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Nurses 'struggle to see depression'


Research has indicated that nurses have “considerable difficulty” recognising depression and distress in patients.

Even though nurses are at the front line of caring for people, they are given little training in mental health, according to researchers from the University of Leicester.

Consultant in psycho-oncology at Leicestershire Partnership Trust Dr Alex Mitchell, who is also an honorary senior lecturer at the university, said when it comes to dealing with depression and distress, nursing staff are “probably the most important group of health professionals”.

His team are developing simple methods to help recognise mood problems, which can be accessed for free at

Dr Mitchell, of the Department of Cancer Studies and Molecular Medicine, said: “In the NHS 400,000 nurses provide valuable support to those suffering a range of physical and mental illnesses but struggle to detect depression in the early stages.

“Nurses are often very capable of forming good therapeutic relationships and provide a great deal of psychological support which is highly valued.

“However their ability to do this is increasingly under pressure from high workloads and little funding for professional development.

“Our first analysis found that 7,000 nurses and healthcare assistants often overlooked depression in clinical settings.

“Nurses working in hospital settings and nursing homes correctly identified about four out of 10 people with depression and practice nurses working in primary care correctly identified only one in four people with depression.”

He said a second study by the university examined the ability of nurses to detect distressed patients and found half were missed until distress became severe.

Dr Mitchell said the research discovered a number of reasons that accounted for the situation.

“It may be unrealistic to expect nurses to remember complex criteria for detection of depression or to apply lengthy screening tools.

“In the future we may focus more on who has impaired function and who needs help rather than depression alone,” he added.


Readers' comments (9)

  • bob cat

    I wonder if this skill is different in different areas, it doesn't mention that in this artlicle. For example A&E nurses are specialists in emergencies where often its a physical emergency eg. MI or GI bleed, therefore how someone feels initially is considered lower in a prioritisation of needs. I imagine in oncology and hospice care this would be at the forefront of considerations with a well trained staff.
    I also wonder what the capability of recognition is in someone who is depressed themselves but desparately coping and would therefore find it very difficult to address another's depression. Maybe this would be so familiar it wouldn't be considered out of the ordinary for a lot of people. Wasn't there a recent estimation that at least 4/10 people at any given time would be diagnosed as depressed were they to come forward for help? Maybe its higher than that, so its not altogether surprising, and given the quality and amount of support in nursing it's not surprising that people continue coping as best they can.

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  • Could it be that in the current economic and political climate that many nurses themselves are depressed and are therefor incapable of recognising distress in their patients? A case of not being able to see the wood for the trees?

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  • Interesting but I think the study might raise more questions than answers.

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  • Detecting depression is not rocket science. If your patient is withdrawn not only with their nurse but with their family, then that is a red flag. If the patient doesn't make eye contact and doesn't want to engage in activities of daily care or sleeps all the time that is another clue. Listen to what the patient is saying and if you're able to sit down with them and talk then you could learn a lot of information. Of course you have to look at each individual case and their medical status.

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  • Having trained in mental health nursing I have to say this small study comes as no great surprise. Training in mental disorders is not part of adult nursing, therefore it's only to be expected that nurses in this field will be unable to recognize depression. Yes patients may be difficult to engage, withdrawn and have problems with sleep, but these things may not always indicate depression as other mental disorders may cause patients to exhibit these symptoms. Perhaps having a mental health nurse in these settings may be beneficial?

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  • 1 in 4 people will have a mental health problem at some point in their life.

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  • it seems that nurses are losing all the basic skills previously associtated with nursing and losing the ability or failing to observe their patients closely. although sophisticated tools are now used to diagnose depression as defined in the classifications of diseases - the American DSM or European ICD, it requires little more than commonsense to determine the moods of your patient and determine if they need support or advice or need referral to mental health services for an assessment.

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  • Saying that what used to be called General Nurses cannot spot cardinal indicators of depression is ridiculous. Mental Nurses didn't go to Hogwarts or somewhere similar to learn their trade, they worked from the same basic tools as their hat and cape toting colleagues in general nursing did (yes I am that old) with the Henderson model and Maslow's hierarchy of needs. That would be like saying Mental nurses can't recognise the signs of an MI or stroke, of course they can although undoubtedly they aren't the best people to deal with it. Likewise general nurses will refer patients to other services that they do not have the skillset to manage.

    A broad understanding of likely symptomology is all that is required for general nurses to be able to identify patients either suffering from depression or likely to do so and then refer on. General nurses have a patient population where someone with mental health problems will stand out a bit in terms of their interaction etc, but for mental nurses, well lets face it, for them its going to be more like looking for a tree in a forest!

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  • all these more recent attititudes of 'division of labour' and 'them and us' which nurses seem to adopt are appaling and are detrimental to the quality patient care. general nurses are, or should be, what the term implies and what the register expects of them, which means they should be capable of looking after their patients hollistically. This obviously includes mental health as well as physical health. The days of Cartesianism are now welll and truly over. If nurses are incapable of recognisising the signs of depression or other clinical signs and symptoms how can they possibly refer them on to the right specialist department for further assesment and treatment if the patient needs this extra support, which many depressed patients actually do not. MH nurses and other personnel don't actually come round their wards seeking out these patients. Such problems are ofen related to the patients' illness and the impact this may have on their lives and their future, all of which one learns about during general training as well as during psychiatric assignments. Some patients with medical conditions may also have pre-existing mental health problems, but also need specialist medical/surgical care on the relevant ward which is not usually available on a psychiatric ward and they may also not require a psychiatric ward admission if their illness is unrelated. In such circumstances it is not excluded for medical and surgical teams to work together in consultation with mental health specialists and the patient if required. This does not exonerate nurses working in general areas whether it be medicine, surgery or A&E, etc. from acquiring the basic skills needed to recognise whether a patient is depressed or not and the professional capacity to support that patient or take further necessary measures in securing that support from the specialists. how do they support the psychological needs of, for example, cancer patients, cardiac patients, relatives of dying patients, traumatised patients, etc. who often have associated depression. these patients spend more of their time under the care of general nurses on a general ward or in outpatients than they do with mh nurses or psychotherapists therefore all nurses must be capable of observing them and noticing any changes in their mental state and offering the appropriate support. you can't just pack every patient, who may be showing signs of depression, off to a psychiatric unit or shove them onto psychotropic drugs to try and make the problem go away. Apart from the training nurses need, observing a patient's mental state is also in large part plain commonsense.

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