Mental Health

It is thought that one in three people attending primary care have a mental health problem.
They do not always discuss their mental health issues with primary care staff but may voice
other concerns linked to their mental health, such as physical symptoms or social concerns.
Consequently, they may attend repeatedly before their underlying mental health problem is
.recognized

:Common mental disorders

:Depression

can negatively affect how a person feels, thinks and behaves. They may feel sad and/or
experience a loss of interest in activities they once enjoyed. It can lead to a variety of
emotional and physical problems and reduce a person’s ability to function both at work and
.at home. The symptoms and experience of depression vary in every person

:There are nine criteria for diagnosis

.Depressed mood most of the day, nearly every day .1

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, .2
.nearly every day

.Significant weight loss when not dieting, or weight gain .3

.Insomnia or hypersomnia nearly every day .4

.Psychomotor agitation or retardation nearly every day .5

.Fatigue or loss of energy nearly every day .6

.Feelings of worthlessness or excessive or inappropriate guilt nearly every day .7

.Diminished ability to think or concentrate, or indecisiveness, nearly every day .8

.Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation .9

:Types of depression

There are different types of depression: subthreshold depression, mild depression,

moderate depression, major depressive disorder, persistent depressive disorder, seasonal
.affective disorder and bipolar disorder

Types of depression that are exclusive to women Women have a higher rate of general (
depression than men. Additionally, there are two depression types that are influenced by
female reproductive hormones, perinatal depression and premenstrual dysphoric disorder
:Anxiety

Anxiety disorders can vary in their severity, but they all have been associated with
significant long- term disability. There may be a lifelong pattern of relapse and remission,
and other problems such as depression or substance misuse may also be present. Most
anxiety disorders have a relatively early age of onset, with symptoms and syndromes likely
.to start in childhood or adolescence

:Types of anxiety include

generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, obsessional
.compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)

Recognising common mental disorders

People with underlying psychological distress may present with a physical health problem
such as increased tiredness, bowel problems, difficulties with sleep, headaches or change in
appetite. Depression and anxiety are common in people with long-term physical conditions.
These individuals may attend to discuss a problem with their long-term condition without
.realising the cause is psychological

To ascertain whether someone has depression and/or anxiety, there are screening
.questions available: two for depression and two for anxiety

The person simply answers ‘yes’ or ‘no’; if they answer ‘yes’ to either question, the
healthcare professional should explore whether this is something they want help with and
consider further assessment of the mood symptoms they are experiencing. Some primary
care practitioners argue that the use of these standardised questions is unnecessary.
However, if they are not used, it has been reported that up to seven out of ten cases of
.depression will go undetected

:The questions are

:Depression questions

During the last month have you often been bothered by feeling down, depressed, or ‘
hopeless?’ Yes/No

During the last month have you often been bothered by having little interest or pleasure in ‘
doing things?’ Yes/ No
:Anxiety questions

Do you feel nervous, anxious or on edge?’ Yes/No ‘

Do you feel unable to stop worrying?’ Yes/ No ‘

:Help question

.Is this something with which you would like help?’ No/Yes, but not today/Yes ‘

:Reference

MLA 9th Edition (Modern Language Assoc.)

Duncan, Deborah. Mental Health and Wellbeing: A Guide for Nurses and Healthcare
.Professionals Working with Adults in Primary Care. M&K Update Ltd, 2021