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The World Health Organization defines depression as being characterized by sadness, low self-esteem, loss of pleasure or interest, loss of sleep or appetite, poor concentration or feelings of guilt and tiredness. The symptoms can last long and be recurring, significantly affecting an individual's ability to function effectively at school or work, or even manage day-to-day life. At its most severe, depression can lead to suicide (WHO, 2017).
Depression is one of the most commonly diagnosed mental disorders among adults. The outlook for depression has evolved over the last 20 years. In the past, it was perceived as an acute and self-limiting illness, but now with increased study, depression is considered a chronic, lifelong illness (Richards, 2011). Depression usually begins at a young age and it is often recurring. Due to these reasons, depression is responsible for the leading cause of disability worldwide with respect to total years lost due to disability (Marcus, 2012). Fortunately, it is treatable.
Depressive disorders include major depressive disorder (MDD), persistent depressive disorder (PDD or dysthymia), and other specified and unspecified depressive disorders. The underlying feature of these disorders is the presence of sad, irritable, or empty mood, along with physical and cognitive changes that prevent the individual’s ability to function. The factors that differentiate the depressive disorders are descriptions of symptoms, their timing, and duration (American Psychiatric Association, 2013).
Major Depressive Disorder (MDD) is one of the common but severe mood disorders. It results in serious symptoms that affect daily activities such as sleeping, eating, or working, and how you feel or think. Symptoms must be present for at least 2 weeks for an individual to be diagnosed with MDD (National Institute of Mental Health, 2015).
MDD diagnostic criteria:
(Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013)
Persistent Depressive Disorder (PDD or dysthymia) is present when symptoms of depression persist for at least two years. An individual diagnosed with PDD might have episodes of severe depression accompanied by periods of less serious symptoms that persist for at least two years to be diagnosed as PDD (National Institute of Mental Health, 2015).
PDD diagnostic criteria:
The most commonly recognized method for depression diagnosis by psychologists is the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5®). This manual depicts the exact description of symptoms, their duration and behavioral criteria to diagnose and differentiate between MDD and PDD.
To help differentiate, to be diagnosed with MDD, the symptoms except weight change and suicidal ideation should prevail for almost every day for at least a 2-week period with depressed mood or loss of interest being present all through the day almost every day (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013).
Since the criteria for a MDD episode contain four symptoms more than what is present in the symptom list for PDD, only a few individuals would have experienced depressive symptoms that have lasted longer than two years. If the entire criteria for a MDD episode have been met at some point during the current period of illness, they must be diagnosed with MDD and not PDD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013).
Absenteeism is defined as the number of days of work missed by employees due to depression. It is the time lost when they are away from work either because they are sick, experiencing symptoms, have a doctor’s appointment, or just did not show up at work. It is expressed as number of days lost/person/year.
Presenteeism is defined as time lost when employees are at work and are not able to function at full capacity due to their depression. When at work they are not as productive because they cannot focus, cannot accomplish their daily tasks or they take longer than usual. It is expressed as number of days lost/person/year.
Basic medical care is basic treatment with any service that is normally available, e.g., antidepressant medication, referral to specialty mental health care and visits to a primary care physician or a psychiatrist, and psychologist. No additional monitoring or collaborative care is provided. It is up to the patient to be compliant and take their medication or keep up with their psychiatrist appointments.
Enhanced care is a treatment model in which a care manager systematically educates primary care patients about evidence-based treatment for the disorder, encourages patients to initiate and comply with this treatment, and proactively monitors their treatment response over time.