Has Indira experienced major depression in the past?

Question

DSM Diagnosis
309.0 Adjustment Disorder with Depressed Mood
318.2 Intellectual Disability, Profound
278.00 Obesity
345.40 Epilepsy, grand mal
369.9 Visual loss

Rationale
An Adjustment Disorder with Depressed Mood was assigned as the primary diagnosis. An identifiable stressor occurred in this case four months ago, as Indira moved into a group home where staff changes made caregiving unstable after being cared for by her mother her entire life. Indira gradually developed depressive symptoms. These impaired her functioning in that she became withdrawn from activities and people and stopped eating. While major depression could be considered as a diagnosis, it appears that Indira is reacting to environmental changes that have created a severe disruption in her previously adaptive life routines. If her symptoms of depression persist for several more months in spite of stabilization in her housing situation and schedule, she may be diagnosed with a mood disorder.
Profound Intellectual Disability was also diagnosed. Indira has an IQ of about 15; coupled with that low IQ, she is unable to complete any activities of daily living by herself. Hence, she seems to have a profound level of intellectual disability.

Risk and Resilience Assessment
Indira can be considered at-risk for symptoms of depression due to the fact that she is a female and had significant chronic physical disorders with which she must cope. She also has the social risk influence of unstable caregiving at her group home. The same risk influences can influence her recovery from her symptoms, although she has additional protective mechanisms working in her favor. Indira has no prior episodes of depression, was assessed early, and has no comorbid mental disorders. Indira’s strengths include her ability to attach to other people, to show affection, and to engage in structured activities. She also has a caring and supportive family. Her mother’s failing health is another risk influence on the course of Indira’s adjustment quality, given her strong reliance on her family.

Treatment
Of the empirically validated interventions for depression, Indira is most suitable for behavioral interventions, due to the intellectual disability that limits her capacity to engage with others on an abstract, cognitive level. The main goal involves Indira having more stability in her living environment. The group home manager, even though he still struggles with few permanent and too many relief staff, can be encouraged to assign one permanent staff to Indira’s apartment. In this way, the permanent staff will be able to pass her knowledge of the residents to the relief staff. Because of this arrangement, all residents of that apartment may enjoy more stability after several chaotic weeks. Permanent staff can be were trained to recognize the needs of the residents of the apartments to which they are assigned. In addition, an activity plan for each week can be established to ensure that residents have proper stimulation in the evening, such as dancing, gym, arts and crafts, and so on. With these changes in place, Indira may begin to enjoy a regular routine, and she can become familiar with the permanent staff assigned to her apartment. Indira can become more social again and her unhappiness may diminish.
Indira’s mother will also be encouraged to take Indira out for an activity on a regular but manageable basis. This shared activity may help Indira feel less abandoned and lonely. It will reinforce the fact that her mother is still in her life, loving and caring for her.

Critical Perspective
This case indicates how environmental events can contribute to the development of mood symptoms, and this is captured in the fact that an adjustment disorder was diagnosed. In Indira’s case, she functioned well with her mother as her primary caregiver, but switching to a group home and one in which there was unstable caregiving, proved to affect her functioning in an extremely negative way. This case shows the significance of environmental supports for people with intellectual disability.

Answer 1

To our knowledge, Indira has not shown depressive symptoms in the past that would warrant a diagnosis of major depression.