Diagnosis and prevalence
Approximately 15% of Australians will experience a depressive disorder (i.e., major depression or dysthymia) at least once in their lifetime (Australian Bureau of Statistics, 2007). These disorders are also common in veteran populations, although prevalence rates differ across deployments. For example:
- Depressive disorders affect about a quarter of Australian Vietnam veterans in their lifetime. Refer to full article by O'Toole et al. (1996) (PDF) .
- Major depression affects about 10% of Australian Gulf War veterans over a 12-month period. Refer to abstract for Ikin et al. (2004) (PDF) .
- The 2012 Australian Defence Force (ADF) prevalence study found a 6% prevalence of depression over a 12-month period amongst currently serving ADF members. Refer to report by Hodson, McFarlane, Van Hooff, & Davies (2011) (PDF) .
Major depression is characterised by a persistently low mood and/or a loss of interest or pleasure in activities. In addition, the depressed veteran may experience a number of additional symptoms including:
- Changes in appetite and/or weight.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Low energy or fatigue.
- Trouble concentrating or making decisions.
- Feelings of worthlessness or excessive guilt.
- Recurrent thoughts of death or suicidal thoughts or behaviour.
Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are the most effective treatments for veterans with depression.
- Structured problem solving: this can help address feared problems that otherwise might be overwhelming.
- Activity scheduling: this involves scheduling a balance of pleasant, achievement-related and physical activities.
- Cognitive therapy: this assists in identifying and challenging excessively negative thoughts about oneself, one’s future, or the loss of a loved one or something highly valued. It aims to provide the veteran with a more balanced and helpful view of events, themselves and others.
IPT for the treatment of depression focuses on:
- Discussing the function of depression rather than the aetiology or cause.
- Examining the way in which depression can affect interpersonal interactions and relationships.
- Further information on depressive disorders and recommended treatments is available in the Mental Health Advice Book that was developed for clinicians who work with veterans.
- View the CBT-based treatment workbook which can be used with veterans who have depression.
- Newer antidepressants (i.e., SSRIs, SNRIs) may be beneficial for veterans who are unable to engage in psychological treatment or when it is unavailable.
New treatment approaches: Mindfulness-based therapies
Over recent decades, mindfulness-based therapies (MBT) have become increasingly popular. Despite its popularity and some promising findings, more research is needed before conclusions can be drawn about its benefit for people with depressive disorders. MBT adds elements of eastern philosophies (e.g., Buddhism and yoga) to CBT, and refers to therapies such as acceptance and commitment therapy (ACT), mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR). Further information is available in this meta-analytic review examining MBTs for depression and anxiety and this systematic review and meta-analysis examining MBCT for depression.
Clinical treatment guidelines
- WHO Management of Mental Health Disorders: major depression chapter.
- Australian and New Zealand clinical practice guidelines for the treatment of depression (PDF) and deliberate self-harm (PDF) .
- NICE clinical guidelines: depression in adults: the treatment and management of depression in adults.
Assessment and measures
The depression, anxiety and stress scale DASS21 (PDF) is a standardised assessment tool for depression, anxiety and stress symptoms that can help you develop a treatment plan and assess symptom severity or treatment progress. The patient health questionnaire-9 (PHQ-9) is a standardised assessment tool specifically for depression. Other measures of psychosocial functioning include:
- Audit for alcohol use (PDF) .
- DAST for other substance use (PDF) .
- WHOQoL-Bref for measure of overall quality of life.
Recommended readings and online resources
- Prevalence of depressive disorders in the Australian population (PDF) .
- Medical Journal of Australia supplements: provides access to peer-reviewed articles on depression, anxiety and other comorbid conditions.
- DVA Evidence Compass: Summarises recent research on effective psychological interventions for adults with depression or the effectiveness of stepped care for the delivery of treatment for depression and anxiety.
- Podcasts: The Anxiety and Depression Association of America interviews experts on a range of topics related to anxiety and depression.
- Thoughts and feeling record (PDF)
- Daily activity schedule (PDF)
- Centre for clinical interventions (CCI) consumer CBT-based workbook for depression