Deciding about management and depression definitions
a. Factors that favour general advice and active monitoring
Subthreshold depressive symptoms:
- Four or fewer of the recognised symptoms with little associated disability
- Symptoms intermittent, or less than 2 weeks’ duration
- Recent onset with identified stressor
- No past or family history of depression
- Social support available
- Lack of suicidal thoughts.
b. Factors that favour more active treatment in primary care:
Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
- Five or more symptoms with associated disability
- Persistent or long-standing symptoms
- Personal or family history of depression
- Low social support
- Occasional suicidal thoughts.
c. Factors that favour referral to mental health professionals
Moderate depression: Symptoms or functional impairment are between ‘mild’ and ‘severe’
- Inadequate or incomplete response to two or more interventions
- Recurrent episode within 1 year of last one
- History suggestive of bipolar disorder
- The person with depression or relatives request referral
- More persistent suicidal thoughts
- Self-neglect.
d. Factors that favour urgent referral to specialist mental health services
Severe depression: Most symptoms and the symptoms markedly interfere with functioning. This can occur with or without psychotic symptoms.
- Actively suicidal ideas or plans
- Psychotic symptoms
- Severe agitation accompanying severe symptoms
- Severe self-neglect.