Running head: CARE PLAN
Care Plan
Author's Name
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CARE PLAN
Introduction
One of the key challenges faced by Lesbian, Gay, Bisexual, Transgender, Queer or Questioning,
and Intersex (LGBTQI) individuals is prejudice and discrimination by the rest of the
heterosexual society. Depression has also been identified as a major mental problem affecting
LGBTQI individuals. Research has established that persistent prejudice and discrimination and
the pressure for one to be himself /herself in the large y heterosexual society lead to anxiety,
stress, and sometimes depression. Coping with the fear, shame, and ridicule associated with
being LGBTQI can be challenging and could potentially affect the individual's life. Also, it puts
the individual at a significantly higher risk of depression, anxiety, substance e abuse as well as
suicidal behavior/thoughts.
Epidemiology and economic costs
According to the Anxiety and Depression Association of America (2019), "somewhere between
30 and 60 percent of lesbians, gay men, bisexuals, or transgender people deal with anxiety and
depression at some point in their lives. That rate is 1.5 to 2.5 times higher than that of their
straight or gender-conforming counterparts." These statistics indicate that LGBTQI individuals
are at a higher risk of psychological and mental health problems compared to their heterosexual
or straight counterparts. One of the major reasons why LGBTQI individuals struggle with these
problems is the constant pressure to read situations in the midst of prejudice and discrimination
against their sexuality.
Further, the Human Rights Campaign Foundation (2018) found that transgender individuals are
nearly four times more likely to suffer depression than their non-transgender peers. Also, 60
percent of LGBQ adolescents report being sad and hopeless; they stopped doing some of their
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usual activities. The study also found that LGBQ young individuals are four times more likely to
attempt suicide compared to their heterosexual counterparts. A study conducted by the Human
Rights Campaign Foundation (2018) found that while 4 percent of queer individuals said they
were afraid of seeking treatment for fear of being discriminated against, 13 percent of them
experienced unequal treatment from healthcare workers as a result of their sexuality. Also, the
study found that transgender individuals are denied access to gender-appropriate facilities on
their learning institutions. These statistics indicate that discrimination and prudence against
LGBQI are pervasive and economically costly, particularly to the affected individuals (Graham
et al. 2011).
Assessment/tools to assess/DSM-5
One of the depression assessment tools is the Beck Depression Inventory (BDI), which is used in
the screening and measurement of the severity of depression. Essentially, 21 BDI consists of
self-report items which the individual must complete using multiple-choice response formats.
This assessment tool is appropriate for individuals aged between 13 and 80 years of age. The
second assessment tool is the Center for Epidemiologic Studies Depression Scale (CES-D). It
consists of 20 self-report items, scored on a 4-point scale, and is used to measure the key
dimensions of depression experienced by the individual within the past week. The other
assessment tools include the Hamilton Depression Rating Scale (HAM-D), Montgomery-Åsberg
Depression Rating Scale (MADRS), and Social Adjustment Scale-Self Report (SAS-SR), among
others.
On the other hand, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
(DSM-5) was established to classify mental disorders in order to improve the diagnoses and
treatment of mental disorders, and research. Under the DSM-5 criteria for depression, "the
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individual must be experiencing five or more symptoms during the same 2-week period, and at
least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure"
(Uher et al. 2014).
Pharmacological interventions
There are several types of medications that could be prescribed for LGBQI individuals with
depression. The first class of medications is Selective serotonin reuptake inhibitors (SSRIs).
According to Mayo Clinic (2019), SSRIs increase the levels of serotonin in the brain while also
blocking the reabsorption (reuptake) of serotonin into neurons. Some of the common SSRIs
used in the treatment of depression include citalopram (Celexa) sertraline (Zoloft), and
escitalopram (Lexapro). However, SSRIs are contraindicated for individuals with bipolar
disorder, bleeding disorder, diabetes, epilepsy, pregnancy, and breastfeeding.
The second class of medications for treating depression is Serotonin-norepinephrine reuptake
inhibitors (SNRIs). Essentially, SNRIs work by blocking serotonin reabsorption and
norepinephrine back into the nerve cells, releasing them. This, in turn, increases the levels of
active neurotransmitters in the individual's brain. Some of the common SNRIs include
venlafaxine, milnacipran, desvenlafaxine, and duloxetine. SNRIs have several symptoms,
including nausea, dry mouth, headache, constipation, insomnia, and loss of appetite. These
medications are contraindicated for pregnant and breastfeeding mothers. The other classes of
mediations include atypical antidepressants, tricyclic antidepressants ad Monoamine oxidase
inhibitors (MAOIs).
Plan of care
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During the first doctor visit, the patent will undergo several depression diagnostic tests. These
include complete blood count (CBC), depression questionnaires, physical exams, as well as
thyroid function tests.
Treatment Goals
i. To reduce the depressive symptoms
ii. To improve the patient's ability to function normally at work, home, and school.
iii. To reduce the risk of suicide.
Treatment
The treatment will combine medication and psychotherapy. According to Cuijpers et al. (2014),
it has been scientifically verified that combined treatment involving psychotherapy and
antidepressants is more effective compared to treatment with antidepressant medication alone.
Cognitive Behavioral Therapy (CBT) is the preferable type of psychotherapy. Essentially, CBT
seeks to enact change in the individual's thinking patterns and behaviors. In this particulate
instance, CBT will help the patient do away with destructive thought patterns and replace them
with more positive and constructive ones.
Follow-up and monitoring
The patient is scheduled to make follow-up appoints every week for effective monitoring of the
medications and their effect.
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References
Anxiety and Depression Association of America (2019). Understanding Anxiety and Depression
for LGBTQ People. Retrieved from
https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/understanding-anxiety-and-
depression-lgbtq
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F.
(2014). Adding psychotherapy to antidepressant medication in depression and anxiety
disorders: a meta-analysis. Focus, 12(3), 347-358.
Graham, R., Berkowitz, B., Blum, R., Bockting, W., Bradford, J., de Vries, B., & Makadon, H.
(2011). The health of lesbian, gay, bisexual, and transgender people: Building a
foundation for better understanding. Washington, DC: Institute of Medicine, 10, 13128.
Mayo Clinic (2019). Depression (major depressive disorder). Retrieved from
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-
20356013
Uher, R., Payne, J. L., Pavlova, B., & Perlis, R. H. (2014). Major depressive disorder in DSM‐5:
Implications for clinical practice and research of changes from DSM‐IV. Depression and
Anxiety, 31(6), 459-471.
