Common Mental Disorders Depression - New Zealand Doctor

3.4 Further assessment where there is concern
Structured psychosocial assessment may alert the practitioner to a potential
mental disorder, in which case problem areas should be explored more thoroughly.
In particular, it is important to find out to what extent symptoms are affecting normal
functioning for the young person/rangatahi/tamariki and to ask them directly about
suicidal intent or attempts. 209
Particular attention should be paid to the symptoms of hopelessness (nothing will
change) and/or helplessness (I can’t change). 162 If a young person/rangatahi/tamariki
expresses hopelessness the practitioner should check what they mean by this and
how they view the future. Profound hopelessness is a strong risk factor for suicide in
adults 210 and in young people it has been linked to increased suicidal ideation and
intent, depression and overall psychopathology. 211 Studies from mixed settings have
found that adolescent-reported hopelessness correlates with high dropout rates and
poor outcomes from treatment for depression. 212,213
Use of a brief assessment tool may be helpful as an aid to clinical judgment
(see 3.5: Assessment Tools: Evidence Review), but does not reduce the necessity
for thorough assessment in formulating a diagnosis.
Assessment of suicide risk
Assessment of suicide risk can be challenging as there is no evidence for absolute
markers that predict the presence or intensity of suicide risk, and assessment only
provides a snapshot of risk at a given time. Moreover, deliberate self-harm such as
superficial cutting may be used as a means of tension reduction, without intention
to die. The most immediately important factors to consider are contextual triggering
factors and the young person’s current mental state. 162 The Guideline Development
Team (GDT) notes that assessment of suicide risk needs to be an ongoing aspect of
monitoring, as new triggers can supervene even if the young person’s mental state
is improving or staying the same.
Assessment of suicide risk represents an integration of the following factors: 162
• intent/definite plan
• lethality
• access to means
• presence of risk factors (eg, alcohol use, impulsiveness)
• hopelessness
• psychosocial triggers
• lack or presence of protective factors.
Questions to assist in assessing risk of suicide may be found in Appendix C:
Assessment of Suicide Risk.
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Identification of Common Mental Disorders and Management of Depression in Primary Care