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Case study 19 - Major Depressive Disorder

Introduction

The claimant was examined 9 months post motor vehicle accident (MVA).  The claimant, who was a passenger in the MVA, in which airbags were deployed, reported no loss of consciousness, and a feeling that “they might die”. The claimant was taken to hospital for imaging and consultation. The claimant was subsequently discharged with soft tissue injuries and recommended to have physiotherapy and psychological counselling. It is noted that the claimant ceased physiotherapy approximately 2 months prior to examination and has not ever seen a psychologist/psychiatrist. The claimant has limited English, was born overseas and had fled to Australia for protection.

The injuries sustained have led to the claimant not completing previous social activities and cessation of employment in a physically demanding role. The claimant reported being under financial distress and has had to borrow financial resources from family members which brings shame.

The Psychological Assessment

Pre-MVA

  • Working 5 days per week in a physically demanding role;
  • Engaged in social activity including competitive sport, dancing and socialising;
  • Reported no psychological trauma because of life prior to coming to Australia.

During Assessment

  • Noted having attempted to return to work 2 days per week, however ceased due to a combination of pain and psychological motivation;
  • Sleeping 9 hours or more per day, noted to be normal sleep duration although broken with onset insomnia;
  • Able to drive for short periods, however becomes anxious when driving for long periods;
  • Avoids the site of the MVA;
  • No reported re-experiencing, nor hyperarousal or hypervigilance;
  • Proved to be a poor historian regarding prior information;
  • Low, dysphoric mood with anhedonia and reduced energy;
  • Reduced movement, motivation, and social withdrawal;
  • No psychotic symptoms and no cognitive testing was completed due to language barrier.

Review of documentation

Hospital emergency department discharge noted a possible need for psychotherapy, but did not make an appointment and noted in the general practitioner (GP) notes that is yet to have an appointment but has a referral.

Diagnosis

The claimant has cardinal features of depression; pervasive low mood and anhedonia. In addition to clinical sleep disturbance, not only rated to pain, reduced motivation, and negative cognitions. As such the clinical syndrome is more severe than that of an adjustment disorder, and therefore meets the diagnosis of Major Depressive Disorder.

There is no specific hyperarousal nor hypervigilance and therefore does not meet the criteria for PTSD.

Minor injury

Section 1.6(3) of the Motor Accidents Injuries Act 2017 (the Act):

A Minor psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.

Part 1 clause 4 (2) of the Motor Vehicle Injuries Regulation 2017:

2) Each of the following injuries is included as a minor psychological or psychiatric injury

a) acute stress disorder

b) adjustment disorder

3) in the clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical manual of Mental Disorders (DSM-5)

As in diagnosis and reasons, the claimant meets the criteria for the more severe condition of Major Depressive Disorder which excludes him from having a “minor injury”.