Common Mental Disorders Depression - New Zealand Doctor

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Since those who are affected by suicidal behaviour in others are also at increased personal risk of suicidal behaviour, support services need to be available for family and friends after a suicide bereavement or suicide attempt. This applies particularly where there is a risk of suicide contagion, which can result in a cluster of suicides. A postvention support initiative is currently being developed by the Ministry of Health to guide programme development in this area, which may from time to time involve participation by primary health organisations. 128 16 Identification of Common Mental Disorders and Management of Depression in Primary Care
2 Principles of intervention in the primary care setting 2.1 Rationale for intervention The high prevalence and morbidity of common mental disorders such as depression and the potential for effective treatment provide a strong rationale for identification, active management and follow-up in primary care. 65,101 Likely benefits include ease of access for patients, early intervention and a holistic and integrated approach. 129 2.2 Recognising potential mental disorders A routine check of psychosocial health is the first step in recognising potential mental disorders and the most vital assessment tools are the communication and observational skills of the practitioner. A structured approach to assessment ensures that the relevant domains are addressed and enables the practitioner to identify risks, protective factors and any issues of cultural context and identity. Functional disability should be considered carefully, as many patients with modest or subthreshold symptoms have significantly impaired occupational or social functioning. 4,73,130 Substance use disorder can be difficult to recognise because it is relatively less disabling than some other disorders. 131 Formal assessment tools may have a supplementary role in diagnosis, but can be time-consuming and are less versatile than global clinical assessment. Tools may also be useful to help assess severity and monitor response to treatment. Although many people with mental disorders present with physical complaints, the majority will divulge psychological problems if asked directly. 132,133 A nonjudgmental manner and assurance of confidentiality increase the likelihood of disclosure. 134 The involvement of family/whänau in the assessment process may also encourage disclosure. Sometimes problems take several sessions to ‘unravel’ in the clinical setting and may involve an assessment process of ‘trial and error’. 135 For all patients with mental distress it is therefore vital to negotiate active follow-up. There may only be sufficient time to address urgent concerns within the course of a 15-minute primary care appointment. In the opinion of the Guideline Development Team (GDT), many patients would benefit from an extended consultation to allow time to explore their personal perspectives and promote self-management goals, 136 though it may be difficult to provide this within current resource constraints. Identification of Common Mental Disorders and Management of Depression in Primary Care 17
Page 1: Identification of Common Mental Dis
Page 4 and 5: Statement of intent Evidence-based
Page 6 and 7: Endorsements Te Ao Maramatanga New
Page 8 and 9: 3.6 Clinical features of common men
Page 10 and 11: List of figures 3.1 When to refer a
Page 13 and 14: About the guideline Foreword The Ne
Page 15 and 16: About the guideline Guideline devel
Page 17 and 18: About the guideline Paediatric subg
Page 19: About the guideline Royal New Zeala
Page 22 and 23: Algorithm 1 Management of depressio
Page 24 and 25: Algorithm 2a Management of severe d
Page 26 and 27: Algorithm 2c Management of mild dep
Page 28 and 29: • limited access to psychiatrists
Page 30 and 31: Asian peoples About 7% of the New Z
Page 32 and 33: 12-month period amongst adults atte
Page 34 and 35: Table 1.2 Prevalence of common ment
Page 36 and 37: 1.4 Etiology of common mental disor
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Page 40 and 41: Sexuality Data from the Christchurc
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Page 46 and 47: to informed consent. 152 There is a
Page 49 and 50: 3 Recognition and assessment of com
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Page 70 and 71: Good practice points Management of
Page 72 and 73: Box 4.1 Whänau Ora The concept of
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6 Management of depression in adult
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Chapter 6 Management of depression
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Recommendations continued... Women
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during pregnancy, of which up to 6%
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Secondary care evidence Based on ev
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Advice for women It may be helpful
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Social networks appear to be an inf
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eastfeeding, or not breastfeeding,
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This evidence comprised two recent
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There is also some evidence that th
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8 Special issues: older adults/ kor
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Chapter 8 Special issues: older adu
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9 Models of care 9.1 Introduction V
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Chapter 9 Models of care were reduc
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Chapter 9 Models of care • networ
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Chapter 9 Models of care service as
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Quality improvement collaboratives
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NZGG has been funded to develop sum
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Appendix A: Guideline development p
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Appendix B: Evidence and recommenda
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Appendix C: Assessment of suicide r
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Appendix D: Assessment tools for co
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Anxiety Anxiety is often comorbid w
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Appendix F: Self-management resourc
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Information about mental disorders
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Dysthymia Dysthymia is a chronic lo
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Glossary, abbreviations and acronym
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References 1. The MaGPIe Research G
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References 38. Tse S, Tong K, Hong
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References 72. Kendler K, Kuhn J, P
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References 107. Halligan SL, Murray
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References 143. Dejesus RS, Vickers
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References 179. Shaffer D, Scott M,
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References 215. Garralda ME, Bowman
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References 249. Zwaanswijk M, Verha
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References 283. Linde K, Berner M,
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References 318. Henkel V, Mergl R,
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References 353. Rush AJ. STAR*D: wh
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References 386. Ward E, King M, Llo
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References 417. Kirsch I, Deacon BJ
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References 451. Zigmond AS, Snaith
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References 486. Appleby L, Warner R
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References 520. Irwin M, Artin KH,
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References 557. Agnew F, Pulotu-End
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Common Mental Disorders Depression - New Zealand Doctor

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