Chapter 1 Linda Gask1 and Carolyn Chew-Graham2 1 University of Manchester, Manchester, UK 2 Research Institute, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, UK Anxiety and depression are both common mental health disorders. They are the commonest mental health problems in the community, and the great majority of people who experience these problems will be treated in primary care. In the UK, primary care services are an integral part of the National Health Service (NHS) in which general practitioners (GPs) work as independent contractors. The GP works as a generalist and a provider of personal, primary and continuing care to individuals, families and a practice population, irrespective of age, gender, ethnicity and problems presented. In this book we will consider both depression and anxiety with reference to specific case histories: the O’Sullivan family and their neighbours (see Box 1.1). We will be adopting a life cycle perspective, considering depression and anxiety at different ages and times of life and in different settings although primarily taking a primary care perspective. Some people may describe themselves as ‘depressed’ when they are unhappy. ‘Depression’ is more than unhappiness: A person who is depressed will experience low mood, which is lower than simply being ‘sad’ or ‘unhappy’, and crucially is associated with difficulty in being able to function as effectively as is usual for them in their everyday life. The severity of this mood disturbance can vary between a mild degree of difference from the norm, through moderate levels of depression to severe depression, which may be then associated with abnormal or ‘psychotic’ experiences such as delusions and hallucinations. Low mood is accompanied by a wide range of other symptoms, which also need to be present in order to make the diagnosis of depression (see diagnostic criteria, Appendix 2). In bipolar disorder, episodes of depression and mania are both experienced. We will not be focusing specifically on bipolar disorder in this book but will highlight how, where and why it is important to distinguish bipolar from unipolar depression. Similarly, ‘anxiety’ is a term in common usage to describe feeling worried and fearful. People who are suffering with one or more of the anxiety disorders also experience symptoms of anxiety to a degree that it interferes with their ability to function. The central emotions at the heart of anxiety are fear and worry. You may be worried and fearful because you feel unsafe and have a sense of foreboding and uncertainty, as in generalised anxiety, or you may have a specific fear or phobia, or experience sudden crescendos of anxiety associated with physical symptoms, which are known as panic. Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are also included among the anxiety disorders (see Box 1.2).
Introduction: Anxiety and Depression
What is depression?
What is anxiety?
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