What’s the evidence 19.1

Access NICE guidelines (CG90) (https://www.nice.org.uk/guidance/CG90) related to recognition and management of depression in adults and answer the following questions.

You will also find guidance here on the stepped care model to treating depression.

What might alert you to the possibility of depression in someone you have been caring for and what might the barriers to recognising and identifying depression be? Consider as many factors as possible.

It is important that you have knowledge of the main symptoms and are alert to the possibility of depression, particularly in people with long term conditions. Presentations of depression can be quite individual, the person may present with a gloomy outlook, become withdrawn, have impaired functioning, e.g. not going to work, not taking care of responsibilities, sleep and appetite disturbance – refer to other symptoms.

Barriers may include – focusing on physical health, and not enquiring about wellbeing in other area. Accepting and attributing low mood to physical health and not exploring further (either you or the person). The person may ‘put on a front’ to hide low mood as they feel embarrassed. Being busy and not wanting to uncover more problems. Being apprehensive or worried that you cannot help or do not know what to do.

Find out what 2 questions you could ask if you suspect a person may be experiencing depression?

During the last month, have you often been bothered by:

  • feeling down, depressed or hopeless?
  • having little interest or pleasure in doing things?


Whooley, M. A., Avins, A. L., Miranda, J., and Browner, W. S. (1997). Case-finding instruments for depression. Two questions are as good as many. Journal of General Internal Medicine, 12(7), 439–445.

If you gain an affirmative response, what would be your next step or steps?

As a student nurse, you should alert you mentor to this response and seek to have a mental health assessment by a qualified practitioner.

Other considerations include finding out sensitively about thoughts of suicide or self-harm, feelings of worthlessness, and levels of concentration.

How their physical health condition is being managed – is this effective and how can it be maximised?

What resources are available locally, for example, online CBT courses, psycho-education groups, peer support groups?