Problem:
"No one noticed because he was the funny one"
Karabo Ndlovu is a 20-year-old Black South African male university student living in residence in Pretoria. He was brought to the campus counselling service by his roommate after several weeks of increasingly concerning behaviour that had initially been masked by humour and social charm. Karabo is known as the funny one in his residence, the person who checks on others, tells jokes in tense situations, and often plays the role of emotional buffer in his social group.
Over the last six weeks, however, his functioning has deteriorated. He has begun skipping morning lectures, sleeping through the day, gaming late into the night, and drinking more heavily on weekends. Friends say his humour has changed in tone: still quick, but darker, more self-directed, and increasingly preoccupied with disappearance, death, and being forgettable. He recently posted a meme about being everyone's backup friend until you disappear, then brushed it off as banter. He has also told friends, "At least if I'm drunk I don't have to think," and, after a party, remarked, "I get why people tap out."
Academically, Karabo is in trouble. His marks have dropped sharply, and he has received formal warning that he may lose funding if he does not improve. He is the first in his family to attend university and has long felt pressure to justify the sacrifices made for him. When asked directly whether he is depressed, he shrugs and says, "I'm just tired of disappointing people quietly." He continues to socialise enough that some peers assume he is coping, but his roommate reports increasing isolation outside of performative settings. Karabo often lies awake at night, rarely eats properly, and has become noticeably thinner. He admits to feeling persistently exhausted, unable to enjoy things unless intoxicated or distracted, and ashamed that everyone sees me as easy and funny when actually I'm drowning.
When the roommate pressed further, Karabo said, "Don't stress, I'm too scared to do anything stupid." That statement initially reassured him. However, a few days later he found repeated internet searches on Karabo's laptop about peaceful ways to die, how many tablets kill you, and can people tell if you plan it. Karabo claimed the searches were for a criminology project, though he is not registered for criminology. During assessment, Karabo first laughs and minimises, but then becomes visibly tearful and admits that there are nights when he thinks about ending his life because it feels as though his existence has become a slow humiliation.
There is no known prior diagnosis, though Karabo reports periods of low mood during matric as well. He denies any clear periods of elevated mood, reduced need for sleep accompanied by increased energy, or distinct hypomanic episodes. He drinks heavily at times and uses cannabis occasionally. He also reports that as the eldest son, he feels responsible for not showing weakness at home. His father reportedly believes depression is a sign of softness, while his mother worries easily, making him reluctant to tell her the truth.
Questions:
Q1. What is the most likely primary mood disorder diagnosis? Need Assignment Help?
Q2. Which DSM-5-TR/ICD diagnostic clues support your formulation?
Q3. What secondary or comorbid disorders/features should be considered?
Q4. What South African contextual factors shape the presentation, diagnosis, and management?
Q5. What suicide-risk indicators, protective factors, and warning signs are present?
Q6. What would be the most appropriate immediate and longer-term management plan