# Situation: A nurse at a Rural Health Unit (RHU) who is trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) sees a 42-year-old man whose wife died of a stroke 4 months ago. For the past 5 weeks he has felt sad most of the day, has lost interest in fishing with his friends, and has stopped going to work. He has no history of mania, and no physical illness was found. According to mhGAP-IG, which additional finding makes depression likely rather than a reaction to his loss?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630000  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse at a Rural Health Unit (RHU) who is trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) sees a 42-year-old man whose wife died of a stroke 4 months ago. For the past 5 weeks he has felt sad most of the day, has lost interest in fishing with his friends, and has stopped going to work.

He has no history of mania, and no physical illness was found. According to mhGAP-IG, which additional finding makes depression likely rather than a reaction to his loss?

## 보기

1. He has lost 4 kg since the funeral because he skips meals
2. He wakes at 3 a.m. each night and cannot fall back asleep
3. He cries every evening when he looks at her photograph
4. He says he has become a worthless burden to his children **✔ 정답**

**정답: 4**

## 해설

When there has been a major loss such as bereavement within the last 6 months, mhGAP-IG considers depression likely only if there is suicidal ideation, beliefs of worthlessness, psychotic symptoms, slowed speech or movement, or a previous history of depression. Otherwise the person is managed under other significant mental health complaints rather than as depression. Weight loss and early waking are depressive symptoms but do not by themselves override the bereavement rule.

## 심화 해설

The bereavement rule in mhGAP-IG
This man has felt sad most of the day for 5 weeks, has lost interest in fishing with his friends, and has stopped working, 4 months after his wife's death. These symptoms could reflect grief or depression. The WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) gives a specific rule for this situation: when there has been a major loss such as bereavement within the last 6 months, depression is considered likely only if certain features are present. Beliefs of worthlessness, such as saying he has become a worthless burden to his children, are one of those features, so this finding makes depression likely.

The features that decide the question
After a recent major loss, mhGAP-IG considers depression likely if any of the following is present: suicidal ideation, beliefs of worthlessness, psychotic symptoms, slowed speech or movement, or a previous history of depression. If none is present, the person is managed under other significant mental health complaints, with support for the grieving process, rather than treated for depression. This rule helps health workers avoid labeling normal grief as illness while still detecting depression that needs treatment.

| Finding | Common in grief? | Decides depression after recent loss? |
| --- | --- | --- |
| Weight loss from skipped meals | Yes | No |
| Early morning waking | Yes | No |
| Crying at her photograph | Yes, expected | No |
| Believes he is a worthless burden | Not typical | Yes |

Why the other findings do not decide it
Weight loss and early waking are depressive symptoms, but they also occur commonly in grief, so they do not by themselves override the bereavement rule. Crying when he looks at his wife's photograph is an expected part of mourning. In grief, painful feelings tend to come in waves linked to reminders of the person who died, and self-esteem is usually preserved. In depression, the person's view of himself is damaged, and feelings of worthlessness or guilt not related to the loss suggest that more than grief is present.

Watch out! Always ask about suicidal thoughts in a bereaved person with depressive symptoms. If suicidal ideation is present, depression is likely under the same rule, and safety assessment becomes urgent.

Exam takeaway
Key point! Within 6 months of a major loss, mhGAP-IG considers depression likely only with suicidal ideation, worthlessness, psychotic symptoms, slowed speech or movement, or past depression. Without these, support the grief and follow up.

## 임상 시나리오

Depression or Grief?The mhGAP-IG bereavement rule
Within 6 months of a major loss, depression is likely only if there is suicidal ideation, worthlessness, psychotic symptoms, slowed speech or movement, or past depression.

His belief that he is a worthless burden to his children meets the rule. Weight loss, early waking, and crying at reminders are common in grief and do not decide it.

Without these features, the person is managed under other significant mental health complaints, with support for grieving and follow-up.

CautionAlways ask a bereaved client about suicidal thoughts; their presence makes depression likely and safety urgent.

## 핵심 개념

- **mhGAP-IG** — The WHO Mental Health Gap Action Programme Intervention Guide for managing priority mental conditions in non-specialist care.
- **Bereavement** — The period of grief and mourning after the death of a loved person.
- **Beliefs of worthlessness** — Persistent views of oneself as having no value, a feature suggesting depression rather than grief.
- **Psychomotor retardation** — Visibly slowed speech and movement, a feature suggesting depression.

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