Depression Case Summary
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​Depression Case Summary

Case Summary:
  • Jose is a 13 year-old male who lives with his mother, father and 9 year-old brother. The family is fluent in English and Spanish and lives in the Bronx. A counselor refers Jose to the neighborhood clinic because he is concerned about his weight.

  • Jose is unclear why he was referred but offers three possibilities: his weight, his asthma, or his difficulty getting along with his schoolmates.

  • Jose has a history of school-related problems. He does not raise his hand or participate in class activities, does not complete his schoolwork and often complains of being bored. He prefers to be home with his mother and does not have many friends.

  • The pediatrician elicits a history that a year ago, Jose saw his grandmother murdered and since then has wanted to stay at home with his mother. He also knows students who lost parents in the events of 9/11 and seems to think about it a lot. Previous visits to a counselor were not successful.

  • The pediatrician encourages them to meet again with a counselor, and also schedules a follow-up visit in two weeks.

  • Jose and his parents miss the follow-up visit. Three months later, Jose's father calls the clinic to request a same day appointment for his son who is very upset and refuses to go to school. At the visit, the father reports that the other kids bully Jose, and that Jose has threatened to jump out of the first floor window.

  • The use of the PSC-17 internalizing score followed by the PHQ-9 diagnostic aid may further elucidate Jose's mental health problems.

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Key Teaching Points 
  1. Research shows that the use of open-minded questions (e.g., "why," "how," or "what do you feel about"), is more effective than a yes-no format in eliciting parents' and youth's concerns. In addition, even if the clinician thinks that she/he understands the chief reason for coming to care, it is often useful to re-ask the open-ended question of what else does the patient need or want to discuss. These questions only take a few minutes and may result in actually saving time over the long run.

  2. Primary care clinicians are well placed to address physical health issues in tandem with mental health issues. In fact, as illustrated in this case, the two may be linked and easier to address together.

  3. Emergency mental health referrals for a true suicide attempt, with a clear and ambivalent wish to die or a specific plan, are quite appropriate and necessary. However, most adolescents have thoughts of death or dying in any given year, so thoughts or threats in and of themselves may not warrant an emergency mental health referral. Instead, one should determine the extent to which the child or youth actually intends to hurt him/herself, whether he/she has specific plans to do so, and his/her degree of impulsivity. Forming a contract with the youth to notify you or the parent if she/he has recurrent thoughts to hurt him/herself can be helpful.

  4. While not the primary concern for this, in the post 9/11 world it is not unusual for children who have had previous traumatic exposures to be more vulnerable to depressive symptomatology as a result of the events of 9/11 or other traumatic incidents.

View the prevalence, symtom​s, diagnosis, treatment and psychopharmacology of depression.​
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