A Case Analysis on
MAJOR DEPRESSIVE DISORDER
In Partial Fulfillment of the
Requirements in NCM 217 - RLE
CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR
NURSING ROTATION
Submitted to:
Maria Febe Libre, RN, MN
Clinical Instructor
Submitted by:
Abedejos, Alyzza Karylle C.
Cortado, Lee Robin G.
Amigleo, Louie
Despi, Tim
Avendaño, Rhiana Shakhia M.
Dongiapon, Kessiah Mae G.
Buenaflor, Alexandrouva H.
Genelsa, Angelie
Caalim, Cyrus Gabriel O.
Gumban, Kyra Kannesha O.
Calle, Elaica V.
Julian, Mars Lorynce D.
BSN 3C GROUP 2
March 14, 2024
1
TABLE OF CONTENTS
I. Introduction.................................................................................................................. 3
II. Goals and Objectives................................................................................................. 4
General Objective:.......................................................................................................4
Specific Objectives:..................................................................................................... 4
III. Biographical Data/Clinical Data/ Brief History........................................................ 5
IV. Course in the hospital............................................................................................... 7
A. Mental Status Examination (MSE).......................................................................... 7
B. Progress Notes.................................................................................................... 14
V. Psychodynamics..................................................................................................... 19
Risk Factors.............................................................................................................. 19
VI. Symptomatology..................................................................................................... 26
VII. Differential Diagnosis............................................................................................ 30
VIII. Medical Management............................................................................................ 46
A. Therapies.............................................................................................................. 46
B. Drug Study............................................................................................................ 49
IX. Nursing Management............................................................................................. 58
A. Nursing Theory..................................................................................................... 58
B. Nursing Care Plans............................................................................................... 62
C. Health teachings................................................................................................... 74
D. Discharge Planning...............................................................................................75
X. Prognosis.................................................................................................................. 79
XI. Bibliography............................................................................................................ 83
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I.
Introduction
Psychiatric nursing is a specific field of nursing that practices a holistic approach
to care and is centered on the use of interpersonal relationships and environmental
factors as a therapeutic approach to the mental health of individuals who suffer from
mental and behavioral disorders. Psychiatric nurses provide a safe and comfortable
environment, improve patient self-esteem, promote positive changes in their patient's
physical and psychosocial well-being, and assist in their daily living activities while
maintaining
their
independence
(American
Psychological
Association,
2023).
Furthermore, psychiatric nurses must establish a therapeutic relationship with their
clients to aid them in transforming their lives for the better through proper assessment,
nursing diagnosis, medication administration, holistic care, education, and minimizing
the side effects of their medication (American Psychiatric Nurse Association, 2023).
According to the World Health Organization (WHO), mental health encompasses
a state of well-being that empowers individuals to navigate life's challenges, fulfill their
potential, engage effectively in learning and work, and contribute positively to their
communities. It's an essential aspect of overall health and vitality, crucial for individuals
and society to thrive. Mental health extends beyond the mere absence of mental
disorders, encompassing a broad spectrum of experiences and distress levels unique to
each individual. This range spans from minor challenges to severe impairment,
sometimes involving risks of self-harm. While those with mental health conditions
frequently encounter barriers to well-being, it's crucial to acknowledge that diminished
mental well-being isn't necessarily unavoidable or consistent among individuals.
Globally, around 970 million individuals are affected by mental disorders, with
anxiety and depressive disorders being particularly common. The COVID-19 pandemic
in 2020 led to a significant surge in the number of people grappling with anxiety and
major depressive disorders. Initial estimates show a 26% and 28% increase
3
respectively for anxiety and major depressive disorders in just one year. According to
the Department of Health (DOH) in the Philippines, mental illness is increasingly
prevalent as a form of disability, affecting a significant portion of the population. At least
3.6 million Filipinos are estimated to experience mental, neurological, and substance
use disorders.
The patient in this case analysis is Mr. R.D.A., who has been admitted to Forestal
Healing Home and Therapeutic Milieu due to two suicide attempts, with the most recent
attempt in January 2024. He has experienced significant loss in life, including the
deaths of both his parents in separate accidents. Mr. R.D.A.'s educational journey has
been challenging, opting for vocational training due to academic struggles during high
school. He has a history of romantic relationships, including a recent breakup and
subsequent new relationship. He survived a serious motorcycle accident in 2020,
resulting in a severe injury to his arm.
This case study will serve as a valuable tool for student nurses to deepen their
understanding of preventing suicide attempts and addressing mental health conditions.
By immersing themselves in this case, student nurses will not only expand their
knowledge base but also refine their clinical skills in effectively managing individuals at
risk of suicide. The comprehensive data provided in this case analysis will empower
student nurses to develop targeted nursing interventions tailored to the unique needs of
individuals struggling with the same mental health condition. Furthermore, by analyzing
real-life scenarios and integrating evidence-based approaches, student nurses can
enhance their critical thinking skills in identifying and mitigating the signs and symptoms
associated with depression. By advocating for mental health literacy, student nurses can
play a pivotal role in reducing stigma and fostering supportive environments for
individuals grappling with the same mental condition.
II.
Goals and Objectives
General Objective:
At the end of the 6-week Care of Clients with Maladaptive Patterns of Behavior
Rotation, the student nurses of BSN-3C Group 2 will be able to have an in-depth
understanding of the client’s mental condition by completing a comprehensive nursing
4
case analysis of the disorder as well as applying knowledge and skills required in the
psychiatric nursing care.
Specific Objectives:
To achieve the general objectives, the student nurses specifically aim to:
a. Analyze the patient's condition and status;
b. present a clear introduction about the disorder that includes its definition,
statistics, a brief overview of the patient, and the implication of this case
symptoms being manifested by the patient;
c. discuss possible differential diagnoses that apply to the patient's condition;
d. classify the medical and nursing management that are actual and possible for the
patient;
e. report a comprehensive drug study based on the presented medications;
f. choose and evaluate nursing theories related to the case;
g. implement appropriate nursing care plans as guiding interventions based on the
manifestations presented by the patient;
h. develop a comprehensive prognosis based on the patient’s condition and
progress; and
i. formulate a client, family, and community-centered recommendation.
III. Biographical Data/Clinical Data/ Brief History
a. Biographical data
Mr. R.D.A, a 27-year-old Filipino male, was born on January 15, 1997, in
Cabangayan, Carmen, Davao del Norte, Philippines. He completed vocational
education and worked as a Sales Associate. Mr. R.D.A is the middle child in his family,
having two sisters. He is a Roman Catholic and is currently single.
b. Clinical data
Weight: 60 kg
Height: 163 cm
BMI: 22.6 kg m/2 (normal)
5
Date of Admission: February 6, 2024
Time of Admission: 5:01 PM
Attending Physician: Dr. Castañeda
Client R.D.A has been admitted to Forestal Healing Home and Therapeutic
Milieu following suicide attempts in December 2023 and, more recently, in January of
this year. Mr. R.D.A has a weight of 60kg, a height of 163cm, and a BMI of 22.6kg m/2.
This admission transpired precisely at 5:01 pm on February 6, 2024, under the service
of Dr. Castañeda.
c. Brief history
Mr. R.D.A is a 27-year-old male from Cabangayan, Carmen, Davao del Norte,
who was born on January 15, 1997. He is a Roman Catholic. Patient R.D.A comes from
a family of 5, including his mother, father, himself, and two sisters. Mr. R.D.A is the
second among the three children.
He describes his father as a serious person and very busy with his job as a
farmer, but his father died due to a motorcycle accident in the year of 2018. He
describes his mother as loving, and he is very close to his mother. Both his mother and
father don’t smoke and only drink alcohol occasionally. His mother loves to cook and
spoils them when they achieve something in school and when they do good deeds. He
feels that he is closer to his mother than his father because of the warm approach of his
mother, but his mother died in 2016 because of a motor accident.
Mr. R.D.A mentioned that his older sister has financed their expenses since their
father died. His older sister is 30 years old, and his younger sister is 24 years old. His
sisters work as accountants in a specific bank, but he doesn’t know the bank’s name.
Mr. R.D. A also works at Gaisano Mall in Tagum as a sales associate.
He completed elementary school at the age of 12. During high school, he
admitted to disliking studying and encountered academic difficulties. He admitted that
he didn’t take his education seriously because he had a romantic relationship at a
young age. He chose to enroll in a vocational course which is automotive, because it
only takes two years for him to finish it than enrolling himself in college.
6
He started having a relationship with women during high school, which lasted
only months. He had a serious relationship in the year of 2020 which lasted for 3 years,
and he admitted that they were living as a couple in one house. After his break up with
his 3-year relationship, he immediately entered into a new relationship which is the
sister of his 3-year relationship ex-girlfriend.
In 2020, he injured his arm during a motorcycle accident. He was taken to the
hospital and was revived twice, then intubated and placed in the ICU for three days.
Unfortunately, he was not able to undergo surgery to fix his dislocated hand as the
accident happened during the COVID-19 pandemic. He returned home and sought help
from a “manghihilot.”
Client R.D.A.’s first attempt at suicide was in December of 2023. He sprayed
insecticide five times in his mouth. He was hospitalized, and according to him, it cost
him 50,000 pesos of his savings, and he consulted a psychiatrist. In January 2024,
client R.D.A. made his second attempt of suicide when he tried to hang himself using an
electric wire. His attempt did not succeed because his sister’s scholar student stopped
him. After his second attempt, he then approached a psychometrician. Patient R.D.A
was admitted to Forestal Healing Home and Therapeutic Milieu on February 6, 2024, at
5:01 PM.
During the assessment, he displayed proper grooming, neat hair, and appropriate
clothes for the weather. He was also talking loudly and appeared to be normoactive. He
weighs 60 kilograms, and his height is 163 cm. He has also been prescribed medicine
by his physician, which is Escitalopram 10mg 1 tab OD, and he has Vitamin C as his
daily supplement.
IV. Course in the hospital
A. Mental Status Examination (MSE)
I. PRE-EXAMINATION
A. GENERAL APPEARANCE
Upon inspection, the client presents himself well-groomed, evident from
his fresh appearance following an early morning bath. His hair is neatly combed
and styled with gel, and he is dressed in a casual green tee and black
7
knee-length shorts, all of which are tidy and free from any visible damage or
discoloration. There are no signs of body or breath odor, and the client applies
deodorant and body lotion after his morning bath. His nails are short and
well-trimmed. The client's skin appears soft and blemish-free, without any signs
of insect bites, lesions, or scars. Standing at a height of 163cm and weighing
60kg, he engages in friendly eye contact when conversing with student nurses.
Overall, the client's appearance aligns well with his chronological age.
B. GENERAL MOBILITY
The client maintains an upright posture while standing and walking,
although his range of motion is somewhat limited due to a disability in his left
upper arm.
C. MOTOR ACTIVITY
The client typically exhibits normoactivity however, a competitive streak
becomes apparent during games and activities, leading to heightened
hyperactivity. Additionally, psychomotor agitation is present such as fidgeting of
legs.
D. BEHAVIOR/NURSE-PATIENT INTERACTION:
The client consistently demonstrates cooperation Throughout the program
and activities. He engages with others in a friendly and responsive manner,
including fellow clients and student nurses. While seated, the client rests his
hands on his thighs, listening attentively and observing the program's
proceedings. Furthermore, the client articulates a profound longing for inner
peace and healing within the facility, expressing a heartfelt desire to overcome
troubling thoughts and attain a sense of serenity and acceptance.
II. STREAM OF TALK
A. CHARACTER
8
Since the first day, the client has consistently shown a willingness to
express his thoughts and emotions, communicating with a natural tone,
appropriate volume, and spontaneity. Often starting his responses with an initial
"Uhmm," the client tends to offer detailed and elaborate answers when asked
questions, occasionally responding promptly without hesitation.
B. ORGANIZATION OF TALK/FORM OF TALK
During conversations, the client consistently provides pertinent and
coherent responses. Additionally, when prompted to elaborate, he could
effectively convey his thoughts in Tagalog or Cebuano. His responses are
straightforward. Furthermore, the client injects humor into his remarks, often
adding playful jests to his answers.
III. EMOTIONAL STATE AND REACTIONS
A. MOOD
The client maintains a euthymic mood. At the beginning of the program,
he often responds with "Ok lang" when asked how he feels, indicating he's doing
fine. Later, after engaging enthusiastically with his teammates in various games
and activities, he exclaims, "Lingaw kaayo ko," expressing that he genuinely
enjoyed himself.
B. AFFECT
The client maintains congruent and fitting emotional responses throughout
the program. The client’s laughter was genuine when he shared a joke, reflecting
an
appropriate
emotional
reaction. Conversely, when sharing personal
challenges, the client is serious, indicating a genuine engagement with the topic.
These varied emotional expressions align seamlessly with the client’s overall
mood, highlighting the congruence between his mood and affect.
IV. THOUGHT PROCESSES
A. CONTENT OF THOUGHT
9
When the client shares his thoughts, history, or experiences, he remains
fully aware of his words and maintains a coherent flow of ideas. He bravely
acknowledges that he decided to seek help at the Forestal Healing Home and
Therapeutic Milieu because of depression, which had led to suicidal thoughts and
attempts in the past. Despite that, he openly expresses his optimism about
finding peace and healing during his stay of 1 or 2 months at the facility. He has
no unusual beliefs and consistently responds with rationality in his thoughts and
expressions.
B. IMPULSE CONTROL
The client exhibited no signs of aggression or hostility toward the student
nurses or other clients. However, the student nurses noticed a pattern where the
client displayed affection towards certain student nurses by exchanging a wink
whenever their eyes met. This occurred consistently for three consecutive days
and once again the following week.
V. NEUROVEGETATIVE DYSFUNCTIONS
A. SLEEP
The client reports maintaining a consistent sleep schedule, typically
getting 8-9 hours of rest each night. He typically wakes up between 5:30 and
6:00 am, though he doesn't immediately shower. Instead, he begins his morning
routine, often exercising or working out before finally showering. In the afternoon,
during siesta time, he typically sleeps for about an hour.
B. APPETITE
The client demonstrates a healthy appetite, eagerly anticipating break time
and showing genuine interest in the food's origin. He never voices dissatisfaction
with the taste or portion sizes, consuming whatever is provided without
complaint. Occasionally, when offered a piece by a student nurse, he gladly
accepts, expressing gratitude with "Kaulaw pud ma'am oy. Salamat ma'am ha."
10
C. DIURNAL VARIATION
Throughout the program, the client maintains a steady mood pattern,
whether it's conducted in the morning or afternoon. His behavior has no
noticeable shifts, as he tends to stay quiet yet attentive while seated during the
program.
D. WEIGHT
Based on the client's chart records, his weight upon admission was 60kg.
However, the student nurse failed to conduct another weight measurement
before his discharge.
E. LIBIDO
The client does not display any noticeable signs of heightened sexual
desire. He maintains stable and adequate energy, enabling him to participate
actively in all program activities.
VI. GENERAL SENSORIUM AND INTELLECTUAL STATUS
A. ORIENTATION
The client is well-oriented, showing a solid grasp of time, place, day, date,
person, and situation. Furthermore, he accurately recalls his name, the identities
of those around him, the facility's name, and the purpose of his admission.
Additionally, he actively monitors the duration of his stay in the facility since
admission, eagerly anticipating his return home to his sisters.
B. MEMORY
The client has a good memory, readily able to recall past recent events
upon inquiry. He can remember the various activities with different groups and
the snacks provided during both morning and afternoon sessions. However,
when asked about how old his parents were when they died, the client was not
able to recall his parents’ ages as well as their birth years.
11
C. ATTENTION SPAN
The client has a good attention span and remains attentive during
program instructions and activities. During conversations, sustained attention and
eye contact are most effective when engaging face-to-face. Even when the
student nurse speaks from behind, the client consistently tries to turn and
maintain eye contact, showcasing his attentiveness and engagement.
D. GENERAL INFORMATION
The client possesses a good understanding of general information. He
was aware of the current trends and happenings outside the facility since it has
been a short time since his admission. Additionally, he mentions being granted
the privilege to watch news programs on television, enabling him to stay informed
about current events worldwide.
E. ABSTRACT THINKING ABILITY
In the Just for Today session, the client actively participated by sharing his
perspective on the image presented on the board. He conveyed his thoughts by
stating, "Kailangan natin magsumikap sa buhay para makamit natin ang mga
bagay-bagay na nais nating makuha."
F. JUDGEMENT/REASONING
When questioned about his plans upon discharge from the facility, the
client expressed his intention to take a brief week or two to rest before returning
to his job as a sales associate. He emphasized his desire not to depend on his
sisters indefinitely, expressing his wish to be a source of strength for them.
Additionally, he conveyed a sense of gratitude for the opportunities life has given
him, expressing a desire to make up for lost time by embracing and cherishing
the blessings he has been granted.
VII. INSIGHT
12
During the nurse-patient interaction, the client vulnerably opened up about his
sense of worthlessness and constant feelings of failure in recent months.
Additionally, he had chronic self-doubt, believing he burdened his sisters when
he should actually be their source of support. However, he discussed his current
circumstances, expressing a strong desire to find inner peace and relief from
stressors. He demonstrated a profound understanding of the necessity of his
admission to the facility, as it was his own decision to seek help in order to
address his confusion regarding his thoughts and emotions. Each day, he
diligently adhered to his medication schedule, recognizing its importance in his
journey toward improvement. On his final day at the facility, he expressed a wish
to extend his stay in order to attend the culmination event the following day as a
gesture of gratitude towards the student nurses who had made a significant
impact on his life during his time there. However, he felt conflicted about the
additional financial burden it would place on his sisters. Nonetheless, the client
conveyed a sense of optimism, stating that he now feels significantly better than
he did before.
VIII. SUMMARY OF MSE
Disturbances noted in the mental status examination include a limited range of
motion due to a disability in the client's left upper arm, as well as moments of
heightened hyperactivity during competitive activities, suggesting potential
difficulties in motor control. Additionally, a pattern of impulsivity is observed in the
client's behavior, as evidenced by displays of affection towards certain student
nurses through winking gestures, indicating possible challenges in impulse
control. Client is aware that he has a problem and was the one who willingly went
to the facility to be admitted. He want to find peace and healing. However he
made comments about having negative self-worth, feeling like he is a burden to
his sisters and that he feels immense guilt to his failed relationship and the stress
his sisters’ are experiencing. Furthermore, no disturbances are noted in sleep,
appetite, weight, libido, orientation, attention span, abstract thinking ability,
judgment, reasoning, or insight.
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Diagnostic Category: Major depressive disorder, Single episode, in Partial
Remission
B. Progress Notes
DATE
SITUATION
February 15,
The
second
2024,
focused
day
on
PROGRESS NOTES
of
duty Client R.D.A. presented with a
recreational good
general appearance. No
activities in which are done to signs of distress were noted. The
physically
and
mentally client
welcomed
the
student
stimulate the clients’ sensory nurses with a warm smile and was
perception and reaction time, able to share a bit of his problems.
as well as facilitate positive However,
social
interaction
there
were
specific
between questions that were responded to
clients through the games “Tap with "Di pako ready mag share
In”, “Stack Me Up”, and “Copy ana, ma'am. Sa sunod napud
Cat.”
hehe."
February 16,
The fourth day of duty involved Client R.D.A. maintained a good
2024
games/activities
that
foster general appearance for this day.
sportsmanship, improved gross He initiated this by greeting his
motor skills, teamwork, and assigned student nurse first and
coordination.
prepared
The
were
activities then
“Pass
shyly
asking for a few
and minutes before taking his vital
Shoot”, “Bounce Pong”, and signs so that he could do his daily
“Lastik Cup.”
morning hair and body routine,
such
as
applying
hair
gel,
deodorant, and body lotion. The
client continued to participate and
engage during the activities as
14
well as maintained active listening
throughout the program.
February 17,
The third day of duty was Client R.D.A. presented a good
2024
mainly to promote cognitive general
stimulation
and
appearance. Moreover,
enhance the client was very active and
hand-eye coordination, focus, participative during the activities.
and coordination of clients by Even though he had a disability on
playing
activities
activities
the
games
prepared.
were
and his left arm, he still managed to do
The well
guessing
during the activities and
4 contributed to the victory of his
pictures in 1 word, transferring team.
marshmallows
to
the other
bowl using chopsticks, and
fanning paper fish to reach the
finish line.
February 22,
The fifth day of duty was a day Client R.D.A presented with an
2024
where clients had occupational excellent general appearance. As
therapy, wherein the clients usual, the client asked for a few
made and designed their own minutes to do his morning hair and
mini garden in three different body routine. During the program,
groups,
fostering
teamwork the client was very active since he
and communication.
was the leader of their group. He
led his team by giving orders on
where to put specific designs and
objects in making their miniature
garden. At the end of the program,
their team received the award of
having the most unique miniature
garden, and R.D.A. interacted with
15
more clients than usual.
February 23,
The sixth day of duty was Client
R.D.A.
presented
an
2024
focused on art therapy in which excellent general appearance as
the clients made origami art. the previous days. The client
The
therapy
involves
fine showed excitement about what
motor skills as well, as it origami art would they be making
reduces stress and anxiety.
for the day since he expressed
that they made a butterfly in one
of their activities with the other
groups.
The
client
was
very
attentive to the instructions and
obedient, and it was evident that
the client was excited since he
opted to fold the paper faster than
anyone else, waiting eagerly for
others to finish so they could do
the next step. He also helped
other clients who were struggling
with
following the instructions.
Overall, the client was observed to
be more comfortable with other
clients as he takes the initiative to
converse with some of them.
February 24,
The seventh day of duty was a As usual, client R.D.A presented
2024
music therapy in which clients with a good general appearance.
were able to use music as a The client was able to share a
way to reduce stress, alleviate song during the music therapy by
sadness, and a tool for the singing Hero. The client seemed
clients
to
share
laughter like he was having fun while
16
together through singing.
listening
to
the
others
sing
because the setup was somewhat
like a get together in which the
client liked since he expressed in
the previous days that he liked to
hang out with other clients and
jam together.
February 29,
On the eighth day of duty, the Client
2024
clients were able to engage in excellent general appearance as
social
interactions
R.D.A
presented
an
with usual. The client was not able to
co-clients and student nurses do his morning hair and body
through
the
human
bingo routine since there were no people
activity. The activity was made at the nurse’s station at that time.
to help the client develop skills He was a bit shy to admit that he
in
task
initiation,
sustained had
attention, and task completion.
not
However,
applied
he
body
looked
lotion.
on
the
positive side, saying, “Di man guro
ko manimaho ma’am no? Bago
raman ko naligo, hehe.” During
the
activity,
R.D.A
had
fun
engaging with other clients and
asking wether they had a dog or
not, and other things that was
present in the human bingo. It was
observed
develop
that
the
client
did
interpersonal
relationships with other clients
since there were a couple of times
when he immediately said “Ay! Si
17
Doc Emy ni,” after reading the
statement “Owns a car,” showing
that he and the other clients
shared a bond that made them
know each other more deeply.
March 2, 2024
On the ninth day of duty, there The
client
presented
a good
was humor therapy and an general appearance, as usual.
amazing race. Humor therapy During the humor therapy, he
involves the sharing of jokes participated by sharing a joke.
between clients and student That also means that the client
nurses.
The
amazing
race had grown comfortable not just
involves
progression
to with the other clients but with the
different
stations
completing
tasks
while student nurses and staff as well.
at
each He participated well and finished
station.
the task fairly along with his team.
The client also expressed his
enjoyment throughout the activity
stating that it was his first time
doing such activity inside the
facility.
March 7, 2024
The tenth day of duty was a Client R.D.A. presented a good
day
where
the
client’s general
appearance.
It
was
concentration skills and critical evident that he was very excited
thinking skills were challenged something
through
the
games
called assigned
“Ansabe” and “Telepartners.”
he
even
student
told
nurse,
his
“May
surprise ako mamaya.” As usual,
the
client
was
attentive
and
participative during the program.
The client was observed smiling,
18
laughing, and really enjoying his
day. He also cheered harder for
his team on this day more than
any other day. When the break
came, at last, he gladly told his
assigned student nurse that he
would be leaving the facility later
that
afternoon.
The
client
expressed his gratitude to the
student nurses by saying “Thank
you!” numerous times. He also
told his assigned student nurse
that he was really grateful to all
student nurses for making his stay
in the facility more memorable, he
had realized a lot and expressed
gratitude once more.
V. Psychodynamics
Risk Factors
Table I: Predisposing Factors
Predisposing
Present
Factors
(✔) OR
Justification
Rationale
Absent
(–)
Age
✔
Client is already 27
The percentage of adults who
years old.
experienced any symptoms of
depression was highest among
those
aged
18–29
(21.0%),
19
followed by those aged 45–64
(18.4%)
and
65
and
over
(18.4%), and lastly, by those
aged 30–44 (16.8%) (Villaroel,
2020).
Gender
–`
The Client is male and According to a 2021 research by
has attempted suicide
Puyat, et al., the prevalence of
twice.
young
Filipino
adults
experiencing moderate to severe
depressive symptoms is higher
in females (10.2%) than males
(7.6%).
Women attempt suicide more,
but men succeed more often.
Successful
suicides
number
about 70 percent for men and 30
percent for women. This has to
do with the lethality of the
means.
Women
tend
to
overdose, while men use more
lethal means such as firearms.
These differences between men
and women may also reflect a
tendency for women to seek and
accept
help
from friends or
professionals,
whereas
men
often view help-seeking as a sign
of
weakness.
Furthermore,
20
several studies have indicated a
higher risk factor for suicide
among gay men and lesbians. It
is thought that this increased risk
may be a function of the social
stigma
and
discrimination
associated with gay and lesbian
orientation
(Townsend
&
Morgan, 2021).
Ethnicity
–
The client is Asian.
Statistics show that age-adjusted
suicide rates are highest among
non-Hispanic American Indian
and
Alaska
Native
(AI/AN)
people and non-Hispanic White
people. (Centers for Disease
Control and Prevention, 2023).
Family
environment
–
The client grew up in
Hard
family
a family with good
factors
such
dynamics. He has a
relationship,
close relationship with
status, level of parental literacy
his mother and
and non-intact family structure
sisters, and his father
were associated with depressive
is a good provider.
symptoms.
as
family
The
environmental
and
environmental
economic
soft
family
factors-conflict
control-were
associated
parent
with
positively
depression,
while cohesion was negatively
related to depressive symptom
after
controlling
for
other
21
important
associates
of
depression (Yan, et al., 2024).
Genetics
–
Client did not mention
Most family studies have shown
that one of his family
that major depression is more
members had
common
depression.
biological relatives of people with
among
first-degree
the disorder than among the
general population. A genetic link
has
been
suggested
in
numerous studies; however, a
definitive
mode
transmission
of
genetic
yet
to
be
(Townsend
&
has
demonstrated
Morgan, 2021).
Biochemical
Influences
✔
The Client is
It has been hypothesized that
prescribed
depressive
Escitalopram which is
related to a deficiency of the
a selective serotonin
neurotransmitters
reuptake inhibitor
norepinepherine, serotonin, and
(SSRI). It increases
dopamine,
intrasynaptic levels of
important receptor sites in the
serotonin by blocking
brain. Norepinephrine has been
the reuptake of the
identified as a key component in
neurotransmitter into
the mobilization of the body to
the presynaptic
deal with stressful situations.
neuron. However,
Neurons that contain serotonin
there are no specific
are critically involved in the
labs showing
regulation
problems in levels of
psychobiological functions, such
illness
at
may
be
functionally
of
many
22
neurotransmitters.
as
mood,
vigilance,
anxiety,
arousal,
irritability,
thinking,
cognition, appetite, aggression,
and circadian rhythm. The level
of dopamine in the mesolimbic
system of the brain is thought to
exert
human
a
strong
influence on
mood
and
behavior
(Townsend & Morgan, 2021).
Neuroendocrin
–
e Disturbances
There are no lab
In clients who are depressed, the
results that show the
normal
presence of
inhibition fails, resulting in a
neuroendocrine
hypersecretion of cortisol. This
disturbances.
elevated serum cortisol is the
system
of
hormonal
basis for the dexamethasone
suppression
test
that
is
sometimes used to determine if
an individual has somatically
treatable depression (Townsend
& Morgan, 2021).
Single Civil
Status
✔
Client is unmarried.
Compared to marriage, being
single or being divorced/widowed
were associated with depressive
symptoms at every age in men.
The presence of a partner may
be more important for mental
well-being (Grundström et al.,
2021).
23
Low
–
The client didn’t face
Comparable risks of depression
Socioeconomic
financial difficulties, he across economy groups suggest
Status
has a stable job as a
that income relative to your
sales associate in one
peers,
of the malls in Tagum
income, is a risk factor for
City; moreover, his
depression. Low Socioeconomic
sister are also already
Status was associated with an
working.
increased
risk
of
across
all
measures
of
status.
Low
rather
than
socioeconomic
absolute
depression
income was associated with the
highest odds ratio for depression
(Jespersen, 2023).
Chronic painful
Client has a disability
Limited data are available on
or disabling
due to a vehicular
suicide
illness
accident. As a result,
disabilities. However, a recent
his left arm is
survey highlighted that in 2021,
shortened. His
adults with disabilities were three
disability does not
times
prevent him from
suicidal ideation in the past
doing most activities,
month
but it negatively
without disabilities (Centers for
impacts his mental
Disease Control and Prevention,
health.
2023). Most disabled people who
✔
among
more
people
likely
compared
to
to
with
report
people
commit suicide aren't driven to it
by the experience of having a
disability;
instead,
these
tendencies are usually due to
difficulty
in
knowing how to
24
navigate society's perception of
disability
and
how
that
perception
impacts
their
relationships
and
livelihood
(Weiss, 2021).
One explanation for increased
suicide risk with chronic disease
is that receiving an ‘unlivable’
diagnosis or the challenges of
living
with
causes
a
a
chronic
mental
depression
or
Maladaptive
illness
state
of
hopelessness.
responses
to
stressors may result in increased
anxiety, depressive symptoms,
and suicidal ideation, all of which
are factors predisposing people
to suicide attempts. In addition,
stress
may
impair
the
immunological mechanisms, and
this can result in a poor response
to
treatment
and
added
psychological stress, which can
culminate in a suicide attempt
(Saad, et.al, 2019)
Table II: Precipitating Factors
Precipitating
Presen
Factors
t (✔)
Justification
Rationale
OR
25
Absent
(–)
Stressful
Client has
Thwarted
belongingness
interpersonal
complicated romantic
fear
negative
relationships
relationships which
exacerbated suicidal ideation. An
caused him to attempt
individual’s meaning of life is
suicide. He cheated
partially mediated by the links of
on his long-time
thwarted belongingness, fear of
partner so they broke
negative evaluation, and suicidal
up, then 2 months
ideation.
later, he broke up with
attenuated the effect of fear of
the girl he cheated on
negative evaluation on suicidal
his long-time partner
ideation (Yu & He, 2023).
✔
of
and
evaluation
Coping
humor
with.
VI. Symptomatology
Symptoms
Present
Justification
Rationale
(✔) OR
Absent
(–)
Persistent Sad or
“Empty” mood
✔
The
client
that
he
confessed Sadness
is
a
normal
became human emotion but when
depressed in November a sad mood last for 2
2023
when
his weeks
or
ex-girlfriend would not interferes
more
with
that
normal,
get back together with everyday functioning, then
him which prompted him it
to
commit
can
be
suicide in depression
a
sign
of
(Fitzgerald,
26
December 2023.
Anhedonia
✔
2019).
The client stated that Anhedonia or losing any
due to his depression, sense of pleasure from
he eventually quit his any
job.
activities
they
previously enjoyed is a
particularly
distressing
symptom, and is a sign of
depression and compels
some
clients
attempt/commit
to
suicide.
(Videbeck,2020).
Hopelessness
✔
The client said that he Hopelessness is present
became hopeless when with
clients
with
his ex-girlfriend would depression because there
not get back together is no foreseeable end to
with him, and when he how
found
that
she
they
are
feeling
was (Berry, 2023).
dating again.
Worthlessness
✔
The client reports that Clients with depression
he
feels
worthless have
difficulty
fulfilling
because he felt he had roles and responsibilities.
not
right.
done
everything Due
to
this,
clients
become
even
more
convinced
of
their
worthlessness for being
unable
to
meet
life
responsibilities (Videbeck,
2020).
27
Irritable / Anger
✔
The
client
confessed If
a
client
have
that he was angry at depression,
anger
may
himself for cheating on show
such
as
his ex-girlfiend.
up
snapping at others over
trivial
things
or
being
unable to handle small
disappointment
reacting
without
negatively.
(Cuncic, 2022).
Presence of guilt
✔
The
client
confessed People with depression
that he felt immense struggle to more to have
guilt
when
fainted,
his
sister perspective in events and
he verbalized see
things
in
context,
“Feel man gud nako na leaving them to feel guilty
sala
to
nako
na and
responsible
even
nakuyapan akong ate, though it is not their fault
na stress na siya ug (Jacobson, 2023).
huna huna sa akoa”. In
addition, he said, “Sala
jud nako ni”, pertaining
to his failed relationships
and his situation that he
is currently in. Also that
he felt like a burden
because he was sorry
because his sister was
paying for the facility ,
as
he
verbalized,
“Maikog ko sa akong
28
mga igsoon kay sila nag
nagabayad diri”.
Recurrent thoughts
✔
The
client
had
two Depression increases the
of death, suicidal
suicidal attempts in the possibility of a suicide
ideation, suicidal
past. The first was on attempt. Depression can
attempt
December 2023 and the make people feel high
second attempt was on levels of emotional pain
January 2024.
and loss of hope, making
them unable to see other
ways to find relief than
ending
their
life
(Schimelpfening, 2023).
Increased
-
alcohol/drug use
Client
verbalized, Turning to alcohol and
“Nagainom
ko
pero drugs to escape problems
usahay lang”. “Wala sad is a pattern that may
ko nakasulay ug drugs”.
accompany
depression.
This is sometimes due to
the
fact
that
these
substances can relieve a
little
anxiety
(Soong,
2023).
Sleep Disturbance
✔
The client is reported to Sleep
disturbances are
have difficulty sleeping common, its either clients
and prolonged use of his cannot sleep or they feel
cellphone
at
bedtime exhausted
and
before admission to the unrefreshed
no
matter
facility.
time
they
how
much
spend in bed (Videbeck,
29
2020).
VII. Differential Diagnosis
Major depressive disorder, single episode, in partial remission
Major Depressive Disorder
PRESENT
Diagnostic Criteria
RATIONALE
JUSTIFICATION
(✔) OR
ABSENT (–)
A. Five (or more) of the following symptoms have been present during the same
2-week period and represent a change from previous functioning: at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical
condition.
1. Depressed mood
✔
The mood in a The client verbalizes,
most of the day,
major depressive “Sinabay ko talaga sila.
nearly every day,
episode is often Sayang
as indicated by
described by the habang yung isa bigay
either subjective
person
report (e.g., feels
depressed,
sad, yung isa ako naman tig
sad, empty,
hopeless,
bigay. Doon talaga nag
hopeless) or
discouraged,
or simula pagka depress
observation made
"down
the ko nung narealize ko na
by others (e.g.,
dumps". In some ginamit lang pala talaga
appears tearful).
cases,
(Note: In children
may be denied at ako sa mga promises
and adolescents,
first
can be irritable
subsequently be
mood.)
elicited
as nang
in
din
kasi
bigay sa akin,
sadness ako. Gi manipulate niya
but
by
may niya”.
an In addition, the client
30
interview.
In also verbalized, “Dili ko
some individuals gusto maka-isip ug mga
who complain of dautan nga butang” as
feeling
"blah," he shares the reason
having
no why he was willing to go
feelings,
or the
feeling
facility.
This
anxious, indicates that the client
the presence of a realizes his condition is
depressed mood still present and this
can be inferred sought interventions.
from the person's
facial expression
and
demeanor.
Some individuals
emphasize
somatic
complaints rather
than
reporting
feelings
of
sadness.
Many
individuals report
or
exhibit
increased
irritability
(Association,
2021).
2. Markedly
–
Loss of interest or The client verbalized,
diminished interest
pleasure is nearly “Gusto ko naay
or pleasure in all, or
always
present, kaistorya” which is
31
almost all, activities
at least to some congruent with his
most of the day,
degree.
nearly every day
Individuals
(as indicated by
report feeling less independent in his
either subjective
interested
account or
hobbies,
observation).
caring anymore," reminders. In addition,
friendly interaction with
may others. He is also
in ADLs and does not
"not require constant
or not feeling any during games and
enjoyment
in activities, he is very
activities
that participative and it is
were
previously evident that
considered
achievements from
pleasurable
these causes him
(Association,
pleasures.
2021).
3. Significant weight
–
Clients
with The client’s weight from
loss when not
depression often February 15 to March 7,
dieting or weight
experience
2024 has shown no
gain (e.g., a
pronounced
significant change.
change of more
weight
than 5% of body
because of a lack
weight in a month),
of
or decrease or
disinterest
increase in appetite
eating (Videbeck,
nearly every day.
2022).
loss
appetite
or
in
(Note: In children,
consider failure to
In
make expected
depression,
weight gain.)
changes
major
from
32
baseline
a
include
decrease
increase
or
in
appetite with or
without significant
weight
loss
or
gain. Weight loss
occurs when the
person
is
not
dieting.
Older
adults
with
moderate-to-seve
re
depression
need
to
be
assessed
for
dehydration
as
well
as
weight
changes (Boyd &
Luebbert, 2019).
4. Insomnia or
The
most The client is reported to
hypersomnia nearly
common
sleep have difficulty sleeping
every day.
disturbance
✔
associated
and prolonged used of
with his cellphone at
major depression bedtime before
is
insomnia, admission to the facility.
which is broken
into
three During his admission in
categories: initial the facility, he reported
insomnia
to have around 8 hours
33
(difficulty
falling of sleep every night.
asleep),
middle
insomnia (waking
up
during
the
night and having
difficulty returning
to
sleep),
and
terminal insomnia
(waking too early
and being unable
to
return
to
sleep).
Less
frequently,
the
sleep disturbance
is
hypersomnia
(i.e.,
prolonged
sleep episodes at
night or increased
daytime
sleep).
The
individual
with
either
insomnia
or
hypersomnia
complains of not
feeling rested
on
awakening
(Boyd
&
Luebbert, 2019).
5. Psychomotor
✔
Psychomotor
The client always
34
agitation or
changes
include shakes his legs when
retardation nearly
agitation
every day
the inability to sit
(observable by
still,
others, not merely
handwringing; or
subjective feelings
pulling or rubbing
of restlessness or
of
being slowed
clothing, or other
down).
objects)
(e.g., seated.
pacing,
the
skin,
or
retardation (e.g.,
slowed
speech,
thinking,
and
body movements;
increased pauses
before answering;
speech
that
decreased
is
in
volume,
inflection,
amount,
or
variety of content,
or
muteness).
The psychomotor
agitation
or
retardation
must
be
severe
enough
to
be
observable
by
others
not
and
represent merely
35
subjective
feelings
(Association,
2021).
6. Fatigue or loss of
–
Fatigue
The client has been
energy nearly every
associated
with observed to have no
day.
depression is a signs of fatigue or loss
subjective
of energy nearly every
experience
of day. He has persistently
feeling
tired been very participative
regardless of how and active in every
much
sleep
or therapy conducted.
physical activity a
person has had.
Even the smallest
tasks
require
substantial effort
(Boyd
&
Luebbert, 2019).
7. Feelings of
✔
The
sense
of The client verbalized,
worthlessness or
worthlessness or “Buanga nako oy.
excessive or
guilt
associated Ngano man nako tu
inappropriate guilt
with
a
(which may be
depressive
delusional) nearly
episode
every day (not
include unrealistic gyud akong pag mahay.
merely
negative
self-reproach or
evaluations
of nako tung tarong na
guilt about being
one's
or babae sa someone na
major nabuhat?”, and “Didto
nag start gyud akong
may depression. Kay grabe
worth
Kay kato lagi gi ilisdan
36
sick).
guilty
gibinuangan ra ko”
preoccupations or indicating his feelings of
ruminations over guilt.
minor
past
failings.
Such
individuals
often
misinterpret
neutral or trivial
day-to-day events
as
evidence
of
personal defects
and
have
an
exaggerated
sense
of
responsibility
for
untoward events.
The
sense
of
worthlessness or
guilt may be of
delusional
proportions (e.g.,
an individual who
is convinced that
he
or
she
is
personally
responsible
for
world
poverty).
Blaming
oneself
for being sick and
for failing to meet
37
occupational
or
intepersonal
responsibilities as
a result of the
depression
is
very
common
and,
unless
delusional, is not
considered
sufficient to meet
this
criterion
(Association,
2021).
8. Diminished ability
✔
Many individuals When asked if it was his
to think or
report
impaired decision to come to the
concentrate, or
ability
to
indecisiveness,
concentrate,
nearly every day
make even minor first gisuggest siya sa
(either by
decisions.
subjective account
may
or as observed by
easily
others).
or
think, facility the client
or answered, “Oo, ay at
They akin ng kapatid ko kasi
appear yung nga parang
distracted nawawala na talaga ako
complain
memory
of sa sarili ko. Kasi
ginagawa ko lahat para
difficulties. Those bumalik sa akin yung ex
engaged
in ko. Like kahit umuulan
cognitively
sa gabi pumupunta
demanding
talaga ako sa kanila
pursuits are often para makipag usap.
unable
to Nag suicide para
38
function.
When kaawan niya”. This
the
major verbalization indicates
depressive
the lack of ability to
episode
is think by the client
successfully
during his previous
treated,
the depressive episodes.
memory
problems
often
fully
abate
(Association,
2021).
9. Recurrent thoughts
Thoughts
of The client had two
of death (not just
death,
suicidal suicidal attempts in the
fear of dying),
ideation,
recurrent suicidal
suicide
attempts December 2023 and the
ideation without a
are
common. second attempt was on
specific plan, or a
They may range January 2024.
suicide attempt or a
from
specific plan for
wish
committing suicide.
✔
or past. The first was on
a passive
not
to
awaken
in
the
morning
or
a
belief that others
would be better
off if the individual
were
dead,
transient
to
but
recurrent
thoughts
of
committing
39
suicide,
to
a
specific
suicide
plan.
More
severely suicidal
individuals
may
have
put
their
affairs
in
order
(e.g.,
updated
wills,
settled
debts),
acquired
needed materials
(e.g., a rope or a
gun), and chosen
a
location
and
time
to
accomplish
the
suicide.
Motivations
for
suicide
may
include a desire
to give up in the
face of perceived
insurmountable
obstacles,
an
intense wish to
end
what
is
perceived as an
unending
and
excruciatingly
painful emotional
40
state, an inability
to
foresee
any
enjoyment in life,
or the wish to not
be a burden to
others.
The
resolution of such
thinking may be a
more meaningful
measure
of
diminished
suicide risk than
denial of further
plans for suicide
(Association,
2021).
B.
The
cause
symptoms
clinically
✔
Depression
can The client was told by
cause great strain his family and
significant distress or
in
impairment in social,
Family members psychiatric help,
occupational, or other
who have limited indicating the significant
important
knowledge about distress in the client’s
functioning.
areas
of
relationships. co-workers to seek
depression
believe
may social and occupational
clients functioning.
should “just get
on with it.” Clients
often avoid family
and
social
relationships
41
because they feel
overwhelmed,
experience
no
pleasure
from
interactions, and
feel unworthy. As
clients
withdraw
from
relationships, the
strain increases
C. The episode is not
attributable
to
✔
the
The
observed The client has no
episode
or diagnosed medical
physiological effects of
symptoms are not disease.
a
directly
substance
another
or
to
medical
caused
by the influence
condition.
of
a substance
(such as drugs,
medications,
or
treatments)
or
any
other
underlying
medical condition
(Millard, 2022).
D. The occurrence of
✔
These
disorders The client has no signs
the major depressive
involve
episode is not better
psychotic
hallucinations which
explained
symptoms
indicate no psychotic
schizoaffective disorder,
(hallucinations,
disorders.
schizophrenia,
delusions,
by
both of delusions or
42
schizophreniform
disorganized
disorder,
delusional
thinking)
disorder,
or
other
depressive
and
symptoms. When
specified
and
unspecified
someone
with
schizophrenia spectrum
MDD
has
and
psychotic
other
psychotic
disorders.
features,
it's
important
to
figure out if these
symptoms
are
due to depression
or
a
separate
psychotic
disorder.
helps
This
in
giving
the
right
treatment
and
understanding
the
person's
condition (Riggs,
2021).
E.
There has never
Manic
episodes The client has no
been a manic episode
are
typically instances of manic/
or
absent in major hypomanic episodes
a
episode.
hypomanic
✔
depressive
disorder
(MDD)
because MDD is
characterized
43
primarily
by
periods
of
depression, while
bipolar
disorder
involves
cycling
between
depressive
episodes
and
manic
or
hypomanic
episodes.
The
absence of manic
episodes is one
of
the
key
diagnostic criteria
that
helps
differentiate
between
these
two
mood
disorders
(Professional,
2021).
Severity/course specifier
Single episode
✔
For an episode to His first depressive
be
considered episode was on
recurrent,
must
be
there December 2023 and the
an second was on January
interval of at least 2024. The interval is
Recurrent episode
2
consecutive less than 2 months.
44
months between
separate
episodes in which
criteria
are
not
met for a major
depressive
episode.
In partial remission
✔
Symptoms of the The symptom that is
immediately
currently present in the
previous
major client is criteria number
depressive
7 - Feelings of
episode
worthlessness or
are present, but excessive or
full criteria are not inappropriate guilt
met, or there is a (which may be
period
lasting delusional) nearly every
less
than
months
any
2 day (not merely
without self-reproach or guilt
significant about being sick).
symptoms
of a
major depressive
episode following
the end of such
an episode.
In full remission
–
During the past 2 The client has been
months,
no discharged less than
significant
signs two months from his
or symptoms of recent major depressive
the
episode.
45
disturbance were
present.
VIII. Medical Management
A. Therapies
TYPE OF
PURPOSE
EFFECTS ON PATIENT
THERAPY
Recreational
Therapy
Recreational
known
therapy,
as
also The client actively engaged and
therapeutic had fun during the activities. He
recreation, is a systematic was also participative in every
process
that
recreation
utilizes recreational
and
activity
that the
other student nurses provided. The
activity-based interventions to student nurses noticed that he
address the assessed needs was
very
of individuals with illnesses always
attentive
and
he
listened well to the
and/or disabling conditions as instructions
of
the
student
a means to psychological and nurses as if he was asked if he
physical
health.
By understood the instruction, he
incorporating
everyday always
hobbies
activities, man ko maam” and he was able
and
recreational
therapy to
addresses
the
emotional,
cognitive,
says “Oh nakasabot
follow
the
rules
and
physical, regulations of the game. He
and even won several prizes as he
social needs of people with aces some activities that were
various
health
(Tint, 2020).
challenges provided. He always cheers his
team, and whenever his team
wins, he claps for their victory
and smiles. And when their
team loses, he just sits down.
46
Art Therapy
Art therapy can help people The art therapy that the student
express
themselves
more nurses provided was origami.
freely, improve their mental Even though the client slightly
health,
and
interpersonal
improve had
difficulty
following
the
relationships. instructions given by the student
The basis of art therapy is nurses,
he could finish his
established on the idea that output
as
he
asked
for
people can recover and feel assistance whenever he had
better via artistic expression difficulty
(Shukla et al., n.d.)
understanding.
folded
the
correspondingly
what
the
He
paper
according
student
to
nurses
instructed. As per observation,
the
client
works finely and
neatly because he wants the
paper to be folded and aligned.
He also helped his friends finish
their origami.
Occupational
Therapy
The
goal
of
occupational Occupational
therapy
was
therapy is to improve the provided to the client with a
skills
needed
to
live
as focus on gardening, specifically
independently
as possible. miniature
Occupational
therapy
gardening.
The
can residents are encouraged to
help you to cope with a (new) showcase their creativity and
mental or physical limitation are given freedom in what they
and
manage
everyday
life.
better
in are doing. Mr. R.D.A seems to
These enjoy
the
activities,
being
interventions aim to enhance cooperative and participative.
clients’
functional He
even
leads
his
group
47
independence,
coping
skills,
meaningful
improve following
and
the
step-by-step
and
expressing
foster procedure,
engagement in excitement while making their
daily tasks (Jarmusz, 2020).
miniature garden. The client
demonstrated abilities to follow
instructions
correctly
effectively
and
and
used
the
materials provided to enhance
creativity
and
craft
unique
products.
Music Therapy
Music
therapy
improves The client actively engaged and
mental
wellness,
reducing had
fun
during
the
music
stress, and alleviating pain, therapy session. The student
making it a promising avenue nurses noticed he seemed to be
for
enhancing
well-being.
overall having fun while singing in front
Additionally, of the other clients. He also
music therapy has shown engaged
in
various
games
promise in providing a safe during
the
game
therapy
and supportive environment session,
even
for healing trauma, building games.
The
winning
client
the
eagerly
resilience, and enhancing the performs whenever requested
functioning
of
individuals to sing for the residents and
dealing with depression. Its student nurses.
effects on mood, self-esteem,
and
overall
well-being
underscore its potential as a
powerful tool for promoting
mental health (Kalimi, Weng,
& Wang, 2021).
48
Exercise
Physical
activity
improves During exercise, the client was
mood and reduces symptoms observed
to be participative
of anxiety and depression. It when doing an exercise. He
also helps in managing stress shows slight difficulty in raising
and enhancing self-esteem. his left arm, as it was dislocated
Additionally, exercise can aid due to an accident. He was also
in
cognitive
including
function, able to show smiles when doing
memory
and an exercise.
attention, which are often
impaired
in
psychiatric
disorders. Regular exercise
can
also
improve
sleep
patterns and energy levels,
leading
to
an
overall
improvement in the quality of
life for psychiatric patients
(Hu, et. al., 2020).
B. Drug Study
Generic Name
Escitalopram
49
Brand Name
Lexapro
Classification
Therapeutic: antidepressants
Pharmacologic: selective serotonin reuptake inhibitors (SSRIs)
Mechanism
of Selectively inhibits the reuptake of serotonin in the CNS.
Action
Therapeutic Effects: Antidepressant action.
Pharmacokinetics
Absorption: 80% absorbed following oral administration.
Distribution: Enters breast milk.
Metabolism and Excretion: Mostly metabolized by the liver
(primarily CYP3A4 and CYP2C19 isoenzymes); 7% excreted
unchanged by kidneys.
Half-life: ↑ in elderly and patients with hepatic impairment.
TIME/ACTION PROFILE (antidepressant effect)
Route
Onset
Peak
Duration
PO
Within
1- unknown
unknown
4wks
Route
and PO (Adult) 10mg ½ tab OD, after lunch for 4 days, then 1 tab
Dosage
OD thereafter
Indication
Major depressive disorder. Generalized anxiety disorder (GAD).
Unlabeled Use: Panic disorder. Obsessive-compulsive disorder
(OCD). Post-traumatic stress disorder (PTSD). Social anxiety
disorder (social phobia). Premenstrual dysphoric disorder
(PMDD).
Contraindication
Hypersensitivity; Concurrent pimozide; Concurrent use of MAO
inhibitors or MAO- like drugs (linezolid or methylene blue);
50
Concurrent use of citalopram; Angle-closure glaucoma.
Use Cautiously in: Personal or family history of bipolar
disorder, mania, or hypomania (may activate mania/hypomania);
History of seizures; Patients at risk for suicide; Hepatic
impairment (dose ↓ recommended); Severe renal impairment;
Side Effects
Derm: sweating.
Endo: syndrome on inappropriate secretion of antidiuretic
hormone (SIADH).
F and E: hyponatremia.
GI: diarrhea, nausea, abdominal pain, constipation, dry mouth,
indigestion.
GU: ↓ libido, delayed/absent orgasm, ejaculatory delay/failure,
erectile dysfunction.
Metab: ↑ appetite.
Neuro: insomnia, dizziness, drowsiness, fatigue.
Adverse Effects
Neuro: NEUROLEPTIC MALIGNANT SYNDROME SUICIDAL
THOUGHTS
Misc: SEROTONIN SYNDROME.
Drug Interaction
Increased risk of bleeding with oral anticoagulants (e.g.
warfarin),
antiplatelet
agents
(e.g.
ticlopidine,
aspirin,
dipyridamole), atypical antipsychotics, and NSAIDs.
May increase the risk of serotonin syndrome with other
serotonergic agents (e.g. TCA, triptans, opioids, tryptophan,
lithium, buspirone).
May
increase
the
risk
of
seizures
with
other
antidepressants (e.g. other SSRIs), neuroleptics (e.g.
thioxanthenes), mefloquine, tramadol, and bupropion.
Increased serum concentration with CYP2C19 inhibitors (e.g.
51
omeprazole, fluconazole, fluvoxamine) or cimetidine.
May increase the plasma concentrations of CYP2D6 substrates
(e.g. metoprolol, desipramine).
Potentially Fatal: Enhanced serotonergic effect with MAOIs,
including linezolid and IV methylthioninium chloride, which may
result in serotonin syndrome. May increase the risk of QT
interval prolongation with pimozide and other drugs prolonging
QT
interval
(e.g.
phenothiazines,
class
IA
haloperidol,
and
III
antiarrhythmics,
astemizole,
mizolastine,
halofantrine, sparfloxacin, moxifloxacin).
Nursing
Before
Responsibilities
● Review the client’s medical history and current medications.
R: To determine any possible interactions or contraindications
that can compromise escitalopram's effectiveness and
safety.
● Check for the client's allergies.
R: To prevent allergic reactions and promote client safety, as
certain people may be allergic to Escitalopram or its
components.
● Monitor vital signs.
R: Monitoring vital signs helps in monitoring the client’s
response to the medication and identifying any deviations
from normal values.
● Assess appearance, behavior, speech pattern, level of
interest, and mood.
R: Assessing appearance, behavior, speech pattern, level of
interest, and mood enables a comprehensive understanding
of
individuals'
facilitating
well-being,
effective
emotions,
communication,
and
intentions,
empathy,
and
52
interpersonal interactions.
● Check the medication expiry date and integrity of the
packaging.
R: Using expired medication or medication with compromised
packaging can affect its efficacy and safety. Ensuring the
medication's
integrity
helps prevent potential adverse
outcomes and ensures the patient receives medication that
meets quality standards.
During
● Read and ensure the accurate dosage of the medication and
verify the client’s understanding of its purposes.
R: Emphasizing the significance of compliance is crucial in order
to maximize the effectiveness of the medication.
● Supervise suicidal-risk pt closely during early therapy (as
depression lessens, energy level improves, suicide potential
increases.
R: Early therapy for suicidal-risk individuals must be closely
monitored because reductions in depressive symptoms may
paradoxically increase the risk of suicide, requiring close
supervision and care.
● Monitor for side effects and adverse reactions.
R: In order to ensure patient safety, ongoing assessment
throughout administration assists in identifying and quickly
addressing any immediate adverse effects.
After
● Document each step of medication administration.
R: Maintaining accurate and timely documentation ensures a
complete record of medicine delivery, which promotes
continuity of care and communication among healthcare
practitioners.
53
● Evaluate for therapeutic effects.
R: To evaluate its effectiveness and monitor for any emerging
concerns,
particularly
focusing
on
the
psychological
well-being of patients with mood disorders.
Generic Name
Ascorbic Acid
Brand Name
RiteMED
Classification
Antioxidant
Mechanism
Action
of Ascorbic acid, is a water-soluble vitamin that acts as a cofactor
and as an antioxidant. It is essential for connective tissue
synthesis, and Fe absorption and storage. Additionally, it is an
electron donor used for collagen hydroxylation, carnitine
biosynthesis, and hormone or amino acid synthesis.
Pharmacokinetics
Absorption: Well absorbed from the gastrointestinal tract.
Bioavailability: Approx 100% (Oral: for doses up to 200 mg).
Distribution: Crosses the placenta, and enters breast milk.
Widely distributed in the body tissues; distributed to the pituitary
54
and adrenal glands, eye tissues and humours, leucocytes, and
brain; low concentration in the plasma and saliva.
Metabolism:
Reversibly
metabolized
via
oxidation
into
dehydroascorbic acid (active), partly metabolized to inactive
compounds including ascorbic-acid-2-sulfate and oxalic acid.
Excretion: Via urine (with high concentrations); minimal
excretion in subthreshold levels (up to 80 mg/day).
Half-Life: 10hrs
TIME/ACTION PROFILE
Route
Onset
PO
2 days to 3 30 mins
1-2 weeks up
weeks
to 3 months
(reversal
Peak
Duration
of
scurvy
symptoms).
Route
and PO (Adult) 1 tab OD
Dosage
Indication
Used to treat vitamin C deficiency, scurvy, delayed wound and
bone healing, urine acidification, and in general as an
antioxidant. It has also been suggested to be an effective
antiviral agent.
Contraindication
Ascorbic Acid/Vitamin C is contraindicated in blood disorders
like thalassemia, G6PD deficiency, sickle cell disease and
hemochromatosis. Avoid taking supplements immediately before
or following angioplasty.
55
Cautiously used in oxalate nephropathy or nephrolithiasis as
acidification by ascorbic acid increases the chances of
precipitation of cysteine, urate, and oxalate stones.
Patient
with
diabetes
mellitus,
G6PD
deficiency,
haemochromatosis, history of renal stones (e.g. oxalate kidney
stones),
predisposition
to
recurrent
renal
calculi. Renal
impairment. Children (<2 years of age) and elderly. Pregnancy
and lactation.
Side Effects
Common side effects: Diarrhea, Nausea, Fatigue
Adverse Effects
NS: Dizziness, headache
CV: Flushing
HEMAT: acute hemolytic anemia
Drug Interaction
Increased absorption of Fe. Increased excretion of Fe with
desferrioxamine.
Induced tissue desaturation with aspirin, nicotine, Fe, phenytoin,
tetracycline, estrogen in oral contraceptives, some appetite
suppressants, and anticonvulsants.
May increase the absorption of Al-containing antacids.
May diminish the activity of anticoagulants (e.g. warfarin).
May increase the serum concentration of estrogen derivatives.
May decrease the serum concentration of amphetamines.
Nursing
Before:
Responsibilities
● Monitor vital signs.
R: Regular vital sign monitoring helps identify early signs of
medication-related complications, such as allergic reactions
or adverse cardiovascular effects, allowing for timely
intervention and treatment.
56
● Examine the client's allergies and reactions.
R: To prevent adverse reactions, some individuals may have
allergies or sensitivities to vitamin C or its components.
● Monitor fluid intake and output of the client.
R: Monitoring fluid intake and output helps ensure adequate
hydration, which is essential for the proper metabolism and
elimination of Vitamin C. This responsibility helps prevent
dehydration and supports optimal physiological function.
● Monitor for signs and symptoms of vitamin C deficiency or
toxicity.
R:
Regular
monitoring
helps
ensure
that
Vitamin
C
supplementation provides the intended therapeutic effects
without causing harm or adverse reactions, promoting
optimal patient outcomes.
After:
● Document the drug's administration.
R: Accurate and timely documenting of vitamin C dosage data is
required to enable continuity of care and communication.
● Assess for client response and adverse effects.
R: Post-administration assessment allows for evaluating the
client's response to vitamin C and monitoring any delayed or
long-term adverse effects.
57
IX. Nursing Management
A. Nursing Theory
Interpersonal Relations Theory by Hildegard Peplau
Hildegard Peplau, a pioneering nurse theorist, is most known for establishing the
Interpersonal Relations Theory, which changed the course of nursing. Peplau, who was
born in 1909, is credited with creating the groundwork for the development of nursing as
a profession with an emphasis on the interpersonal interactions between nurses and
patients. Her theory of interpersonal relations places a strong emphasis on the value of
understanding, empathy, and communication in the nurse-patient relationship. Peplau
believed that nurses need to take an active role in their patients' care, educating them
about their health issues and incorporating them in the decision-making process.
The theory of interpersonal interactions by Hildegard Peplau can be used to
direct nursing interventions for Mr. R.D.A.'s depression and suicidal thoughts. Nurses
can carefully evaluate Mr. R.D.A's mental health, learn about his past, and understand
his thoughts on depression and suicidal ideation starting with the orientation phase. As
the identification phase progresses, the nurse uses this opportunity to expertly identify
and define the precise problems that Mr. R.D.A. is dealing with while creating a secure
environment in which he may express his feelings and worries.
As we progress through the exploitation phase, collaboration becomes key, as
the nurse and Mr. R.D.A. work together to develop a personalized care plan addressing
his depressive symptoms and suicidal thoughts. This phase represents the nurse's
proactive approach to creating a therapeutic alliance and actively supporting the
58
patient's mental health objectives. Additionally, the resolution phase gives the nurse the
chance to assist Mr. R.D.A. in finding useful coping skills, support networks, and
approaches to reduce the likelihood of recurrent depression episodes and suicidal
thoughts by facilitating a reflective appraisal of the progress achieved. Throughout this
process, the nurse has been implementing Peplau's theory, which includes effective
communication, empathic listening, and educational support, to build rapport and trust
and create a supportive atmosphere for Mr. R.D.A’s general well-being.
The Environmental Theory by Florence Nightingale
Florence Nightingale was born in 1820 in Italy to a wealthy British family. She
was raised in the Anglican faith, and believed the God called her to be a nurse. This call
came to her in February 1837 while at Embley Park. Florence Nightingale is the most
recognized name in the field of nursing. Her work was instrumental for developing
modern nursing practice, and from her first shift, she worked to ensure patients in her
care had what they needed to get healthy. Her Environmental Theory changed the face
of nursing to create sanitary conditions for patients to get care.
The Environmental Theory underscores the pivotal role of the environment in
promoting health and well-being, a principle relevant even in contemporary psychiatric
nursing practice, particularly when caring for clients with Major Depressive Disorder
(MDD). Nurses can implement Nightingale's principles by ensuring a therapeutic
59
environment that is clean, safe, and conducive to healing, thereby fostering a sense of
calm and comfort for clients. Moreover, nurses can advocate for policies and resources
that support mental health awareness and access to care while providing education to
empower clients in managing their condition. By adopting a holistic approach that
addresses the physical, emotional, social, and spiritual dimensions of the individual,
nurses can effectively apply Nightingale's theory to enhance the quality of care provided
to clients with MDD, ultimately promoting their overall well-being and recovery.
The focus of nursing in this model is to alter the patient’s environment in order to
affect change in his or her health. The environmental factors that affect health, as
identified in the theory, are: fresh air, pure water, sufficient food supplies, efficient
drainage, cleanliness of the patient and environment, and light (particularly direct
sunlight). If any of these areas is lacking, the patient may experience diminished health.
Nursing Need Theory Virginia Henderson
Virginia Henderson was born in 1897 in Kansas City, Missouri, as the fifth of eight
children. Her parents returned to Virginia and raised her there. Following her early
schooling, she followed her passion for nursing, graduating from the Army School of
Nursing in 1921. Some years later, in 1932, she received her Bachelor's and Master's
degrees from Teachers College at Columbia University, demonstrating her dedication to
lifelong study. Virginia Henderson established the Nursing Need Theory based on her
clinical and educational experiences. Henderson's purpose was not to construct a
nursing theory, but to describe the particular emphasis of nursing practice. The notion
60
emphasizes the significance of improving the patient's independence so that
development following hospitalization is not slowed. Her emphasis on fundamental
human needs as the major focus of nursing practice has resulted in more theory
development about the patient's requirements and how nursing might help satisfy them.
Virginia Henderson's Nursing Need Theory is extremely pertinent to the case of
R.D.A, a depressed client with a history of suicide attempts who is now receiving
psychiatric treatment. Henderson's philosophy highlights the idea that nursing's
fundamental function is to help people satisfy their basic requirements and gain
independence in doing important tasks. In R.D.A's instance, the idea applies since his
sadness may impair his capacity to meet basic requirements, both physically and
emotionally. Nurses, informed by Henderson's theory, can identify R.D.A's individual
requirements, such as emotional support, safety, and self-esteem, and work with him to
build techniques that encourage independence and well-being. This may include
encouraging therapeutic conversation, creating a secure and supportive atmosphere
within the psychiatric hospital, and aiding R.D.A in recovering control of his life.
Using Henderson's Nursing Need Theory, nurses may get insight into R.D.A’'s
specific needs by completing a complete assessment of his physical and emotional
needs. The approach guides nurses in delivering holistic treatment, addressing both his
current mental health difficulties and the underlying causes of his depression. Nurses
should prioritize developing a therapeutic relationship with R.D.A., encouraging open
communication, and including him in decision-making about his treatment plan. The
emphasis on aiding persons in obtaining independence is consistent with allowing
R.D.A to engage in his rehabilitation path actively. By concentrating on Henderson's
idea, nurses may help R.D.A's total well-being by meeting his basic needs and
promoting a route to mental health rehabilitation.
61
B. Nursing Care Plans
Name of the Patient: R.D.A.
Age & Sex: 27 years old, Male
Ward & Bed no.:
Chief complaint:
Attending Diagnosis:
Diagnosis:
DATE
AND
TIME
CUES
F
Objective
N
E
E
D
H
NURSING
DIAGNOSIS
PATIENT
OUTCOME
NURSING INTERVENTIONS
Risk for suicidal
Within the 6 weeks
Make a no-suicide contract with
E
cues:
E
behavior as
of nursing
the client.
B
● History of
A
evidenced by
intervention, the
Rationale:
R
prior
L
history of suicidal
client will not injure
often arise from a sense of
U
suicide
T
attempts.
himself.
hopelessness and lack of control.
A
attempts
H
R
(1st
Y
attempt
15,
2024
Creating
IMPLE
MENT
A
TION
March 7, 2024
1
Suicidal
a
safety
EVALUATION
10:00 AM
thoughts
GOAL MET
contract
After 6 weeks of
Rationale:
empowers the client by giving
nursing
P
A past history of
them a proactive role in managing
intervention, the
was in
E
suicide attempts
their safety. It allows them to
client didn’t harm
December
R
increases the
identify
himself.
and 2nd
C
likelihood of
supports they can turn to in times
9:00
attempt
E
further attempts by
of crisis.
AM
was in
P
8 fold. This is due
January).
T
to the experience
Remove any potential weapons or
I
of having gone
any objects that may inflict harm
O
through the
Rationale: Provide safety and
● Loss of
important
coping strategies and
2
Prepared by:
Lee Robin G.
62
relationshi
p
● The client
N
process of
remove items that may be used
contemplating and
impulsively during the actively
then attempting
suicidal phase.
is
suicide. This
observed
‘rehearsal’
Monitor for signs that the client
to be
consolidates their
has a plan to commit suicide
active and
thoughts at some
again.
energetic.
level, such that
Rationale: Identifying signs of a
them similar
suicide plan early on provides an
is
precipitants
opportunity for intervention before
diagnosed
present once
the
with
again, they are
escalates
depressio
more likely to
recognizing the warning signs,
n
reconsider suicide
mental health professionals can
● The client
as an option
implement targeted interventions
is taking
(Malhi et. al.,
to address the underlying issues
an
2019).
and mitigate the risk of self-harm.
● The client
Cortado, St. N
Rhiana Shakhia
3
M. Avendaño,
St. N
client's
to
suicidal
an
ideation
attempt.
By
antidepre
Put on either suicide precaution
ssant
or suicide observation, depending
drug
on the level of suicide potential.
(Escitalop
R: Protection and preservation of
ram).
the patient’s life at all cost during
Angelie Genelsa,
St. N
63
a crisis is part of the medical and
nursing staff's responsibility.
Identify situations or triggers and
ineffective coping behaviors that
4
may result in suicidal thoughts or
actions:
Rationale: To determine the most
appropriate
develop
interventions
and
more positive coping
techniques
Encourage the client to verbalize
thoughts and feelings and find
5
alternative ways to cope with
these feelings.
Rationale: Helps the client gain
control over actions and life in
general.
During
the
crisis
period,
healthcare workers will continue
6
64
to emphasize these four points:
a. The crisis is temporary
b. Unbearable pain can be
survived
c. Help is available
d. You are not alone
Rationale: Because of “tunnel
vision”,
clients
do
not
have
perspective on their lives. These
statements give perspective to
the client and help offer hope for
the future.
Keep
accurate
and
thorough
records of the client’s behavior
7
(verbal and physical) and all
nursing/physician actions
Rationale: If client checks and
attention to the client’s needs or
requests are not documented,
they do not exist in a court of law.
65
Educate
the
client
on
Escitalopram and the importance
8
of compliance to the medicine.
Rationale: Educating the client
about Escitalopram allows them
to develop realistic expectations
regarding
the
outcomes
timeline
of
Understanding
and
treatment.
that
antidepressants often take time to
exert their full effects can help
manage expectations and reduce
frustration
if
immediate
improvements are not observed.
66
DATE
AND
TIME
CUES
Febr
Subjective
uary
cues:
N
E
E
D
Ineffective
PATIENT
OUTCOME
E related
nursing
to intervention,
Client
A inadequate
verbalized
L knowledge
client
of demonstrate
2:00
“Wala ko naga T treatment regimen compliance
PM
comply
H as evidenced by medication
pirmente
NURSING INTERVENTIONS
health Within 6 weeks of Explain
H self-management
22,
2024
NURSING
DIAGNOSIS
verbalization
of regimen.
to
the
client
the
IMPLE
MENT
A
TION
EVALUATION
1
March 7, 2024
importance of daily compliance of
the his
anti-depressant
10:00 AM
medicine
will which is the Escitalopram.
R:
Following
the
GOAL MET
prescribed
to treatment plan, including taking
After 6 weeks of
Escitalopram daily, gives the best
nursing
chance for a positive therapeutic
intervention, the
client
sakong
M medication
outcome
and
improvement in
tambal”
A non-compliance by
overall well-being.
demonstrate
N the client.
“Naga
rako
will
adherence to the
take A
Incorporate the client in their
tambal G Rationale:
2
prescribed
health goals.
treatment
kung feel nako E Patients who fail to
R: Listening to client’s objectives,
regimen,
as
mutukar akong M adhere
preferences,
evidenced
by
depression”
Objective
Cues:
to
their
and
concerns
is
E prescribed
crucial
for
building
trust,
N treatment regimen
personalizing
treatment
and
T are
empowering individuals to take
at
risk
experiencing
of
charge of their health.
consistently
taking prescribed
medications daily
and verbalization
67
-
-
by
client,
“Magtake
nako
worsened
with
outcomes,
Make
depression
increased
regimen simpler.
ug tambal adlaw
last 2023
symptom severity,
R: Simplifying treatment plans
adlaw
Prescribed
and complications
makes it easier for clients to
nako ma depress
medication
related
follow through.
usab
have
underlying
not
health
the
Diagnosed
to
their
the
client’s
treatment
condition.
Help the client see a trend when
followed
Non-adherence to
making positive changes.
regularly:
medication
R:
Escitalopra
regimens can lead
journaling, charts, or mobile apps,
m
to
can significantly motivate clients
1tab OD
para dili
og
maka
perwisyo sakong
been
10mg
3
treatment
failure,
Visual
cues,
such
4
as
Prepared by:
to track their health progress,
exacerbation
of
enhancing their engagement and
symptoms, and a
motivation on their health journey.
ate".
Kyra Gumban,
STN.
higher likelihood of
hospitalization
emergency
visits
or
Use the acronym OARS to help
room
explore the client’s thoughts and
(Ackley
al., 2021).
et
5
feelings.
questions
Kessiah Mae G.
(Encourages the patient to think
Dongiapon, St.N
O
–
Open-ended
deeper)
68
A
–
Affirmations
patient’s
(Build
the
confidence and their
ability to succeed)
R – Reflective listening (Show the
patient you are listening and give
them a chance to correct or
Alexandrouva
Marian H.
Buenaflor, St. N
elaborate)
S – Summarize (Tie up the plan,
goals, and next steps)
R:
Motivational
interviewing
techniques empower clients to
explore their intrinsic motivations
for change.
69
DATE
AND
TIME
CUES
Subjective
N
E
E
D
S
F
Risk
E
cues:
E
situational low self nursing intervention, R: Checking the mental state is
B
“Nahadlok
L
esteem related to the client will be able crucial as some patients could
R
man gud ko
F
feelings of shame to
U
sa isulti niya
-
and guilt.
A
(last partner
P
R
PTA),
sa
E
Rationale:
Y
kanang mga
R
Situational
ipanabi niya
C
self-esteem refers
Have the patient describe how
sa mall.”
E
to
they view themselves as well as
able
to
P
negative
how they think others view them.
determine
2
ko
T
perception of self,
R:
goals:
2
sa akong ate
I
owing to situation
misconceptions. The nurse may
(1) going back
0
kay siya ang
O
changes such as
be able to collaborate with the
to work 1 or 2
2
nagagastos
N
loss of body parts
client
weeks
4
sa
tanan
/
or
misconceptions.
sa
S
abilities.
@
akoa. Dili ko
E
self-esteem
3
gusto
L
often a result of
2
2
“Na-ikog
tungod
NURSING
DIAGNOSIS
PATIENT
OUTCOME
NURSING INTERVENTIONS
IMPLE EVALUATION
MENT
A
TION
1
March 7, 2024
for Within 6 weeks of Monitor the mental status.
having
determine
personal
goals
@10:00 am
2 be experiencing extreme stress
to and
suicidal
improve
reaction
self-esteem.
esteem.
thoughts
to
low
as
GOAL MET
a
situational
After 6 weeks
of
low
a
functional
intervention,
Discuss
on
and
how
to
2
confront
redirect
the client was
after
discharge, and
Low
is
nursing
(2) planned to
Identify the patient’s strengths
and past coping behaviors.
3
take a trip with
his sisters to
70
:
mahimong
F
real or anticipated
R:
0
pabigat
0
pa
-
lifestyle changes,
available strengths will make it
lalo sa akong
C
fear,
easier to help the patient cope
pamilya.”
O
feelings,
N
relationship
“Sukad atong
C
issues,
low
Inform the patient it is normal to
nadisgrasya
E
resilience,
or
have a help-seeking behavior.
O. Caalim, St.
ko,
nakita
P
rejection
by
R:
N
nako nga lahi
T
others.
P
M
na ang trato
negative
Building
on
the
already
Bohol soon.
with the present situation.
4
This reduces the stigma
Cyrus Gabriel
associated with seeking help and
promotes early intervention.
sa ubang tao
sa akoa.”
Model
positive
behavior
and
“Gina-try jud
R: The nurse can prevent the
nako
patient
from
ruminating
negative concepts by engaging
positive pero
in
dili jud nako
offering
malikayan
decisions, and helping them set
usahay
the
conversations,
patient
simple
na
and achieve goals. This can
maghuna-hu
increase the patient’s sense of
na
self-esteem in their abilities.
ug
dili
G.
on
maging
positive
Elaica
Calle, St. N
assist with goal setting
na
5
Tim Despi, St.
N
71
maayo
maong
Provide the patient feedback in
nagpa-admit
his attempts to secure autonomy,
ko kay para
reality,
makaiwas ko
problem-solving, and a sense of
magisgeg
capability.
huna-huna
R: The patient needs continuous
ug
positive feedback and support to
mga
positive
6
self-esteem,
negative
manage behaviors to promote
thoughts.”
self-esteem.
Moreover,
the
patient will benefit from feedback
Objective
that provides a realistic appraisal
cues:
of his or her development while
● Attempted
strengthening
suicide
twice
the
effective
change made by the patient.
due
to
Refer
to
resources
relationship
counseling
issues with
R: Other resources depending
previous
on the causes of low self-esteem
and current
may
romantic
assistance or life coaching.
include
and
7
employment
72
partners
● Has
disability at
left
upper
arm due to
previous
motor
accident
● Has
been
diagnosed
with
depression
● Has
been
prescribed
with
antidepress
ant
medication
(Escitalopr
am)
73
C. Health teachings
A. Individual
It is essential to educate residents on the importance of adhering to their doctor's
medication prescriptions. Encouraging patients to embrace self-care practices, such as
modifying their diet, incorporating regular exercise, prioritizing adequate sleep,
refraining from alcohol consumption, and seeking social support, holds significant value.
These approaches are practical tools for addressing challenges, impacting symptom
frequency and severity, enhancing overall well-being, and fostering self-esteem. Active
engagement in self-care can mitigate feelings of hopelessness and helplessness for
patients while allowing doctors to consider reducing medication dosages. Additionally,
acknowledging and accepting unpleasant emotions can profoundly affect a patient's
ability to manage stress, stabilize moods, and maintain control over their life.
B. Family
Encourage family members to openly share their thoughts and feelings about
their current situation. Doing so, they can better understand how the problem impacts
them personally. Additionally, educational sessions for the client's family should be
provided regarding the client's medication, its purpose, and the importance of
adherence to the prescribed regimen. Emphasize the significance of taking medications
as scheduled to ensure the client's well-being and prevent missed doses. The
involvement of family and friends is vital in supporting the client's treatment and
recovery journey. Foster a supportive environment and cultivate a non-judgmental
atmosphere to facilitate open communication. Recognize that family members may be
experiencing distress and offer them reassurance and empathy during this challenging
time.
C. Community
Community symposiums serve as platforms for professionals to disseminate
information on mental health, various illnesses, and available resources. This enhanced
knowledge equips community members to recognize signs of mental health issues,
understand their consequences, and advocate for early intervention. By fostering open
74
dialogue and dispelling misconceptions, these symposiums help reduce mental
disorders' stigma, fostering a more empathetic and understanding community.
Additionally, emphasizing holistic well-being offers insights into stress management,
coping strategies, and resilience-building techniques for individuals and families. This
enhances personal resilience and enables community members to support others and
contribute to a more resilient and mentally healthy community. Attendees gain
knowledge on identifying risk factors, providing support to those in distress, and seeking
timely treatment to prevent the worsening of mental health issues. Ultimately, mental
health symposiums underscore the importance of empowerment and resilience in
promoting overall well-being.
D. Discharge Planning
METHOD
RATIONALE
Medication
-
-
Inform the resident and their family
-
Encouraging prompt and effective
that adhering to the prescribed
therapeutic responses facilitates
home medications is essential.
optimal recovery and contributes to
Inform the family and resident
symptom management.
about
the
need
to
renew
-
Renewing
prescriptions
prescriptions, ensuring they know
guarantees
an
uninterrupted
the medication's purpose, dosage,
provision of essential medications,
and administration route.
fostering consistency within the
treatment regimen. This practice
also
sustains
therapeutic
medication levels in the body,
thereby diminishing the likelihood
of relapse or recurrence of mental
health symptoms.
-
Inform the resident and their family
-
To ensure that the resident and
75
that
medications
may
cause
their family are well-informed, to
undesirable side effects.
alleviate any concerns the resident
may have if adverse effects arise,
and
to
interventions
identify
suitable
for
managing
potential side effects.
Exercise
-
-
Provide education to the resident
-
These practices promote mental
on practicing relaxation techniques
and emotional well-being, reduce
like meditation for stress relief and
stress, and improve overall coping
emotional well-being.
abilities.
Encourage the resident and their
-
Aerobic exercise can assist in
family to engage in physical
addressing physical health
activities together, such as walking
concerns associated with
in familiar areas outdoors or
conditions such as schizophrenia
participating in physical therapy
and offsetting the adverse effects
exercises like stretching.
of antipsychotic medications, such
as diabetes.
-
Encourage the resident and their
-
Engaging in aerobic activities can
family to participate in therapeutic
boost the resident's confidence,
activities such as painting and
increase engagement, and foster
music therapy, which can offer
resilience. Additionally,
emotional support.
participating in music and/or art
activities can alleviate stress and
anxiety.
Treatment
-
Encourage the client and his family
to attend family therapy sessions.
-
Family therapy sessions aim to
improve communication, foster
76
understanding, and resolve
conflicts within the family unit,
ultimately enhancing familial
relationships and promoting
individual and collective well-being.
-
Encourage client’s participation in
-
CBT enables reframing of thinking
Cognitive Behavioral Therapy
during moments of heightened
sessions.
anxiety or panic.
Outpatient
-
Recommend maintaining a calm
-
To manage stress levels effectively
and quiet environment for the
and prevent the recurrence of
resident.
symptoms such as delusions or
hallucinations.
-
Instruct the family to ensure the
-
resident's safety at all times.
Ensuring
a
safe
environment
involves removing any potentially
harmful objects that the resident
could use as a weapon, thus
reducing the risk of self-harm or
harm to others.
-
Highlight
the
attending
scheduled
appointments
significance
with
of
-
follow-up
To
guarantee
medication
healthcare
adherence,
consistent
promote
effective treatment outcomes, and
providers to the resident and their
prevent illness progression.
families.
-
Direct the resident and family to
promptly
notify
healthcare
-
To deliver timely interventions and
mitigate the risk of deterioration.
providers of any adverse reactions
77
to prescribed medications.
Diet
-
Advise client to limit sugar and
-
processed foods
Minimize the intake of refined
sugars, processed foods, and
sugary beverages, as they can
lead to fluctuations in blood sugar
levels and exacerbate mood
swings.
-
Instruct client to avoid caffeine and
-
alcohol
Excessive consumption of either
substance can lead to adverse
effects, exacerbating anxiety,
disrupting sleep patterns, impairing
cognitive function, and increasing
the risk of mood disorders and
addiction, highlighting the
importance of moderation and
awareness of their potential impact
on mental well-being.
-
Stay Hydrated
-
Minimize the intake of refined
sugars, processed foods, and
sugary beverages, as they can
lead to fluctuations in blood sugar
levels and exacerbate mood
swings.
-
Mindful Eating
-
Mindful eating promotes
awareness of the mind-body
connection, recognizing how food
choices and eating behaviors
78
impact physical sensations,
emotions, and overall well-being.
X. Prognosis
1-poor
2-fair
3-good
Factors
Rating
Justification
a. Onset of
3
R.D.A is currently 27 years old; his depression
illness
and suicide attempts started last December
2023 and January 2024; hence, he was 26
years old. His depression started later and not
during his childhood years.
b. Duration of
3
The client’s depression and suicide attempts
illness/pre-mo
happened between December and January. It
rbid
lasted for three months before his admission.
personality
c. Factors
1
Family- R.D.A.’s parents died in 2016 and
2018, both due to a motorcycle accident.
Their loss of parents may have contributed to
the client’s depression. Moreover, as their
parents died, her older sister stood up and
became their parent; seeing her sister faint
due to stress made him blame himself as the
root of her sister’s problem, which led to his
second attempt.
Relationship- The client’s broken relationship
79
with
her
girlfriend
due
to
his infidelity
contributed to his depression. Moreover, he
got overwhelmed by his next partner, as it
seemed she was just milking some money out
of the client’s pocket.
Work- The client was offered a promotion but
declined because he doesn’t see himself as
suitable for the position and finds it hard to
manage the staff. Moreover, his performance
was poor since he was preoccupied with his
thoughts and the fear of being exposed to his
workmates.
d. Mood and
3
affect
The client was participative. He interacts with
the staff, student nurses, and his co-clients.
He didn’t display any signs of withdrawal.
e. Attitude and
3
Client R.D.L show a willingness to comply and
willingness to
follow his medication regimen as he is eager
to take the
to heal from depression.
medication
f. Any
3
R.D.A displays readiness to be discharged.
depressive
His mood and affect were harmonious with
features
each other. He has concrete plans after that,
such as taking a week's rest and continuing
his work.
g. Family
support
3
After R.D.A.’s first suicide attempt, his sister
accompanied him and went to a psychiatrist.
After the second attempt, her sister still
80
accompanied him to a new Psychometrician
for his treatments. His sister was with him
upon admission; his bills were shouldered by
his sister. He wasn’t visited at the facility as he
lasted only for a month but was fetched during
discharge.
2.71
Scale:
POOR= 1-1.6
FAIR= 1.7-2.3
GOOD= 2.4-3
RATING
NUMBER
WEIGHT
NUMBER x
TOTAL/7
WEIGHT
GOOD
6
3
18
2.57
FAIR
0
2
2
0
POOR
1
1
1
0.14
GOOD= 2.71
A study from Cole, 2023 identified prognostic factors which included age, gender,
cognitive status, comorbidities, fracture type, anxiety, pain, residence status, social
support, stress, activities of daily living, mobility and function.
The prognosis for clinical depression depends on a few factors, including Its
severity if it’s treated or untreated, If you have other mental health or medical
conditions. Untreated episodes of clinical depression (major depressive disorder) can
last six to 12 months. About 10% to 15% of people with the condition die by suicide;
81
hence, a poor prognosis. Approximately 80% to 90% of people with the condition who
seek treatment eventually respond well to treatment. The prognosis is associated with
the
presence
of
triggering
factors.
When
the
depressive disorder appears
spontaneously, the prognosis is usually better.
In the client’s case, his depression started a year ago; his suicide attempts were
on December 2023 and January 2024. His depression was due to the loss of parents,
intimate relationship, and self-blaming. He was participative during the activities; he led
his groupmates; he socialized with the student nurses, staff, and co-clients; he was also
compliant with his medications. He was also able to verbalize his thoughts, feelings, life
experiences, problems, and plans upon discharge. His admission to the facility was of
his own will alongside her sisters. He showed a willingness to recover and to be free
from his stressors to prevent relapse. His family shows full support in his recovery; her
sisters paid for his two-month stay in Forestal Healing Home and Therapeutic Milieu.
Upon the physician’s order, R.D.A was discharged last March 7, 2024, and his sisters
fetched him. In the aforementioned table, the client got six out of seven good, 1 poor,
and no fair. Each total was divided into the total number of items, and its total score was
2.71, which indicates a good prognosis.
82
XI. Bibliography
About Psychiatric-Mental Health Nursing. (2023). From American Psychiatric Nurses
Association: https://www.apna.org/about-psychiatric-nursing/
Adjustment Disorder | 5-Minute Clinical Consult. (n.d.).
https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688
671/all/Adjustment_Disorder
Ahernandez. (2023, March 1). Nursing diagnosis Situational low self-esteem. Nursing
Diagnosis. https://nandadiagnoses.com/situational-low-self-esteem/
Association, A. P. (2021). Diagnostic and Statistical Manual of Mental Disorders
(DSM-5). American Psychiatric Publishing.
Bains, N., & Abdijadid, S. (2023, April 10). Major depressive disorder. StatPearls - NCBI
Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559078/
Berry, J. (2023, October 10). 14 common signs and symptoms of depression. Medical
News Today. https://www.medicalnewstoday.com/articles/326769
Bipolar disorder. (n.d.). https://caps.ucsc.edu/resources/bipolar-disorder.html
Bipolar II Disorder. (2022, February 14). PsychDB.
https://www.psychdb.com/bipolar/bipolar-ii
Boyd, M. A., & Luebbert, R. (2019). Essentials of psychiatric nursing. Lippincott Williams
& Wilkins.
Bowers, E. (2023, April 26). 8 depression symptoms you shouldn’t ignore.
EverydayHealth.com.
https://www.everydayhealth.com/depression/symptoms/depression-symptoms-yo
u-shouldnt-ignore/
Bsn, A. G., RN. (2023, July 1). Hildegard Peplau: Interpersonal Relations Theory.
Nurseslabs.
https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/#h-hildeg
ard-peplau-s-interpersonal-relations-theory
Büscher, R. (2020). Internet-Based Cognitive Behavioral Therapy to Reduce Suicidal
Ideation: A Systematic Review and Meta-analysis. JAMA Network Open, 3(4),
e203933–e203933. https://doi.org/10.1001/jamanetworkopen.2020.3933
83
Ccm, M. W. B. R. (2023, November 21). Ineffective health maintenance nursing
diagnosis & care plans | NurseTogether. NurseTogether.
https://www.nursetogether.com/ineffective-health-maintenance-nursing-diagnosis
-care-plan/?fbclid=IwAR3bAhZA_HeUJbFcjgiS9wky0ruG9O3JzBqdPTtmxUkMq
D9G0i65XCo8l5A.
Cuncic, A. (2022, November 21). the Connection Between Depression and Anger.
Verywell Mind.
https://www.verywellmind.com/connection-between-depression-and-anger-50857
25
Disparities in suicide | Suicide Prevention | Centers for Disease Control and Prevention.
(2023). https://www.cdc.gov/suicide/facts/disparities-in-suicide.html
Dorothea E. Orem - Nursing Theory. (2019, August 13). Nursing Theory.
https://nursing-theory.org/nursing-theorists/Dorothea-E-Orem.php?fbclid=IwAR1b
vqOfW5WqWDxw4S58cWIzm_bWyNCk6c91CeZA6YFInR4D1uYfU-VKqJs
Dresden, D. (2020, September 30). What is psychodynamic
therapy?https://www.medicalnewstoday.com/articles/psychodynamic-therapy
Ellis, M. (2019, October 10). Depression isolation: What to do when a loved one
becomes socially withdrawn. Bridges to Recovery.
https://www.bridgestorecovery.com/blog/depression-isolation-what-to-do-when-a-l
oved-one-becomes-socially-withdrawn/
Fitzgerald, J. (2019, January 22). Depression versus sadness: How to tell the
difference. Medical News Today.
https://www.medicalnewstoday.com/articles/314418
Grundström, J., Konttinen, H., Berg, N., & Kiviruusu, O. (2021). Associations between
relationship status and mental well-being in different life phases from young to
middle adulthood. SSM-Population Health, 14, 100774.
https://doi.org/10.1016/j.ssmph.2021.100774
Gurnaccia, M. (2024, February 20). Feeling like a burden? what it means and how to
overcome it. BetterHelp.
https://www.betterhelp.com/advice/rejection/feeling-like-a-burden-what-it-meansand-how-to-overcome-it/
84
Holland, K. (2022, April 27). Cognitive Behavioral therapy for depression. Healthline.
https://www.healthline.com/health/depression/cognitive-behavioral-therapy?fbclid
=IwAR36-6GZxq6oOEUxShwr8vNsSvDmEushbhxiQB_5vbqtWkWOgQAqYG5H
Y34
Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., Cuijpers, P., &
Penninx, B. W. J. H. (2020). Exercise interventions for the prevention of
depression: a systematic review of meta-analyses. BMC Public Health, 20(1),
1–11. https://doi.org/10.1186/s12889-020-09323-y
Jacobson, S. (2023, March 11). Is guilt a hidden cause of your depression?. Harley
TherapyTM Blog.
https://www.harleytherapy.co.uk/counselling/guilt-and-depression.htm
Jain,
A.,
&
Paroma
Mitra.,
P.
(n.d.).
Bipolar
Disorder.
StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK558998/
Jang, J., Park, S. Y., Kim, Y. Y., Kim, Y. H., Lee, G., Seo, J., Na, E. J., Park, J. Y., &
Jeon, H. J. (2022). Risks of suicide among family members of suicide victims: A
nationwide sample of South Korea. Frontiers in Psychiatry,
13.https://doi.org/10.3389/fpsyt.2022.995834
Jespersen, A. P., Madden, R. A., Whalley, H., Reynolds, R. M., Lawrie, S. M., McIntosh,
A. M., & Iveson, M. H. (2023). Socioeconomic Status and Depression – A
Systematic review. medRxiv (Cold Spring Harbor Laboratory).
https://doi.org/10.1101/2023.12.04.23299380
Leamey, T. (2023, February 1). Here’s why drinking water is the key to good mental
health. CNET.
https://www.cnet.com/health/mental/heres-why-drinking-water-is-the-key-to-goodmental-health/?fbclid=IwAR2qfR4Hr8uyfbD9EnGsoE1W9Zjgm_n1iZ0t53qOR9W
Jqc4hwJcnkwlBhR4
Madigan, A., & Daly, M. (2023). Socioeconomic status and depressive symptoms and
suicidality: The role of subjective social status. Journal of Affective Disorders,
326, 36–43. https://doi.org/10.1016/j.jad.2023.01.078
85
Malhi, G., Bell, E., Mannie, Z., & Das, P. (2019, December 19). Attempting suicide
changes the brain? - gin S malhi, Erica ... Australian & New Zealand Journal of
Psychiatry. https://journals.sagepub.com/doi/10.1177/0004867419897807
Maurya, C., Muhammad, T., Dhillon, P., & Maurya, P. (2022). The effects of
cyberbullying victimization on depression and suicidal ideation among
adolescents and young adults: a three year cohort study from India. BMC
Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-04238-x
Marzani, G., & Neff, A. P. (2021, February 15). Bipolar Disorders: Evaluation and
treatment. AAFP. https://www.aafp.org/pubs/afp/issues/2021/0215/p227.html
‘Mental health crisis a rising epidemic in PH’ – experts. (n.d.). Philippine News Agency.
https://www.pna.gov.ph/articles/1211404#:~:text=In%20the%20Philippines%2C%
20mental%20illness,Department%20of%20Health%20(DOH).
Millard, E. (2022, April 14). Depression: DSM Diagnostic Criteria and Treatment
Overview.
https://www.medcentral.com/behavioral-mental/depression/assessment-diagnosi
s-adherence-depression.
https://www.medcentral.com/behavioral-mental/depression/assessment-diagnosi
s-adherence-depression
Næss, E. O., Mehlum, L., & Qin, P. (2021). Marital status and suicide risk: Temporal
effect of marital breakdown and contextual difference by socioeconomic status.
SSM-Population Health, 15, 100853.
https://doi.org/10.1016/j.ssmph.2021.100853
Nall, R. (2020, March 29). Depression and fatigue: An unfortunate connection.
Healthline. https://www.healthline.com/health/depression/fatigue
Nightingale’s Environment Theory - Nursing Theory. (2023, June 14). Nursing Theory.
https://nursing-theory.org/theories-and-models/nightingale-environment-theory.ph
p
Nursing Care Plan (NCP) for Suicidal Behavior Disorder. (n.d.). [Video]. NURSING.com.
https://nursing.com/lesson/nursing-care-plan-for-suicidal-behavior-disorder
Older Adults – Suicide Prevention Resource Center. (2020).
https://sprc.org/populations/older-adults/
86
Omar. (2023, December 19). Top therapy for suicidal thoughts. Alter Behavioral Health.
https://alterbehavioralhealth.com/blog/top-therapies-treat-suicidal-thoughts/
Professional, C. C. M. (n.d.). Clinical Depression (Major depressive disorder). Cleveland
Clinic.
https://my.clevelandclinic.org/health/diseases/24481-clinical-depression-major-de
pressive-disorder
Prasko, J., Ociskova, M., Kamaradova, D., Latalova, K., Vrbova, K., Sedlackova, Z.,
Jelenova, D., Havlikova, P., & Mainerova, B. (2020). Cognitive Behavioral
Therapy and Dialectical Behavioral Therapy in Suicidal Patients. European
Psychiatry, 30(S1), 1–1. https://doi.org/10.1016/S0924-9338(15)30747-1
Products - Data Briefs - Number 379 - September 2020. (n.d.).
https://www.cdc.gov/nchs/products/databriefs/db379.htm
Psychiatric
Nursing.
(2023).
From
American
Psychological
Association:https://dictionary.apa.org/psychiatric-nursing
Puyat, J. H., Gastardo-Conaco, M. C., Natividad, J. N., & Banal, M. A. (2021).
Depressive symptoms among young adults in the Philippines: Results from a
nationwide cross-sectional survey. Journal of Affective Disorders Reports, 3,
100073. https://doi.org/10.1016/j.jadr.2020.100073
Saad, A. M., Gad, M. M., Al‐Husseini, M. J., Alkhayat, M. A., Rachid, A., Alfaar, A. S., &
Hamoda, H. M. (2019). Suicidal death within a year of a cancer diagnosis: A
population‐based study. Cancer, 125(6), 972–979.
https://doi.org/10.1002/cncr.31876
SANOSKI, BS, PharmD, FCCP, BCPS, eds. 2019. Davis's Drug Guide for Nurses - 16th
Ed. Philadelphia, PA.
Schlax, J., Jünger, C., Beutel, M. E., Münzel, T., Pfeiffer, N., Wild, P. S., Blettner, M.,
Kerahrodi, J. G., Wiltink, J., & Michal, M. (2019). Income and education predict
elevated depressive symptoms in the general population: results from the
Gutenberg health study. BMC Public Health, 19(1).
https://doi.org/10.1186/s12889-019-6730-4
Schimelpfening, N. (2023, June 16). Why do people die by suicide?. Verywell Mind.
https://www.verywellmind.com/why-do-people-commit-suicide-1067515
87
Seltzer, L. (2023, November 8). Depression and recklessness: Can they be blood
brothers?. Psychology Today.
https://www.psychologytoday.com/intl/blog/evolution-of-the-self/202311/depressio
n-and-recklessness-can-they-be-blood-brothers
Smith, L. (2021). What is psychodynamic therapy? Patient.
https://patient.info/news-and-features/what-is-psychodynamic-therapy
Sobanski, T., Josfeld, S., Peikert, G., & Wagner, G. (2021). Psychotherapeutic
interventions for the prevention of suicide re-attempts: a systematic review.
Psychological Medicine, 51(15), 2525–2540.
https://doi.org/10.1017/S0033291721003081
Soong, J. (2023, October 16). 6 Common Depression Traps to Avoid. WebMD.
https://www.webmd.com/depression/features/depression-traps-and-pitfalls
Toler, L. (2021, April 25). What is adjustment disorder? Verywell Mind.
https://www.verywellmind.com/adjustment-disorder-symptoms-causes-diagnosis-t
reatment-coping-5119568
Townsend, M. C., & Morgan, K. I. (2021). Psychiatric Mental Health Nursing: Concepts
of Care in Evidence-based Practice.
Videbeck. (2022). Psych Mental Health Nrsng 9e (int Ed).
Virginia Henderson: Nursing Theory & Impact | StudySmarter. (n.d.). StudySmarter UK.
https://www.studysmarter.co.uk/explanations/nursing/nursing-theories/virginia-he
nderson/?fbclid=IwAR0wDW6scXS_30elGzN-0UXtCcBqxE_HGgWstkll4R-tcaEY
kbMFEGzpJ5Q#:~:text=The%20Virginia%20Henderson%20Nursing%20Theory,n
ecessary%20strength%2C%20will%20or%20knowledge
Weiss, T. C. (2021, August 13). People with Disabilities and Suicide Awareness.
Disabled World. https://www.disabled-world.com/disability/awareness/suicide.php
World
Health
Organization:
WHO.
(2022c,
June
8).
Mental
disorders.
https://www.who.int/news-room/fact-sheets/detail/mental-disorders/?gad_source=
1&gclid=Cj0KCQjwncWvBhD_ARIsAEb2HW-F07Gj3qPfcM-AmWb2ECBxV3S6M
FvZiabkUI2g1W9kCtxssZASnjAaAvPaEALw_wcB
Yan, N., Zhou, T., Hu, M., Cai, Y., Ling, Q., Shiferaw, B., Wang, W., & Miao, C. (2024).
Familial Resilience in Crisis: Navigating the mediating landscape of depressive
88
symptoms between uncertainty stress and suicide behavior among Chinese
university students. Psychology Research and Behavior Management, Volume
17, 283–294. https://doi.org/10.2147/prbm.s445252
Yu, Y., & He, M. (2023). Perceived stress from interpersonal relations predicts suicidal
ideation in Chinese university students: Roles of meaning in life and coping
humor. Heliyon, 9(3), e14106. https://doi.org/10.1016/j.heliyon.2023.e14106
89