Self-Assessment Questions (SAQs) for Study Session 12

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

Read Case Study 12.1 carefully and then answer the SAQs below.

Case Study 12.1  Mrs Woynitu

Mrs Woynitu is a 35-year-old married woman living in one of the villages you are responsible for. She seems to have changed in her behaviour of late and appears irritable and non-caring whenever you visit her house. She does not seem interested in talking much. You have been wondering whether she has some problems with you personally. However, in one of your regular visits, she tells you that she often has headaches and back pain and has not been able to carry out her household work because she has been feeling more tired than usual.

When you talk to Mrs Woynitu further, she tells you that she has been feeling this way for about three months now. Three months ago she had a major conflict with her husband, who would have assaulted her had it not been for the intervention of neighbours. Her relationship with her husband has been bad since that time. She had struggled to get the work done because of her tiredness and lack of concentration on activities. She does not like it when neighbours visit and talk. She has also lost her enjoyment in coffee. She has lost her appetite and has lost weight. She thinks that her son’s school problems are her fault although she is unable to say what exactly she has done wrong. She sometimes thinks bad things may happen to her and her family. She even sometimes thinks life is not worth living and wishes she were dead.

SAQ 12.1 (tests Learning Outcomes 12.1 and 12.2)

Which of the key symptoms of depression are present in Mrs Woynitu’s story, suggesting that she has depression?


Mrs Woynitu has several symptoms of depression. You have noticed that she has become more irritable, which some individuals manifest instead of feelings of sadness. She has also lost energy and concentration. She seems to have lost interest and has begun blaming herself. She has lost appetite and weight. She is also feeling hopeless and is having death wishes. All these symptoms of depression are also mentioned in Table 12.1. Not only does she have numerous symptoms but she also has problems with her functioning in that she struggles to do her daily work and her relationship with her neighbours seems to have deteriorated. As this case illustrates, depression is not only about behavioural symptoms, but also about impairment in daily functioning.

SAQ 12.2 (tests Learning Outcome 12.2)

Why do you think it may be difficult to assess Mrs Woynitu and to consider depression as a possibility?


It is not very difficult to identify symptoms of depression in Mrs Woynitu. However, there are at least three barriers that may impede your ability to recognise depression:

  1. In the beginning you did not have the chance to speak to Mrs Woynitu and understand her problem because she didn’t want to talk. You could easily interpret her behaviour as personal malice and could have chosen to avoid her.
  2. She started by telling you about backache, headache and tiredness. If you did not stop to listen to her story further, you could have interpreted these physical symptoms as manifestations of a physical disease. If you were to do so, you would have lost an opportunity to help Mrs Woynitu and would potentially have spent resources unnecessarily.
  3. You could also have interpreted her emotional difficulties as understandable consequences of her marital difficulties.

SAQ 12.3 (tests Learning Outcome 12.3)

Why do you think Mrs Woynitu may have developed depression?


Mrs Woynitu’s marital difficulties may have triggered her depression. But her self-blame and disinterest in engaging with the neighbours may lead to worsening of her depressive symptoms. Although you could think that the depressive symptoms are understandable consequences of the marital conflict and not real depression, it is not common for people to have so many depressive symptoms just because of difficulties in their lives. Mrs Woynitu also has symptoms that are difficult to explain in terms of these difficulties. For example, feeling too hopeless to the extent of having death wishes, self-blame and lack of enjoyment are not usual in people feeling depressed because of some difficulties in their lives.

SAQ 12.4 (tests Learning Outcomes 12.4 and 12.5)

Describe how you may help Mrs Woynitu.


  • a.You can try to understand the marital problems in more detail without getting too involved in the problem.
  • b.You can explain that you think Mrs Woynitu may be depressed. This will help her to understand her experiences better. In this context you can tell Mrs Woynitu that because of her depression, she is beginning to avoid people, and this is likely to make her depression worse.
  • c.It is important to assess whether there is a risk of her harming herself (see also Study Session 10).
  • d.It is important to learn what she has done to solve the problem with her husband. If her relationship improves, it could begin the process of improving the depression.
  • e.Check how much support she is getting from her husband. It may help to involve the husband. The husband is not likely to know that his wife is depressed and that some of her behaviour may be due to depression. Understanding the problem better may help her husband to support his wife better.
  • f.You can also use locally accepted methods of solving disputes between couples.
  • g.Mrs Woynitu will benefit from remaining involved with her neighbours, so encourage her to continue doing this. She would also benefit from broader social support from family and friends. You could encourage her to identify sources of support and engage with those.
  • h.Encourage Mrs Woynitu to eat regularly; to continue doing things that she enjoyed before she became depressed; and to exercise.
  • i.Mrs Woynitu is also likely to benefit from medication. This will be discussed in the next answer.

SAQ 12.5 (tests Learning Outcome 12.5)

Would you refer Mrs Woynitu to a higher level health facility? If yes, why, and if no, why not?


Overall, there are many reasons to support referring Mrs Woynitu. She appears to have a severe depression given the number of symptoms she has, the potential risk and functional impairment. When someone has severe depression it is better to refer them. Mrs Woynitu is likely to require medication and will need this prescribed from the nearby health centre or hospital.

Summary of Study Session 12