Case: Sandy, 20 years old female with depressed mood

Sandy T. is a 20-year-old female who is referred to you by her family physician for depression

and presents with signs and symptoms that meet criteria for persistent depressive disorder.

Identifying data 20-year old female living with:

• Stepmother • Two step siblings

Work Domestic servant in her own home

Schooling Did not go past high school

Presenting complaint “I’m irritable most of the time’’, “I cannot sleep at night”, “I

cry a lot”, “I do not feel happy”.

HPI Adverse childhood experiences

Early loss of mother

Father remarried to stepmother, then father died

Currently lives at home with stepmother, her two stepsiblings,

and works long hours doing house chores

The 5 P’s

Presenting complaints Assessment

Irritability Clinical interview
Sleeplessness MSE
Crying spell Subjective rating of
problems

Perpetuating Protective
Predisposing Precipitating
factors factors
factors factors
Unsupportive Insight of
Early losses as Losing father
stepmother and problem
mother
Feeling of siblings
Kind,
abandonment by
Long hours of hardworking
loss of parents
domestic work
Reading habit
coping mood
with drug use

Diagnosis Management
Rapport building
Persistent
depressive Psychoeducation
disorder
Activity scheduling

Problem solving
Case Formulation with the Biopsychosocial Model

Biological Psychological Social

Predisposing Family history of Adverse childhood Difficulty making
depression events including loss of social connections
mother
Precipitating Late onset of menstrual Loss of father Feeling of
periods abandonment
Perpetuating Has been coping with Coping style as Lack of friends and
drug use; although avoidance, self-blame resources
initially helpful, now it Unsupportive
makes her more stepmother and siblings
depressed
Protective Like reading, walks Kind, hardworking Fairy godmother