What are the key components of a comprehensive assessment for adults with suspected depression in primary care?

A comprehensive assessment for adults with suspected depression in primary care extends beyond a simple symptom count, incorporating various factors to understand the individual's condition thoroughly ¹,².

• Initial Identification and Scope: Healthcare professionals should be alert to possible depression, particularly in individuals with a past history of depression or a chronic physical health problem ². Initial screening involves asking if, during the last month, they have often been bothered by feeling down, depressed or hopeless, or by having little interest or pleasure in doing things ². If a person answers 'yes' to either question and the practitioner is competent, a review of their mental state and associated functional, interpersonal, and social difficulties is required ². If the practitioner is not competent, the person should be referred to an appropriate professional ².
• Comprehensive Evaluation: The assessment must consider the severity of symptoms, previous history, duration, and course of the illness ². It should also take into account the degree of functional impairment and/or disability associated with the possible depression ¹,². A validated measure (e.g., for symptoms, functions, and/or disability) should be considered to inform and evaluate treatment ²,³.
• Detailed Discussion and Exploration of Contributing Factors: It is crucial to discuss how various factors may have influenced the development, course, and severity of their depression ². These factors include:
  • Any history of depression and coexisting mental health or physical disorders ².
  • Any history of mood elevation, to determine if the depression may be part of bipolar disorder ².
  • Past experience of, and response to, previous treatments ².
  • Personal strengths and resources, including supportive relationships ².
  • Difficulties with previous and current interpersonal relationships ².
  • Current lifestyle, such as diet, physical activity, and sleep ².
  • Any recent or past experience of stressful or traumatic life events ².
  • Living conditions, drug (prescribed or illicit) and alcohol use, debt, employment situation, loneliness, and social isolation ².
• Risk Assessment and Management: Always directly ask people with depression about suicidal ideation and intent ²,³. If there is a risk of self-harm or suicide, assess whether the person has adequate social support and is aware of sources of help, arrange help appropriate to the level of need, and advise them to seek further help if the situation deteriorates ². If a person presents a considerable immediate risk to themselves or others, they should be referred urgently to specialist mental health services ²,³,⁴,⁵. People should also be advised of the potential for increased agitation, anxiety, and suicidal ideation in the initial stages of treatment ².
• Communication Considerations: For individuals with language or communication difficulties (e.g., sensory or cognitive impairments or autism), consider asking about their symptoms directly using an appropriate method of communication or asking a family member or carer about the person's symptoms ².