Depression assessment in afya

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''Screening'' - if yes do fuller assessment
during past month have you been bothered by feeling down or hopeless ?
during past month have you been bothered by having little interest or pleasure in doing things ?

''Assessment''
''Hospital Anxiety and depression scale (HAD)''
14 questions - 7 anxiety and 7 depression - encourage to answer quickly
each scored 0-3 - so 21 for A and 21 for D
0-7 normal, 8-10 borderline 11+ case

''Patient Health Questionnaire (PHQ-9)''
over past 2/52 have you been bothered by .... 9 items scored out of 3
includes thoughts of self harm
0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe

''DSM IV - NICE'' grades depression 
depressed mood most of day nearly every day
markedly diminished interest or pleasure in almost all activities most of day nearly every day
significant wt loss or gain when not dieting with change in appetite
insomnia / hypersomnia nearly every day
psychomotor agitation or retardation nearly every day
fatigue / loss of energy nearly every day
feelings - worthlessness, excess/inappropriate guilt nearly every day
diminished ability to think or concentrate, indecisiveness - nearly every day
recurrent thoughts of death, suicidal ideation without plan or attempt / specific plan

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