12.6.1 Determining how bad the depression is
Determining the severity of depression will allow you to decide whether you need to refer the individual with depression to the next health facility for further assessment. The severity of depression depends on the following:
- Number of symptoms: if the individual has many symptoms of depression, (as listed in Table 12.1) the depression is likely to be more severe.
- Nature of symptoms: if the individual has certain symptoms, such as severe hopelessness, suicidal thoughts, severe problem with sleep, significant weight loss (loss of about 1 kilogram a week over the preceding weeks), restlessness, or symptoms indicative of psychosis, the depression is likely to be severe. When these symptoms occur in the context of understandable life stress, they indicate that depression has developed.
- The possibility of significant risk: risk of suicide or violence (detailed in Study Session 10).
- History of suicide or mental illness in the person’s family.
- History of mania.
Based on the above criteria, you can classify depression into three types: mild depression, moderate depression and severe depression (see Box 12.2).
Box 12.2 Classifying the severity of depression
- Person has few (3–4) symptoms of depression (refer to Table 12.1)
- Person can do their day-to-day activities with minimum problems caused by the depression
- Person has about five symptoms of depression
- Person experiences problems in carrying out their daily responsibilities and it can take them longer to finish a task because of the depression
- Person has 8 or more symptoms of depression (usually more)
- Person has very clear difficulty carrying out normal responsibilities, or has stopped working or carrying out daily responsibilities
- May have suicidal thoughts or plans; may even have attempted to commit suicide
- Other severity indicators such as psychotic symptoms can also occur