients who died by suicide had made contact with a primary care health provider within the three months preceding their deaths.(5-7) Patients who died by suicide were also more likely to visit their primary care practitioner than a psychiatrist.(6) This suggests that primary care practitioners are in a unique position to identify at-risk individuals and possibly intervene. (6,8,9) Primary care practitioners have been identified as one of the key potential gatekeepers in suicide prevention efforts.(10) Despite this, not all primary care practitioners routinely ask about suicide in depressed patients. WHAT CAN I DO IN MY PRACTICE?There are concerns that enquiring about suicide in patients who are depressed may trigger suicide, but evidence has shown this to be untrue. (12) Acknowledging and discussing suicide may reduce, instead of aggravate, suicidal ideation. Asking about suicide may help primary care physicians to identify high-risk patients who require urgent intervention (such as hospitalisation) and to uncover risk factors, some of which are amenable to intervention. (9) There are numerous tools to screen for suicide risk. One of the more widely used suicide assessment tools is the SAD PERSONS scale. This is a ten-item mnemonic, which was first developed as a tool for medical students and non-psychiatrist physicians to guide suicide risk assessment.(13) The use of the tool has been found to improve identification of persons with suicidal ideation. (14) The letters in the mnemonic represent demographic, behavioural and psychosocial risk factors for suicide (Box 1). Each risk factor that is present is accorded a score of 1 point, for a maximum of 10 points. Patterson et al recommended that: (a) patients with scores of 3-4 should be closely monitored; (b) hospitalisation should be strongly considered for those with scores of 5 and 6; and (c) patients with scores of 7-10 should be hospitalised for further assessment.(13) A systematic review of the performance of the SAD PERSONS scale in the clinical setting concluded that it did not acutely predict suicide behaviour. (15) Nonetheless, it is an easy scale to remember and use in the primary care setting.Information acquired via such assessment tools can add to the overall information obtained during a thorough suicide assessment. However, a systematic review concluded that there was insufficient evidence for the usefulness of suicide risk screening tools and that suicide assessment tools should not replace a thorough suicide assessment. (16) Each risk factor that is present is accorded a score of 1 point, for a maximum of 10 points.Patterson et al (13) recommended:• Close monitoring for patients with scores of 3 to 4• To strongly consider hospitalisation for those with scores of 5 and 6• Hospitalisation for further assessment for patients with scores of 7-10Note: Regardless of the score obtained, overall clinic...

show abstract

Section: Optimising Treatment Of Underlying Depressive Disordermentioning

confidence: 99%

Depression in primary care: assessing suicide risk

Ng¹,

How²,

Ng³

2017

smedj

Self Cite

View full text Add to dashboard Cite

show abstract

“…Genetic factors have also been considered as a likely cause. [ 7 8 9 10 11 ] According to the Diagnostic and Statistical Manual of Mental Disorders 5 th edition, depressive disorders are characterized by the presence of sadness, emptiness, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual's everyday performance. [ 6 ] Depression is frequently undiagnosed and untreated.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and associated factors of depression among medical students of Saudi Arabia: A systematic review

AlJaber

2020

J Family Med Prim Care

View full text Add to dashboard Cite

The main purpose of our review study was to estimate depression prevalence among Saudi Arabian medical students according to the published articles and try to reveal the main associated factors. A systematic search was performed through PubMed/Medline and Google Scholar databases. A review of 18 studies published between January 2010 and March 2019 was composed of the following selection of necessary articles approved by PICO (population, intervention, control, and outcomes) criteria. The prevalence of depression among medical students of Saudi Arabia ranged from 30.9% to 77.6% with a mean prevalence of 51.5%. Depression severity was evaluated by various questionnaires, so we summarized the extracted data and revealed that medical students tend to have moderate to severe depression to a greater extent than mild depressive symptoms (33.27% vs 29.9%). The findings of this review suggest a high incidence of depression among medical students and the influence of associate sociodemographic factors. Females are considered to be at a higher risk of depression. First-year medical students are the most susceptible to develop depressive symptoms. Smoking is strongly associated with depression severity. Marital status, eating habits, usage of stimulants, and sleep disturbances are within significant findings of our review study.

show abstract

“…(1) In this article, we describe the management of depression in primary care. This follows earlier articles that discussed the diagnosis of major depression and the important differentials to consider when a patient presents with low mood, (2) and the assessment of suicide risk.…”

Section: What Is Major Depression?mentioning

confidence: 89%