9 Major Depression Nursing Care Plans

Included in this nursing care plan guide are nursing diagnoses for major depression. Get to know the nursing assessment, interventions, goals, and related factors to the different nursing diagnoses for major depression.

What is Major Depression? 

Major depression (or major depressive disorder) is classified under mood disorders which are characterized by disturbances in the regulation of mood, behavior, and affect that go beyond the normal fluctuations that most people experience. Per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), an individual must have five (5) of the following symptoms, of which one must be a depressed mood or anhedonia causing social or occupational impairment, to be diagnosed with major depressive disorder (MDD) (Bains & Abdijadid, 2022):

  • Persistently low or depressed mood
  • Anhedonia or decreased interest in pleasurable activities
  • Feelings of guilt or worthlessness
  • Lack of energy
  • Poor concentration
  • Appetite changes
  • Psychomotor retardation or agitation
  • Sleep disturbances
  • Suicidal thoughts

The DSM-5 also classifies depressive disorders as:

  • Disruptive mood dysregulation disorder
  • Major depressive disorder
  • Persistent depressive disorder (dysthymia)
  • Premenstrual dysphoric disorder
  • Depressive disorder due to another medical condition

Furthermore, depressive disorders may be further categorized by specifiers:

  • Peripartum onset
  • Seasonal pattern
  • Melancholic features
  • Mood-congruent or mood-incongruent psychotic features
  • Anxious distress
  • Catatonia

Major depressive disorder is a highly prevalent psychiatric disorder. It has a lifetime prevalence of about 5% to 17%, with the average being 12%. The prevalence rate is almost double in women than in men (Bains & Abdijadid, 2022). Non-Hispanic Asian adults were least likely to experience mild, moderate, or severe symptoms of depression compared with Hispanic, non-Hispanic white, and non-Hispanic black adults (Halverson & Bienenfeld, 2023).

According to the CDC, from 2016 to 2019, 2.7 million children aged 3 to 17 years were diagnosed with depression. The incidence of depression was 0.9% in preschool-aged children, 1.9% in school-aged children, and 4.7% in adolescents according to a study. In another study, more than 22% of female high school students and more than 11% of male high school students reported one current or lifetime episode of unipolar depression (Halverson & Bienenfeld, 2023).

Although rates of depression in women and men are highest in those aged 25 to 44 years, the incidence of clinically significant depressive symptoms increases with advanced age, especially when associated with medical illness or institutionalization (Halverson & Bienenfeld, 2023). 

Major depressive disorder is a clinical diagnosis; it is mainly diagnosed by the clinical history given by the client and mental status examination. The clinical interview must include medical history, family history, social history, and substance abuse history along with symptomatology. A complete physical examination, including a neurological examination, should also be performed (Bains & Abdijadid, 2022).

You can learn more about major depression in our study guide here.

Nursing Care Plans for Major Depression

Nursing care plan goals for clients with major depression include determining a degree of impairment, assessing the client’s coping abilities, assisting the client to deal with the current situation, increasing the client’s self-esteem, promoting the client’s safety, improving the client’s social support, and promoting health and wellness.

Here are nine (9) nursing care plans (NCP) and nursing diagnoses for major depression:

  1. Risk For Self-Directed Violence
  2. Impaired Social Interaction
  3. Spiritual Distress
  4. Chronic Low Self-Esteem
  5. Disturbed Thought Processes
  6. Self-Care Deficit
  7. Ineffective Denial
  8. Hopelessness
  9. Deficient Knowledge

Risk For Self-Directed Violence

Clients diagnosed with major depression are at an increased risk for self-directed violence due to their intense feelings of hopelessness, helplessness, and despair. These clients may also have impaired decision-making abilities and difficulty coping with stress, leading to an increased risk for self-harm. In severe cases, suicidal ideation and intent may be present, making it critical to closely monitor and address these risks in the care plan.

Nursing Diagnosis

  • Risk for self-directed violence

Risk factors

Possibly evidenced by

  • Not applicable for risk diagnosis. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

  • The client will seek help when experiencing self-destructive impulses.
  • The client will have a behavioral manifestation of absent depression.
  • The client will have satisfaction with social circumstances and achievements of life goals.
  • The client will identify at least two-three people he/she can seek out for support and emotional guidance when he/she is feeling self-destructive before discharge.
  • The client will not inflict any harm to themself or others.
  • The client will identify support and support groups with whom he/she is in contact within one month.
  • The client will state that he/she wants to live.
  • The client will start working on constructive plans for the future.
  • The client will demonstrate compliance with any medication or treatment plan within the next two weeks.
  • The client will demonstrate alternative ways of dealing with negative feelings and emotional stress.

Nursing Assessment and Rationales

1. Identify the level of suicide precautions needed. If there is a high risk, and does hospitalization require it? Or if there is a low risk, will the client be safe to go home with supervision from a family member or a friend?
A client with a high risk will require constant supervision and a safe environment. Assess if the client has admitted previous suicide attempts, abuse any substances, has no peers/friends, and has any suicide plans. When the client has contemplated or attempted suicide, the burden is on the healthcare professional to directly explore the situation with the client in as much detail as possible to determine the current presence of suicidal ideation as well as accessible means and plans (Halverson & Bienenfeld, 2023).

2. Check for the availability of the required supply of medications needed.
Normally, a suicidal client’s medical supply should be limited to 3 to 5 days. Clients who attempt to commit suicide with prescribed medications represent one of the greatest clinical challenges. The dilemma involves balancing the fact that psychotropic drugs alleviate mental illness symptoms with the reality that some clients will use the very same medications to commit suicide. A study points out the need to pay attention to the number of stockpiled medications available to potentially self-destructive clients (Halverson & Bienenfeld, 2023).

3. Assess the client presenting with somatic symptoms carefully for an indication of depressive disorder.
Clients with major depressive disorder may not initially present with a complaint of low mood, anhedonia, or other typical symptoms. In the primary care setting, where are many of these clients first seek treatment, the presenting complaints often can be somatic, such as fatigue, headache, abdominal distress, or changes in weight. Clients may complain more of irritability or difficulty concentrating than of sadness or low mood (Halverson & Bienenfeld, 2023).

4. Identify factors that predispose the client to depression.
A thorough family history is important because depression can be familial. Familial, societal, and environmental factors appear to play significant roles in the course of depressive illness in children and youths, even in preschool children. A study described anaclitic depression or marasmus in infants being raised in an orphanage and in hospitalized children whose parents were not allowed to visit (Halverson & Bienenfeld, 2023).

5. Perform a mental status examination.
The diagnosis of major depressive disorder is based on the history and the mental status examination. Children with major depressive disorder may present with initially misleading symptoms such as irritability, a decline in school performance, or social withdrawal. Older adults may present with confusion or a general decline in functioning; they also experience cognitive symptoms and fewer complaints of sad or dysphoric mood (Halverson & Bienenfeld, 2023).

6. Assess the client’s mental status regarding the potential for committing suicide.
Another mental status review is designed to focus on evaluating an individual’s potential for committing suicide. One specific concern is a flat affect by the client when describing their thoughts and plans of suicide and self-destructive behavior. Three types of thought changes represent the areas for major focus and concern: command hallucinations telling the client to kill themselves, delusions about the benefits of suicide, and an obsession with taking their own lives (Soreff & Xiong, 2022).

Nursing Interventions and Rationales

1. Encourage clients to express feelings (anger, sadness, guilt) and come up with alternative ways to handle feelings of anger and frustration.
Clients can learn alternative ways of dealing with overwhelming emotions and gain a sense of control over his/her life. In the earliest stages of psychiatric hospitalization, with the most severely ill clients whose behaviors make talk-based therapy impractical or impossible, sensitive relationship-building has to come first. At its core, relationship-building is about language. It calls for identifying a specific communicative channel to enable initial interpersonal contact (Birnbaum, 2017).

2. Contact the family, and arrange for crisis counseling.
Clients need a network of resources to help diminish personal feelings of helplessness, worthlessness, and isolation. Engaging the family can be a critical component of a treatment plan, especially for pediatric and late-onset depression. Family members are helpful informants, can ensure medication adherence, and can encourage clients to change behaviors that perpetuate depression (Halverson & Bienenfeld, 2023).

3. If hospitalized, follow unit protocols.
There are different measures for suicidal clients in the hospital, clinic, and community. If suicidality is present, hospitalization with the client’s consent or via emergency commitment should be undertaken unless there are clear-cut means to ensure the client’s safety while outpatient treatment is begun (Halverson & Bienenfeld, 2023).

4. Assist in establishing a safety plan.
The Joint Commission recommended the development of a collaborative safety plan as an alternative to no-suicide contracts. Safety planning has been found to be acceptable to and more feasible by both suicidal clients and staff. Clients report it helps maintain their safety. Crisis response planning, a form of safety planning, resulted in fewer suicide attempts, lower suicidal ideation, and greater treatment engagement than no-suicide contracts, according to a randomized clinical trial (Stanley et al., 2018).

5. Activate links to self-help groups.
Responding to calls for greater efforts to reduce youth suicide, the Garrett Lee Smith Memorial Act to date has provided funding for 68 state, territory, and tribal community grants, and 74 college campus grants for suicide prevention efforts. Efforts at universities, for example, include creating comprehensive networks of individuals who are trained to recognize signs, symptoms, and communications of suicide and responding by connecting students to needed resources (Soreff & Xiong, 2022).

6. Perform post-discharge follow-up interventions.
These interventions, particularly those that involve in-person and telephone contact, are effective for clients diagnosed with major depressive disorder. One ED study found a 30% lower suicide attempt rate with an intervention consisting of screening, providing basic written material on safety planning, and several calls to suicidal clients and their significant others (Stanley et al., 2018).

7. Prepare the client for electroconvulsive therapy (ECT) as indicated.
ECT is a highly effective treatment for depression, especially when the client has a high risk of suicide. The onset of action may be more rapid than that of drug treatments, with the benefit often seen within one week of commencing treatment. However, this modality still poses numerous risks, including those associated with general anesthesia, postictal confusion, and, more rarely, short-term memory difficulties (Halverson & Bienenfeld, 2023).

8. Provide close monitoring for pediatric clients taking antidepressants.
In October 2003, the FDA issued a public health advisory regarding reports of suicidality in pediatric clients being treated with antidepressant medications. However, these agents are not contraindicated because access was important for those who could benefit from it. Therefore, the FDA recommended that pediatric clients taking antidepressants should be provided with close monitoring. Close monitoring includes at least weekly face-to-face contact with clients or their family members or caregivers during the first four weeks of treatment; visits every other week for the next four weeks; visits at 12 weeks; and then visits as clinically indicated beyond 12 weeks (Halverson & Bienenfeld, 2023).

9. Remove anything that the client may use to hurt or kill themselves.
Remove sharp or potentially dangerous objects. Ask the client for any weapon, such as knives or pills, and secure them away from the client. A study of the association between the provision of mental health services and suicide rates found that removing ligature points (places where things like ropes could be attached) was associated with significant reductions in the overall psychiatric inpatient suicide rate and in the rate of inpatient suicide by hanging (Soreff & Xiong, 2022).

10. Administer antidepressants, as prescribed.
Selective serotonin reuptake inhibitors (SSRIs) have the advantage of ease of dosing and low toxicity in overdose. SSRIs are greatly preferred over the other classes of antidepressants for the treatment of children and adolescents, and they are also the first-line medications for late-onset depression. The adverse-effect profile of SSRIs is less prominent than that of some other agents, which promotes better adherence (Halverson & Bienenfeld, 2023).

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See Also

Other recommended site resources for this nursing care plan:

Other care plans for mental health and psychiatric nursing:

References and Sources

References and recommended sources for this care plan guide for major depressive disorder:

Paul Martin R.N. brings his wealth of experience from five years as a medical-surgical nurse to his role as a nursing instructor and writer for Nurseslabs, where he shares his expertise in nursing management, emergency care, critical care, infection control, and public health to help students and nurses become the best version of themselves and elevate the nursing profession.

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