Major Depressive Disorder Assessment Strategies

Introduction

The mental health problem that I have selected is Major Depressive Disorder.

This can be recognized by low mood, low self-esteem and loss of pleasure in normal activities. This is known by many names such as clinical depression, unipolar depression and major depressive disorder. The symptoms interfere with all areas of a person’s life- personal, social and economic and are experienced most days and have been present for at least two weeks. Depression can be described as mild, moderate or severe; melancholic or psychotic. (BeyondBlue, 2014)

Depression has a high lifetime prevalence – one in seven Australians will experience depression in their lifetime. (ABS, 2009). Ranked 13.3%, depression has the third highest burden of all diseases in Australia (AIHW, 2007).

Assessment Framework

The purpose of a conducting a clinical assessment is to gather information enabling the clinician to determine what is likely to be causing impairment in the individual’s functioning. I would develop a hypothesis and proceed to rule in/ rule out associated disorders while progressing through the process. Each individual case would require consideration for options regarding, interview, symptoms checklists and behavioral assessments. (Goldfinger & Pomerantz, 2010)

The structured process of assessment would include

File Review & Collateral Information

I would check the GP referral and conduct a file review, appraising historical information and copies of reports and notes from previous interviews. (Week2, Weekly Notes). I would also gather collateral information from significant others to assist in the overall assessment of the individual

Clinical Assessment

To determine what symptoms the individual is presenting I would conduct a face-to-face initial interview. I would establish parameters of assessment (e.g. informed consent and confidentiality) and build rapport with the individual through the acceptance, understanding and respect. (Phares & Trull, 1997). This would enable the individual to feel comfortable and gain trust in the process. Groth-Marnat (2003) discuss the benefit of the face-to-face interview as enabling the clinician to make behavioural observations and note the idiosyncrasies and reaction to their current challenges and difficulties including the risk of harm to self and others. I would take note of the history of the presenting difficulties and note the onset of symptoms. I would also conduct a psychosocial evaluation. (Wright, 2011).

Psychological Testing: Selection, administration and interpretation

A psychological test uses standardised materials, administration instructions, time limits and scoring procedures for all test takers.(Cohen et al, 1996). This step in the process would assess the individual’s appearance, behaviour, speech, mood, thought processes, attention, memory and level of consciousness through the use of the Mental Status Examination (Daniel & Crider, 2003). I would also assess the presence of symptoms consistent with diagnostic criteria for depression. As outlined in Wright (2011), to support the hypothesis of depression I would use self-report, symptom focused measure such as Structured Clinical Interview for DSM Disorders (SCID) or Beck Depression Inventory (BDI) during the interview phase. In selecting the diagnostic tools I would review validated assessment tools in line with major international classification for depressive conditions such as DSM-IV-TR Criteria for Major Depressive Episode and Major Depressive Disorder (APA, 2000). I could use the Minnesota Multiphasic Personality Inventory (MMPI-2) to help develop treatment plans and differential diagnosis (Butcher et al, 1989).

A trained professional with the expertise in depressive disorders should administer, score and interpret the information. The analysis of test scores would be transformed into a standardized metric and compared to various sets of norms.

Psychological tests are only one element of the assessment and should never be used alone as the sole basis for a diagnosis. A detailed history of the individual and a review of psychological, medical, educational, or other relevant records are required to lay the groundwork for interpreting the results of any psychological measurement. (FAQS, 2014)

Psychological Assessment Report & Feedback

In the writing of the report I would first determine who the audience would be- i.e. referring GP, case manager or individual and include background information that had been gathered during the semi-structured interview. The outline of each test conducted and the results of the symptom and behavioral checklists, along the results from structured interview and behavioral assessment would be included in the report. (Goldfinger & Pomerantz, 2010)

Modification of approach for different individual populations

Cultural and language differences in the individual may affect test performance and may result in inaccurate test results. There is also the potential for the standardized testing to exhibit“cultural bias” (Goldstein & Hersen, 2000). I would need to be aware before psychological testing begins if the individual is not fluent in English and/or belongs to a minority culture. I would need to consider the inclusion of an interpreter or cultural support person during the assessment. (ACAP, 2013) Different tests would also need to be considered that were age specific i.e. Child, Adolescent or Elderly.

Conclusion

Overall, the psychological assessment holds avitalrole in counseling and clinical practice. Without the useof psychological testing, the treatment of thepatientwould not be as effective and fewer people wouldreceivethe necessaryhelpthey need to live a healthy life.

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. (4th Text Revision ed.) Washington, DC: American Psychiatric Association.

Australian Bureau of Statistics (2009). National Survey of Mental Health and Wellbeing: Summary of Results, 4326.0, 2007. ABS: Canberra.

Australian College of Applied Psychology (2013) Facilitate the Counselling Process

Australian Institute of Health and Welfare (2007). The Burden of Disease and Injury in Australia. AIHW: Canberra.

Beyond Blue (2014) Sign and Symptoms. Retrieved 20/08/14 from Beyond Blue website: http://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms

Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A, & Kaemmer, B. (1989).The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.

Cohen, R.J., Swerdlik, M.E., Phillips, S.M. (1996) Psychological testing and assessment: An introduction to tests and measurement (3rd ed.). Mountain View, CA, US: Mayfield Publishing Co. (1996). xxviii 798 pp.

Daniel, M. S., & Crider, C. J. (2003). Mental Status Examination.Diagnostic interviewing (3rd ed.).

FAQS (2014) Psychological tests Retrieved 20th August 2014 from FAQS.org website http://www.faqs.org/health/topics/56/Psychological-tests.html#ixzz3AvfH5RMR

Goldfinger, K., & Pomerantz, A. M. (2010).Psychological assessment and report writing. Los Angeles, CA: SAGE.

Goldstein, G. & Hersen, M. (Eds.). (2000).Handbook of Psychological Assessment (3rd ed.). New York: Pergamon

Groth-Marnat, G. (2003).Handbook of psychological assessment(4th ed.). Chapter 3,

Laureate Online Education (2011) Week 2, Weekly notes: Assessments in mental health https://elearning.uol.ohecampus.com/bbcswebdav/institution/UKL1/MAP/201480_AUGUST/APPTRE/readings/APPTRE_Week02_weeklyNotes.html

Phares, E.J. & Trull, T.J (1997) Clinical psychology: concepts, methods, and profession

Wright, A. J. (2011).Conducting psychological assessment: A guide for practitioners. Hoboken, NJ: John Wiley & Sons.