Introduction
A 17-year-old adolescent female with a history of attention deficit hyperactivity disorder (ADHD) acknowledged worries regarding her likelihood of developing major depressive disorder (MDD) due to her family’s record of the condition during a thorough visit to assess her health status. The patient also expressed worry about her grandmother’s new breast cancer prognosis. The nurse practitioner (NP) used the 2016 Screening for Depression in Children and Adolescents by the U.S. Preventive Service Task Force (USPST) and Bright Future’s screening guidelines to address the patient’s worries and provide the necessary health oversight.
Risk Factors and Symptoms Associated with Major Depressive Disorder
Risk Factors
MDD represents a form of affective disorder distinguished by persistent negative feelings such as despair, hopelessness, and anhedonia. Comprehending the affiliated indicators and hazards – which could stem from psychological, biological, or environmental factors – is indispensable in the early detection and therapy of MDD.
One of the foremost risk factors for MDD is a genealogy of depression (Cheung et al., 2018). According to Zuckerbrot et al. (2018), individuals with a family background of depressive conditions are more likely to acquire MDD. The patient’s admittance regarding her mother and grandmother having undergone MDD intervention hinted that she might be more vulnerable to the disorder.
Another conceivable hazard of MDD is the patient’s recent experience with her grandmother’s breast cancer diagnosis. In keeping with the research, those who undergo substantial worry or trauma are more prone to suffering from depression (Zuckerbrot et al., 2018). The patient’s apprehensions about MDD could be compounded by her anxieties regarding her grandmother’s well-being.
Another potential risk factor for MDD is ADHD, as it is not unusual for ADHD, a neurodevelopmental disorder, to coincide with other psychiatric ailments such as depression (American Academy of Pediatrics, 2022). The patient disclosed that she was diagnosed with ADHD at ten years of age, indicating that she may have an increased likelihood of developing MDD.
Symptoms
Symptoms of MDD can differ in each patient, factoring out key variables like age. They may include changes in appetite or weight, feelings of hopelessness or helplessness, difficulty sleeping, fatigue, loss of energy, difficulty concentrating, and thoughts of suicide or death (Cheung et al., 2018). Individuals with MDD often have a persistent low mood and may lose interest in activities they once enjoyed. In adolescents, irritability may also be a prominent symptom.
Appropriate Health Supervision Screenings for MDD
Screening for MDD is a critical component of health supervision in children and adolescents. By using screening tools, healthcare practitioners can identify individuals at risk of MDD, facilitating early intervention and treatment (Buniket al., 2022). There are several appropriate health supervision screenings for MDD available to NPs that can determine the next steps in health supervision.
One such screening tool is the Patient Health Questionnaire-9 (PHQ-9) (Kroenke, K., n.d.). The PHQ-9 is a self-administered questionnaire that evaluates the severity of depressive symptoms in patients. It includes nine questions that assess symptoms such as low mood, anhedonia, changes in appetite or weight, fatigue, and sleep disturbances. The PHQ-9 is widely used in primary care settings to screen for depression and has shown good sensitivity and specificity for identifying individuals with MDD.
The Beck Depression Inventory-II (BDI-II) is a valuable screening instrument to use following an assessment of MDD. A self-administered assessment called the BDI-II is used to gauge how severe depressive symptoms are in patients (Wang & Gorenstein, 2021). It has 21 questions that examine signs like hopelessness, shame, feeling inadequate, and suicidal ideas. The BDI-II is frequently used in research contexts as a depression screening tool because it is a valid and reliable indicator of patients with MDD.
Based on the screening findings, the nurse practitioner (NP) must decide the next steps in health supervision. Further assessment and therapy are required if the patient’s screening results exceed the suggested MDD cutoff. This may entail directing the patient to a mental health specialist for a thorough assessment, counseling, and drug administration.
The NP can also give the patient psychoeducation about melancholy and coping mechanisms to control their symptoms (CDC, 2021). It is crucial to understand that screening tests are not diagnostic tests, and a positive outcome does not imply that the patient has MDD in all cases. A thorough assessment by a mental health expert should be conducted after a favorable result is obtained to determine the diagnosis and the best course of treatment.
Current Recommendations for Management and Follow-up of MDD for This Specific Patient
In this situation of a teenager whose family history portrays kin with MDD, it is crucial to follow the accepted recommendations for managing and tracking MDD. The nurse practitioner (NP) is required to provide comprehensive information about the symptoms, risk factors, and accessible treatments for MDD, as well as psychological counseling about depression. In children and adolescents, routine depression screening is not advised unless there is a known risk factor or cause for worry, according to the USPSTF’s 2016 recommendation statement on the subject (Siu AL., n.d.).
The Bright Futures recommendations also encourage talking about the value of getting enough sleep, exercising regularly, and maintaining a healthy diet (Bright Futures, n.d). The NP may recommend the proper psychotherapy and medication depending on the patient’s specific requirements and desires. The NP should use a suitable screening instrument, such as the PHQ-9 or BDI-II, considering the patient’s known risk factors.
If the patient’s evaluation surpasses the screening tool’s proposed threshold, the nurse must direct the patient to a mental wellness specialist for an extensive appraisal. Following the detection of MDD, a specialist in mental health can select the most suitable course of action, which could consist of psychotherapeutic intervention, pharmacological treatment, or a blend of both methodologies (Bunik et al., 2022). In anticipation of a catastrophic mental health episode, such as self-inflicted harm or suicidal thoughts, the NP and the patient’s family should jointly design an emergency strategy.
In addition to recommending the patient to a mental health specialist, the NP might also recommend internet support groups and additional resources for the patient’s family. The patient’s kin must be included in the treatment and follow-up for MDD because family support can significantly affect the patient’s recovery (Bunik et al., 2022). To ensure continuous care and ideal symptom management, the NP can help with the partnership between healthcare professionals engaged in treating the individual, such as closely associating with the primary care doctor and the recommended psychiatrist.
Subsequent care for MDD should be individualized to cater to the patient’s specific needs. It may involve periodic appointments with a mental health professional to oversee symptoms and modify the treatment plan as necessary. The NP must supervise the patient’s reaction to therapy and collaborate with the mental health professional to tweak the treatment plan as required (Bunik et al., 2022). Consistent follow-up visits with the NP can also prove beneficial in guaranteeing appropriate care and support for the patient.
Conclusion
In conclusion, identifying likely risk factors and symptoms correlated with MDD is fundamental to conducting adequate screening and management in young adults. Appropriate screening tools can aid in identifying potential symptoms and directing future steps in health supervision. Based on the patient’s apprehensions and risk factors, the NP should propose a comprehensive evaluation for depression and provide resources and support for addressing her concerns and coping with her family’s history of MDD and recent breast cancer diagnosis.
References
American Academy of Pediatrics. (2022). Depression in children and teens. HealthyChildren. Web.
Bright Futures. (n.d.). Depression. Promoting Healthy Mental Development: A Bright Futures Online Curriculum. Web.
Bunik, M., Hay, W. W., Levin, M. J., & Abzug, M. J. (2022). Chapter 4: Adolescence. Current diagnosis & treatment: Pediatrics (pp. 101–108). McGraw-Hill Education.
CDC. (2021). Positive parenting tips. Centers for Disease Control and Prevention. Web.
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., Stein, R. E. K., Levitt, A., Birmaher, B., Campo, J., Clarke, G., Emslie, G., Kaufman, M., Kelleher, K. J., Kutcher, S., Malus, M., Sacks, D., Waslick, B., & Sarvet, B. (2018). Guidelines for adolescent depression in primary care (glad-PC): Part II. treatment and ongoing management. Pediatrics, 141(3). Web.
Kroenke, K. (n.d.). PHQ-9 (patient health questionnaire-9). MDCalc. Web.
Siu AL. (n.d.). Screening for depression in children and adolescents: U.S. preventive services task force recommendation statement. Annals of internal medicine. Web.
Wang, Y.-P., & Gorenstein, C. (2021). The Beck Depression Inventory: Uses and applications. The Neuroscience of Depression, 165–174. Web.
Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E. K., Laraque, D., Levitt, A., Birmaher, B., Campo, J., Clarke, G., Emslie, G., Kaufman, M., Kelleher, K. J., Kutcher, S., Malus, M., Sacks, D., Waslick, B., & Sarvet, B. (2018). Guidelines for adolescent depression in primary care (glad-PC): Part I. Practice Preparation, identification, assessment, and initial management. Pediatrics, 141(3). Web.
