Issues Of Classification And Diagnosis

Once we have described issues of classification and diagnosis for depression and seen what the evidence might be for each of them, there are some broader questions which we need to consider.

a) How does self-ranking explain why there are such high rates of under and over-detection of depression?

To answer this question, you need to look at the work of Karen Melrose. This article is reprinted in your resources booklet. You can hear an interview with Karen Melrose on Health Check. You can stream this from the BBC: wind 13 minutes 8 seconds into the programme. You can hear the same interview via Dropbox here.

b) How does co-morbidity affect the reliability and validity of diagnosis of depression?

Co-morbidity can be defined as the presence of more than one illness. Use the text book extract  on page 7 of your resources booklet to help answer this question. You can also watch the final section of the extract on diagnosis from the Deeply Depressed programme: follow this link to Dropbox.

c) Why is the range of symptoms in depression important?

This is a complex question. To understand it, you have to grasp the difference between classification and etiology. Classification is about placing labels on to clusters of symptoms. Etiology is about explaining what causes a mental health condition. If you read this article by Graham Davey (see also pages 7-8 of your resources booklet), you can see how the two processes have diverged from each other in his view. As you have seen from the video in the lesson, people with very different symptoms can be diagnosed with depression. So we might put the two ideas together and say that in reality, there are several different types of depression each with a different set of causes. As we learn more about the brain, we’ll get a better idea of what causes each of them. Read the article and decide what you think: does it sound like depression is really one condition or several?

d) How has DSM5 addressed issues of classification and diagnosis of depression?

The work we have done has been based on DSM-IV, the classification system published by the American Psychiatric Association more than ten years ago. DSM-IV has just been replaced by DSM5. This has been controversial in many respects. You can get a flavour of the controversy from these two articles, both of which are in your resources booklet.

http://pro.psychcentral.com/2013/dsm-5-changes-depression-depressive-disorders/004259.html

http://www.bbc.co.uk/news/health-20986796

This video discussion from Al Jazeera gives you some useful background. If flash player isn’t working, you can access this video here: https://www.dropbox.com/s/dglpcdq0wod625p/Inside%20Story%20Americas%20-%20Redefining%20mental%20illness.mp4.

Ask yourself what DSM5 is doing about some of the issues which we have identified in the lessons and whether this represents a real improvement on DSM-IV.

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