A nurse is conducting a mental health assessment on a client. The client reports feeling extremely fatigued, having difficulty concentrating, and having thoughts of worthlessness. The nurse recognizes these as:

Choice A rationale:

Symptoms of major depressive disorder (MDD) are characterized by causing significant distress, not mild distress. The distress associated with MDD is usually severe and impairs daily functioning.

Choice B rationale:

While insomnia is a common symptom of major depressive disorder (MDD), it is not necessary for the diagnosis. Other symptoms, such as changes in appetite, psychomotor agitation or retardation, fatigue, and diminished interest or pleasure, can also contribute to the diagnosis.

Choice C rationale:

The correct answer. Symptoms of major depressive disorder (MDD) must not be due to a medical condition. It's crucial to rule out medical conditions that can mimic depressive symptoms, such as hypothyroidism or certain neurological disorders.

Choice D rationale:

The presence of a manic or hypomanic episode would indicate a diagnosis of bipolar disorder, not major depressive disorder (MDD). Bipolar disorder involves distinct periods of both elevated mood and depressive episodes.

Choice E rationale:

The correct answer. To meet the diagnostic criteria for major depressive disorder (MDD) according to DSM-5, an individual must experience five or more symptoms of depression during a continuous two-week period. These symptoms must include either depressed mood or loss of interest/pleasure. The scenario did not specify all the symptoms, but the persistent feelings of sadness, guilt, worthlessness, weight loss, and insomnia described align with the criteria.

Choice A rationale:

Positive life events, although beneficial, are not typically considered contributors to the development of depression. Positive events generally have a positive impact on mental health and may even serve as protective factors against depression.

Choice B rationale:

High income is not commonly recognized as a direct contributor to depression. In fact, higher income can provide access to better resources and opportunities that might contribute to better mental health outcomes.

Choice C rationale:

Lack of social support is a well-established factor contributing to the development of depression. Social support plays a crucial role in buffering against stress and providing individuals with a sense of belonging and emotional connection. A lack of strong social ties can lead to feelings of isolation and increase vulnerability to depression.

Choice D rationale:

Optimistic thinking is typically considered a protective factor against depression rather than a contributor to its development. Optimistic thinking involves a positive outlook on life and the expectation of positive outcomes, which can act as a resilience factor against depressive symptoms.