1. The client/caregiver can define depression.
   1. It is a mood state that is characterized by low mood, sadness, and hopelessness that persists beyond a few weeks.
   2. It may be caused by a life event (reactive depression) or occur independent of any life event (major or unipolar depression).
   3. It can be chronic or short-term.
   4. The exact cause of depression is not known. Two neurotransmitters (serotonin and norepinephrine) that allow brain cells to communicate may be implicated.
2. The client/caregiver can list factors that increase the risk of depression.
   1. National Institute for Mental Health states that 3 to 4 million men are affected by depression. Depression affects twice as many women.
   2. People who are separated, divorced, and widowed are more at risk.
   3. People who use drugs or alcohol are more at risk.
   4. Parents whose children recently left home are more susceptible.
   5. People with chronic debilitation and chronic or terminal illnesses are vulnerable.
   6. People who think negatively are more at risk.
   7. People with a family history of depression are more vulnerable.
3. The client/caregiver can recognize signs and symptoms of depression.
   1. Sad mood
   2. Appetite changes (increase or decrease)
   3. Sleep changes (insomnia or hypersomnia)
   4. Inability to concentrate
   5. Marked decrease in pleasure
   6. Apathy (including lack of interest in sex)
   7. Guilty feelings
   8. Energy changes (restlessness or inactivity)
   9. Suicidal thoughts
4. The client/caregiver can list the results of depression.
   1. Poor work performance
   2. Poor relationships with others
   3. Disruption of families
   4. Suicide
5. The client/caregiver can list some treatment options for depression.
   1. Psychotherapy
   2. Medication therapy
   3. Electroconvulsive therapy
6. The caregiver can list measures to assist clients in dealing with depression.
   1. Encourage clients to stay with treatment.
   2. If needed, to monitor the client’s compliance with appointments and use of medication.
   3. Encourage clients to follow treatment plans and avoid the use of alcohol or any substance abuse.
   4. Other emotional support includes the following:
      1. Recognize and praise even minor accomplishments.
      2. Encourage clients to verbalize emotions.
      3. Be honest and consistent. Do not criticize.
      4. Do not accuse clients of “faking” or being “lazy.”
      5. Do not ignore remarks about suicide.
   5. Encourage clients to make decisions for himself or herself.
   6. Encourage clients to become involved in interests and activities.
   7. Encourage independence.
   8. Obtain medical attention for prolonged signs of depression.
7. The client can list self-help measures to cope with depression.
   1. Eat a well-balanced diet.
   2. Use vitamin and mineral supplements approved by physicians.
   3. Take medications and keep appointments for therapy.
   4. Set realistic goals in consideration of new diagnosis of depression.
   5. Break large tasks into small ones, and do what you can.
   6. Try to be with other people. Have someone to confide in. Avoid keeping yourself isolated and alone.
   7. Participate in activities that you enjoy or that make you feel better.
   8. Do mild exercise or participate in an activity.
   9. Expect your mood to improve gradually, not instantly.
   10. Postpone important decisions until the depression have improved.
   11. Try to replace negative thinking with positive thinking.
   12. Allow family and friends to help you.
8. The caregiver can list measures to prevent suicide.
   1. Ask the client whether he or she has ever considered suicide.
   2. Remove any dangerous objects (i.e., knives, guns, and stockpiling pills).
   3. Arrange for hospitalization if the client is threatening suicide.
   4. Assist client to identify one or more alternatives to suicide.

Resource

SAMHSA’s National Mental Health Information Center
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0049/default.asp

Depression and Bipolar Support Alliance (formerly National Depressive and Manic-Depressive Association)
800-826-3632
www.dbsalliance.org

Healthy People 2010
www.healthypeople.gov/Document/HTML/Volume2/18Mental.htm

Psychological counseling

Spiritual counseling

Crisis intervention hotline

Support groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.
Varcarolis, E. M. (2006). Manual of psychiatric nursing care plans. St. Louis: Saunders Elsevier.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com