Depression in Learning Disabled Persons: Clinical Presentation and Assessment.

This study explores the issue of syndrome boundaries for depression in learning disabled persons; and the relationship between the issue and appropriate diagnostic and assessment procedures. The study was carried out with sixty learning disabledpersons comprising three main subject groups: those diagnosed with major depressive episode; those with other psychiatric disorders; and those with no diagnosed disorder. Informant reports on clinical presentation were obtained by using a checklist/structured interview schedule with definitions/behavioural anchors for DSMIVbased criterion symptoms and for associated features. Subject self reports were obtained on the SRDQ. Depressed subjects were found to exhibit fullDSMIVcriteria for major depressive episode irrespective o f disability level. Key symptoms found to differentiate between depressed subjects and subjects with other psychiatric disorders were sad mood, anhedonia, fatigue and hallucinations. Subjects with diagnosed disorder were reported to exhibit similarly elevated rates for other symptoms irrespective o f diagnosis. Theelevatedratesfor associated features such as irritability, aggressive behaviour and self injury found with both psychiatrically active groups suggest that these features should be viewed as general concomitants o f psychopathology. SRDQ scores were significantly different for the three main study groups and were in a direction congruent with their reported clinical status. An exploratory comparison was made between the data from the study and other studies comprising disabled and non-disabled samples. The findings raised questions about the boundaries between different syndromes and appropriate diagnostic practices for learning disabled persons with complex psychiatric presentations. The cost-benefits of different assessment approaches to depression with learning disabled persons are discussed