Depression is a prevalent mental illness affecting an estimated 350 million people globally, with significant implications for disability and disease burden. Common symptoms include depressed mood, loss of interest, and impaired concentration, with screening tools like the PHQ-2 and PHQ-9 aiding in diagnosis. Major depressive disorder (MDD) is diagnosed based on the presence of specific symptoms causing significant distress or impairment, following DSM-IV criteria.

1. Depression DSM IV
Abdullatif Sami Al Rashed
Family and Community Medicine Block 5.2
College of Medicine, King Faisal University
Al Ahsa, Saudi Arabia

2. Introduction
• Depression is defined as a mental illness that causes a
steady low mood. People who suffer from depression tend to
be distressed and have a sense of disappearing.
• Depression is common in primary care patients, with an
incidence from 10 % to 14 % among patients who present to
a physician's office for any reason.

3. Introduction
• Today, depression is estimated to affect 350 million
people.
• According to the World Health Organization (WHO), by
the year of 2020, depression will be the second-leading
cause of world disability, and by 2030; it is expected to
be the largest contributor to disease burden.

4. Clinical Manifestations
• Classically, patients with depression present with
psychological symptoms of:
1. Depressed mood,
2. Loss of interest in activities,
3. Impaired concentration,
4. Feelings of worthlessness or guilt, and
5. Suicidal ideation.
However, some patients may instead
report nonspecific symptoms!

6. Risk Factors

7. Screening
• The U.S. Preventive Services Task Force (USPSTF) has published
more recent reviews on depression screening.
• Ultrashort screening instruments, such as the Patient Health
Questionnaire (PHQ)-2 may rule out, but not definitively diagnose,
depression.

8. Screening
• The PHQ-2, which asks two simple questions about mood and
anhedonia, and has been found to be up to 97% sensitive and
67% specific in adults, with a 38% positive predictive value and
93% negative predictive value.
• A PHQ-2 score ranges from 0-6. A score of 3 or greater is positive
and patient should be evaluated more by prompt administration of
the full PHQ-9

10. Screening
• The PHQ-9 is one of the most common instruments used for
depression screening, diagnosis and monitor treatment.
• It is increasingly administered for confirmation of a positive PHQ-2
result.

11. Screening
• The PHQ-9 is valid, takes two to five minutes to
complete, and has demonstrated 61% sensitivity and
94% specificity for mood disorders in adults.

13. Diagnosis of Major Depressive
Disorder (MDD)
• The criteria of diagnosing MDD according to DSM-IV is:
1. Five (or more) of the PHQ-9 symptoms have been present -More
than half the days- or -Nearly every day- during the same 2-week
period.
2. At least one of the symptoms either 1) depressed mood or 2) loss of
interest or pleasure marked More than half the days or Nearly every
day.

14. Diagnosis of Major Depressive
Disorder (MDD)
• The criteria of diagnosing MDD according to DSM-
IV is:
3. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
4. The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general
medical condition (e.g., hypothyroidism).
3. The symptoms are not better accounted for by Bereavement, i.e.,
after the loss of a loved one, the symptoms persist for longer than 2
months or are characterized by marked functional impairment,
morbid preoccupation with worthlessness, suicidal ideation,
psychotic symptoms, or psychomotor retardation.

15. Treatment
(Pharmacological)

18. Treatment
(Non-Pharmacological)

19. Treatment
(Non-Pharmacological)

20. Reference