Clinical Depression vs. Layman's' Depression: What Nurses Need to Know
Submitted by Michael C. LaFerney RN, PMHCNS, BC
Tags: depression
Many patients claim to be depressed. The word depressed can have many meanings. The Oxford dictionary defines depressed as a person in a state of general unhappiness or despondency. (1)The Merriam-Webster Dictionary states depressed is low in spirit or sad. (2) Other synonyms for depressed include blue, dispirited,down, down in the dumps, downhearted, gloomy, grim low or low spirited. and dejected. There are many other expressions or words that mean.” depressed” to the layman. I have often received consults on patients by nurses who report a patient is depressed based a self report given to the nurse. I then go see the patient who is eating well,sleeping at night and attending multiple activities. When I asked what they meant by depressed. She responds“ I miss my family” I have received calls regarding a patient in long-term care threatening self- harm . When I ask them about it and discuss whether an inpatient psychiatric admission is needed for their safety they sometimes will state that they were angry, upset,or some other reason and they didn't mean it. Some tell me “it's just an expression.” I then coach them to use the correct wording for their unhappiness as “I was mad at the nurse” or “my family didn't visit.”
Nurses as close direct caregivers often utilize depressed in the layman's interpretation. They sometimes use emotional reasoning and negative cognitions as” I”d be depressed to be in a nursing home or if I had the medical issues many patients have.” This an be mistaken empathy. Of course we all have period of feeling sad or unhappy. People will often respond to some short support as active listening or reassurance. Mental health professionals view depressed with a much different and broader definition. There are many types of depression. These include Major depression, Persistent depressive disorder (formerly called dysthymia ), disruptive mood dysregulation disorder, premenstrual dysphoric disorder and depressive disorders due to a medical condition. There are various other severe depressions as Seasonal affective disorder, prenatal and postpartum depression, bipolar depression and Atypical depression. Being depressed in one of these categories requires several more criteria. While subjective criteria as feeling and voicing being depressed is a criteria a person with MDD must have experienced 5 or more of the listed symptoms with a specif time period to be given this diagnosis. In my example above the patient voiced being depressed but is eating sleeping well and attending daily activities. She does not meet the criteria for MDD. To have Persistent depression disorder an adult must have at least three symptoms over a period of two years. There cannot be a period of two successive months without symptoms in the two year time frame. Disruptive mood dysregulation disorder occurs between ages 6 and 18 and must be differentiated from other childhood disorders as Oppositional defiant disorder .A child can have both. The outburst must occur at least 3 times a week and be beyond the usual temper tantrums seen in childhood. Some depressions must occur during specific time period as after pregnancy or during the winter months. (3)
Saying one is depressed without the supporting symptoms and time frame is usually a short term issue or related to some specific event. These can be resolved with short support or counseling. We can teach patients other words to express what they are really feeling as I am “disappointed” my family didn't visit rather than expressing being depressed. Nurses and healthcare professional should become knowledgeable about the various types of depression and DSM-5 criteria. They can then do a medical and mental health history to ascertain symptoms so that a correct diagnose can be determined. They can administer short tool as the PHQ-2 or 9, the Beck's Depression Inventory or other available screening tools to see if further assessment should be considered. In summary we should be aware of the general layman's term depressed in healthcare settings to avoid their being labeled inappropriately and ensure they are evaluated using the total criteria so that care and treatment can be implemented.
References
- Oxford reference Dictionary Taken 27 December 2023 from the www at: https://www.oxfordlearnersdictionaries.com/us/definition/english/depressed#:~:text=%2Fd%20%C9%AA%CB%88prest%2F-,%2Fd%C9%AA%CB%88prest,very%20sad%20and%20without%20%20hope
- Merriam-Webster Dictionary Taken 27 December 2023 from the World Wide Web at: https://www.merriamwebster.com/dictionary/depressed
- Cleveland clinic, Depression, Taken 27 December 2023 from the World Wide Web at: https://my.clevelandclinic.org/health/diseases/9290-depression
Michael C. LaFerney is a psychiatric clinical Nurse specialist at Healthdrive, Framingham ,MA