Common Mental Disorders Depression - New Zealand Doctor

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Good practice points Recognition of common mental disorders in young people Practitioners involved in the assessment of young people for mental disorders should endeavour to build a supportive and collaborative relationship with the young person and their family/whänau Practitioners should discuss the right to confidentiality and exceptions to confidentiality with the young person In young children, a standardised format such as the HEARTS acronym (Home, Education, Activities, Relationships, Temper, Size) should be used for routine assessment of psychosocial wellbeing Practitioners should be aware of the cultural identity and health care preferences of young people in their care Opinion of the Guideline Development Team, or feedback from consultation within New Zealand where no evidence is available 3.1 Applying strengths-based and biomedical models Recent models of health promotion take a positive youth development or ‘strengthsbased’ approach, which focuses on enhancing resiliency and minimising obstacles to healthy development. This contrasts with the traditional biomedical model, which focuses on problem identification and risk management. 170-172 Research on resiliency suggests that there are factors that help to protect young people/rangatahi/tamariki from harm across categories of ethnicity, social class and gender, by acting as a buffer against adverse circumstances. 173 Social connectedness has been identified as a strong protective factor against mental disorder. Strengths/resilience-based models aim to help young people/rangatahi/ tamariki build positive connections with the people and communities around them and learn new skills to increase their capacity to cope with both current and future situations. 170 The strengths-based approach aligns well with Mäori philosophies of development and holistic models such as Te Wheke, which focus on affirmation rather than dysfunction. 18,174 It is also congruent with emerging medical models that explain and treat disorders by addressing psychological, social and environmental issues as well as biological and genetic factors (eg, the biopsychosociocultural model). 175 Although the strengths-based approach is promising, there is as yet little hard evidence about applicability or efficacy. In practice, both strengths-based and biomedical models are useful and a dual strategy of promoting protective factors while reducing risk factors is suggested. 173 24 Identification of Common Mental Disorders and Management of Depression in Primary Care
Chapter 3 Recognition and assessment of common mental disorders in young people/rangatahi/tamariki 3.2 Screening young people/rangatahi/ tamariki for common mental disorders There is ongoing debate about the merits of screening for common mental disorders among young people/rangatahi/tamariki in primary health care or educational settings. Evidence was sought on screening young people/rangatahi/tamariki in an educational or primary care setting. Screening in this context refers to routine use of a tool, over and above customary clinical assessment. Two systematic reviews were identified, but neither found any randomised controlled trials to determine whether screening for mental disorders improves either identification rates or outcomes for young people. 66,176 However, a further two systematic reviews evaluated the role of routine screening in educational settings for depressive disorders 177 and/or anxiety disorders, 178 or elevated symptoms of depression 177 and/or anxiety 178 with targeted psychological intervention in those testing positive on screening. One reported a clinically meaningful reduction in depression scores (mean effect size 0.55) and calculated that thirty-one students would need to be screened (and, if necessary, treated) in order to successfully treat one case of depression. 177 The other systematic review reported positive results from a number of school programmes targeting depression and anxiety. 178 There was very little evidence about long-term effectiveness and none about potential negative effects. There was evidence that screening for mental disorders in a student population is feasible 179 and that asking about suicidal behaviour in an educational setting does not appear harmful. 180 There was insufficient good-quality evidence to evaluate the feasibility of screening in a primary health care setting. 181,182 Screening young people/rangatahi/tamariki: issues for evidence-based practice Given the lack of evidence on the long-term and/or adverse effects of screening with early intervention for young people/rangatahi/tamariki with mental disorders, routine use of a screening tool is not recommended in any setting at present. However, there is sufficient evidence to support further research on the benefits and risks of routinely screening young people/rangatahi/tamariki in an educational setting for common mental disorders in conjunction with early psychological intervention in those screening positive. Identification of Common Mental Disorders and Management of Depression in Primary Care 25
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
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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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