Depression

Clinical tools

Featured links

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 may differ across veteran cohorts. 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 2010 Australian Defence Force (ADF) mental health and wellbeing study found a 6% prevalence of depression over a 12-month period amongst currently serving ADF members.  Refer to report by McFarlane, Hodson, 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:

  • 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

Treatment information

Recommended treatments

Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are the most effective treatments for veterans with depression.

The key components of CBT for treatment of depression include:

  • 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.
  • Access the CBT-based treatment workbook to use 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. 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). Despite its popularity and some promising findings, more research is needed before conclusions can be drawn about its benefit for people with depressive disorders, however MBCT shows promise for preventing relapse ( Piet & Hougaard, 2011). 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

Assessment and measures

  • Screening questions for depression concerning mood and interest may indicate that further assessment is required
  • There are several standardised assessment tools for depression that can help you develop a treatment plan, and assess symptom severity or treatment progress. The DASS-21 (PDF) is an assessment tool for depression, anxiety and stress symptoms, and the Patient Health Questionnaire-9 (PHQ-9)  is an assessment tool specifically for depression
  • Other assessment tools for depression include the Hamilton Depression Scale (HAM-D), the Beck Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale (HADS)."

Recommended readings and online resources

Publications

Multimedia

  • Podcasts: The Anxiety and Depression Association of America interviews experts on a range of topics related to anxiety and depression.