The Diagnostic and Statistical Manual of Mental Disorders V (ADSM V) is currently in use in the UK for diagnosing people with clinical depression. The System requires the patient to have been suffering from five of the symptoms which are presented to them for a minimum of two weeks. Also, one of the five symptoms must either be a depressed mood or loss of interest. The additional symptoms may include insomnia nearly every day, fatigue or loss of energy nearly every day or significant weight loss or weight gain.
In addition to fulfilling this, the patient must be a sufferer of these symptoms effecting their everyday life, be it social distress or other important areas of functioning. Finally, a diagnosis of depression according to the ADSM cannot be carried out if any of the symptoms are caused by the effects of a substance, such as self medication or a more abusive drug. There are several issues with the classification of depression. Firstly, as mentioned previously, the classification in use is the fifth version of the ADSM.
Although this shows we are constantly improving the classification of the illness, it also shows that our knowledge of depression is not at its full extent, and that some classifications ay differ with different versions of the ADSM. The main limitation of this measure of depression is that it is not scientific. Simply defining depression based upon the presence of five arbitrarily defined symptoms seems to be an insubstantial method. Without the use of blood tests or brain scans with definitive results, the classification of depression is reliant upon self report, which may not be reliable.
However, the strength of self reports is that the patient can receive therapy tailored to suit their condition specifically. Issues with labeling are also apparent in diagnosing someone with a form of oppression. There is a stigma which surrounds the topic of depression which is incredibly negative towards those who suffer from it. This may lead to people being unwilling to seek help from their doctor in fear that they might be a victim of this. Less severe than that is the idea that the label itself may lead to others treating the sufferer differently which may prevent them from leading a normal life.
When discussing the concept Of self report in diagnosing depression (as done previously) it is also important to mention that by classifying all individuals under the same label we are assuming that hey share the same characteristics, which is not the case as each person has at least five symptoms which are personally applicable to them, by this method. By putting everyone under the same umbrella bedspread’s’, key differences can be missed and this could lead to a treatment which does not work for them.
A final issue with labeling is the concept of the self fulfilling prophecy or the attribution theory. This is when the patient receives a diagnosis and the goes on to conform to their diagnosis, and so someone with depression then may lean towards exaggerating the typical symptoms involved. There are also weaknesses in the reliability of the diagnosis of depression. The reliability is the consistency of the measuring tool. For example, whether or not two doctors both diagnose depression in the same patient, or if the same diagnosis is made at different times are examples of good reliability.
This is known as inter-rater reliability and test retest. Snaring (2000) found that inter-rater reliability is ‘good’ in depression, achieving a correlation of 0. 8, however test retest is only ‘fair’, at best only scoring a correlation of 0. 6. This may mean there is subjectivity about the 9 symptoms seed to classify depression, making it incredibly unreliable. In addition to reliability is the validity of the diagnosis of depression. The validity concerns whether it measures what it intends to measure.
The Beck Depression Inventory is considered to be high in validity because it was constructed as a result of a consensus amongst mental health clinicians from their observations of psychiatric patients. Also, it is common for depression to occur alongside another mental illness such as anxiety, which shares some of the same symptoms as depression which means a diagnosis could be impaired if it is not measuring what it is intending to measure. For example, Burrows et al (1995) found that healthcare providers often under-diagnosed depression in 56% of nursing home residents as they assumed the symptoms were caused by other factors such as aging.
Therefore validity is Often at fault in diagnosing depression. The diagnosis of depression may be culturally bound. Although depression exists in all countries and is widely believed to often be a result of biological implications, it is certainly treated differently in different cultures. Most obviously, the ADSM is a Western method of classifying oppression and another method used internationally is the International Classification of Diseases. Although it seems similar, including its time span of two weeks, there are several different symptoms which the patient must fulfill in order to be diagnosed.
This means that depression may be treated with different levels of severity in some countries. However there are also differences in the opinion and perception of mental illnesses in other countries. For example in the Nigerian language Hooray, there is only one word to denote depression, anxiety and anger (Abuse 1993). Also, there are incredibly high rates Of compensation in many non-western cultures, particularly some Asian and Arabic nations, and this is thought to be because strong expressions of emotions, particularly negative emotions, is considered socially unacceptable.
This could mean that help is sought after less often than it should be, and therefore there are fewer diagnoses of mental illnesses. There are also theories that in more affluent, developed countries people often use depression as an alternative to accepting that life is sometimes difficult, which explains why clinical depression is less common in ender-developed countries; they have more to be genuinely depressed about.
Depression amongst young people has recently risen Incredibly high and whether this is due to the fact that there is more awareness and less taboo about mental illnesses or whether it has been ‘popularized’ is an ongoing discussion. Finally, there is a significant gender difference in depression, however there are several reasons to explain why. It is clear that women are considered to have a higher prevalence to mental illnesses as they are ‘more emotional’. This is true, although it is due to evolutionary traits as it would not eave been adaptive for men to admit to weakness, whereas women are more likely to acknowledge vulnerability.
Women are also predisposed to suffer from mental illnesses such as depression and anxiety due to their physiology. These facts however could lead to doctors over diagnosing depression in women as they may conform to the stereotype of being neurotic, again reducing the validity of the diagnosis of depression. In conclusion, there are several issues related to the classification and diagnosis of depression which make it both less valid and less reliable, and therefore we must continue to treat it in case by case scenarios.
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