I work in Rehabilitation nursing, and some of this rings true. Residents who get depressed often refuse care and treatment. This is a great article about this issue, if you work in this field, read it. Even if you don’t work in rehab, this is something you might find helpful.

Situation: M.J. is a 32-year-old female currently in an inpatient rehabilitation program. She was admitted 5 weeks ago S/P Motor Vehicle Accident, with a diagnosis of traumatic brain injury (TBI). The patient was engaged in the rehabilitation program and had progressed well until 2 weeks ago. Since that time, her appetite has decreased and she has lost 5 pounds. She reported feeling more tired and taking multiple naps during the day. She has been voicing more concerns about the hopelessness of her situation, has refused to go to therapy, and has denied that she is feeling sad. Nurses report that she has required more PRN pain control.

Consultation: Anne Gnnderson, GNP CRRN-A, an assistant professor at the University of Illinois Chicago College of Medicine, Department of Medical Education, and John Tomkounak, MD, associate dean of curriculum at Rosalind Franklin University Chicago Medical School, reply:

Major depressive disorder (MDD), referred to as simply depression, is a primary mood disorder. For many rehabilitation patients, depression is a common medical problem that affects the patient’s recovery. MDD, however, is often overlooked by healthcare providers and inappropriately (or inadequately) diagnosed for many patients who present with depressive symptoms. Numerous studies cite lack of time, lack of knowledge and skill, and the stigma associated with psychiatric illness as causes of this deficit.

In inpatient rehabilitation programs, depressed patients tend to use the program less effectively, make less progress, and have an increased length of stay. After discharge, depressed patients leave the house less often, do not become involved in recreational pursuits, and report having less contact socially (Wu, 1995). Patients and families often tend to minimize the depressive symptoms or treat the symptoms as something that is “expected” after a traumatic injury. With MJ., it could be easy for her family, and even healthcare providers, to brush off the symptoms as part of an appropriate response to a TBI. Depressed individuals are also less likely to be referred for, seek out, or successfully complete rehabilitation programs or to use adaptive devices (Horowitz, 2003). Rehabilitation providers must recognize the symptoms of depression and provide the necessary treatment for these patients as part of the overall treatment plan.

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