# Situation: Six weeks after a strong typhoon destroyed homes in a coastal barangay, a nurse from the Rural Health Unit (RHU) who is trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) visits an evacuation center. She sees a 38-year-old fisherman and his 14-year-old daughter. At the center the nurse screens survivors for three conditions, each with a minimum symptom duration in mhGAP-IG: Condition X: depression Condition Y: posttraumatic stress disorder Condition Z: prolonged grief disorder Which set of minimum durations matches mhGAP-IG?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630203  
> 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: Six weeks after a strong typhoon destroyed homes in a coastal barangay, a nurse from the Rural Health Unit (RHU) who is trained in the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) visits an evacuation center. She sees a 38-year-old fisherman and his 14-year-old daughter.

At the center the nurse screens survivors for three conditions, each with a minimum symptom duration in mhGAP-IG:
Condition X: depression
Condition Y: posttraumatic stress disorder
Condition Z: prolonged grief disorder
Which set of minimum durations matches mhGAP-IG?

## 보기

1. X 1 month, Y 3 months, Z 6 months
2. X 1 month, Y 1 month, Z 12 months
3. X 2 weeks, Y 1 month, Z 6 months **✔ 정답**
4. X 2 weeks, Y 3 months, Z 12 months

**정답: 3**

## 해설

mhGAP-IG requires core symptoms of depression for at least 2 weeks, considers posttraumatic stress disorder when symptoms with considerable difficulty in daily functioning last at least 1 month after the event, and suspects prolonged grief disorder when intense longing and difficulty functioning last at least 6 months.

## 심화 해설

The correct set of durations
The mhGAP Intervention Guide (mhGAP-IG) sets a minimum symptom duration for each condition so that normal, short-lived reactions to adversity are not labeled as disorders. The matching set is: depression 2 weeks, posttraumatic stress disorder 1 month after the event, and prolonged grief disorder 6 months. Remembering these three thresholds lets the nurse decide who needs treatment and who needs support and watchful waiting after a disaster.

What each threshold means
For depression, mhGAP-IG requires core symptoms, such as persistent depressed mood or markedly diminished interest or pleasure, for at least 2 weeks, along with difficulty in daily functioning. Posttraumatic stress disorder is considered when characteristic symptoms (re-experiencing, avoidance, and a heightened sense of current threat) with considerable difficulty in daily functioning persist for at least 1 month after the potentially traumatic event. Prolonged grief disorder is suspected when intense yearning or longing for the deceased, often with emotional pain and difficulty functioning, lasts at least 6 months after the loss.

| Condition | Minimum duration in mhGAP-IG | Core features |
| --- | --- | --- |
| Depression | 2 weeks | Persistent low mood or loss of interest, with impaired functioning |
| Posttraumatic stress disorder | 1 month after the event | Re-experiencing, avoidance, heightened sense of threat, with considerable difficulty functioning |
| Prolonged grief disorder | 6 months after the loss | Intense longing for the deceased and difficulty functioning |

Why the other sets are wrong
Watch out! The wrong options mix in numbers from other contexts. One month is not the depression threshold; core symptoms for 2 weeks are enough. Three months is not the mhGAP-IG threshold for posttraumatic stress disorder, and twelve months is not its duration for prolonged grief disorder. Using longer thresholds would delay care for survivors who already meet criteria, while using shorter ones would label normal distress as disorder.

Applying the thresholds in an evacuation center
Six weeks after the typhoon, the PTSD and depression windows can already be met, but prolonged grief disorder cannot yet be diagnosed. In the early weeks after a disaster, most people show distress that improves with basic needs, safety, social support, and psychological first aid. The nurse screens, provides support and psychoeducation, and follows up those whose symptoms persist past the thresholds and impair functioning. People with significant symptoms below the threshold still receive support and are reassessed rather than dismissed.

Exam takeaway
Key point! mhGAP-IG durations: depression 2 weeks, PTSD 1 month, prolonged grief 6 months. Think of the sequence as two weeks, one month, six months, increasing with how long a normal reaction is expected to last.

## 임상 시나리오

mhGAP-IG Duration ThresholdsScreening survivors after a typhoon
Depression: core symptoms for at least 2 weeks. Posttraumatic stress disorder: symptoms with considerable difficulty functioning for at least 1 month after the event.

Prolonged grief disorder: intense longing and difficulty functioning for at least 6 months after the loss, so it cannot be diagnosed six weeks after the typhoon.

Most early distress improves with safety, basic needs, social support, and psychological first aid; follow up those whose symptoms persist.

CautionDo not use 3 months for PTSD or 12 months for prolonged grief. Survivors below the thresholds but in distress still receive support and reassessment.

## 핵심 개념

- **mhGAP-IG** — WHO guide that helps non-specialist health workers assess and manage priority mental health conditions.
- **Posttraumatic stress disorder** — A condition after a traumatic event with re-experiencing, avoidance, and a heightened sense of threat.
- **Prolonged grief disorder** — Persistent, intense longing for a deceased person with impaired functioning beyond the expected time.
- **Psychological first aid** — Humane, supportive help for people in distress after a crisis, focused on safety and basic needs.
- **Duration threshold** — The minimum time symptoms must last before a condition is considered.

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