Page 7 - Depression in adults: treatment and management

Depression in adults: treatment and management (NG222)

Definitions of depression and severity Definitions of depression and severity

Depression refers to a wide range of mental health problems characterised by the absence of
a positive affect (a loss of interest and enjoyment in ordinary things and experiences), low
mood and a range of associated emotional, cognitive, physical and behavioural symptoms. For
more detail, see the International Classification of Diseases-11 (ICD-11) or the Diagnostic
and Statistical Manual of Mental Disorders-5 (DSM-5) criteria for depression.

Depression severity exists along a continuum and is essentially composed of 3 elements:

• symptoms (which may vary in frequency and intensity)

• duration of the disorder

• the impact on personal and social functioning.

Severity of depression is therefore a consequence of the contribution of all of these elements.

Traditionally, depression severity has been grouped under 4 categories (subthreshold, mild,

moderate and severe) but in the development of this guideline the committee wanted to
develop a way of representing the severity of depression which best represents the available
evidence on the classification and would help the uptake of the recommendations in routine
clinical practice. This guideline has therefore defined new episodes of depression as less
severe or more severe depression.

Less severe depression encompasses subthreshold and mild depression, and more severe
depression encompasses moderate and severe depression. Thresholds on validated scales

were used in this guideline as an indicator of severity. For example, a score 16 on the PHQ-9
scale was used, with scores less than 16 defined as less severe depression, and scores of 16 or
more defined as more severe depression.

1.1 1.1 Principles of care Principles of care

1.1.1 When working with people with depression and their families or carers:

• build a trusting relationship and work in an open, engaging and non-judgemental
manner

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