Case summary
Sue is a 38 year old female presenting with depression which has lasted three months. She has a history of depressive episodes since she was 19 years old. She reported general continuous low mood, and a loss of interest in activities she usually enjoys, like soccer, which she now avoids. She said that she suffers from early morning waking with difficulty returning to sleep, lack of appetite and feels lethargic.
To get to sleep at night she drinks three or four glasses of wine, although more recently this has increased to four or five glasses. Sue denied thinking of suicide; however, she reported that she thinks about how good it would be to die as it would be an escape.
The current episode of depression commenced when she recently moved. She relocated from the town where she had previously lived and in which her mother remained. She moved to a country town several hundred kilometers away. The move was to enable her husband, Tom, to take up a new job that looked promising. She too had found work as a primary school teacher.
Her mother rings her daily and tells Sue how lonely she is and how much she misses her. Sue worries she too may be depressed and feels guilty that she cannot support her mother during this time because of the distance between them. Sues older sister lives in a major city, further away, and is unable to offer much support to either Sue or their mother.
Her sister is well at the moment, although she too suffered from depression in the past.
Sue reports increased arguments with her partner, Tom. She says he is frustrated because she is withdrawing from him and he complains she just comes home from work and goes straight to bed expecting him to do everything for her. He tells her he needs her support after a hard time at work where things are not going as well as he had hopped they would in his new job. Sue just does not have the energy to cope with his difficulties and she retreats to her bedroom.
She is afraid he will leave her. He too is drinking more than usual and is more restless and irritable than usual.
Brief
Ask the clinical question -
What is the question that you're going to ask? What is the treatment evidence for middle aged females with depression?
- consider the presenting problem
- consider the case (gender and age)
1. Critically evaluate the evidence base for the treatment of the presenting problem and make a clinical decision as to which treatment intervention you would implement. Consume the evidence about the presenting problem.
Acquire the evidence- Critical components to consider in evidence based practice.
1. Best available research evidence
2. Clients values
3. Clinical expertise
- how do we go about acquiring the evidence?
- Consult text books, literature search, best practice guidelines
- looking at the APS litrature review manual. Use the APS as part of the evidence.
- do a literature search of a more recent meta analysis.
- PICK MULTIPLE STUDYS TO REVIEW. State whether they are Level1 (meta analysis) level 2 (rct) etc.
-Appraise the evidence
- What is the quality of the evidence?
- Is there a sound body of research?
For each study the following questions must be answered, you can provide the information per intervention.
a) Is the study's research question relevant?
b) Does the study add anything new?
c) Was the study design appropriate for the research question?
d) Did the study methods address the key potential sources of bias?
e) Was the study performed in line with relevant protocols?
f) Were the statistical analyses performed correctly for the stated hypothesis?
g) What were the effect sizes?
h) Do the results justify the conclusions?
i) Conflicts of interest
2. Provide a plan for implementing the chosen intervention which demonstrates your knowledge of the key features of the intervention.
Apply the results-
- we need to decide what treatment intervention we will use in our case
3. Consider the outcome evaluation of the chosen intervention.
Assess the outcome-
- assess the outcome based on clinical observation
- also base client feedback and formal testing.