SIRA Logo

Case study 15 - Major Depressive Disorder and Acute Stress Disorder/Adjustment Disorder

An example of an Insurer incorrectly assessing Minor Injury.

Overview

This case study looks at the clinical variance between Major Depressive Disorder and Acute Stress Disorder/Adjustment Disorder and the determination of a minor/non-minor injury.

Introduction

The claimant was examined 9 months post motor accident, was driving in traffic and a passenger when the vehicle was hit on the driver’s side. The claimant did not lose consciousness, the airbags were deployed, and the claimant reported feeling that “they might die”. They were taken to Hospital for imaging and assessment. The claimant was subsequently discharged with soft tissue injuries and recommended to have physiotherapy and psychological counselling. The claimant ceased physiotherapy approximately 2 months prior to examination and has not ever seen a psychologist or psychiatrist. The claimant was born overseas and has limited English language ability.

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 stress and has had to borrow from family members which they feel is shameful.

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 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 motor accident;
  • No reported re-experiencing, nor hyperarousal or hypervigilance;
  • 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.

Review of Documentation

Hospital Emergency department discharge noted a possible need for psychotherapy, but did not make an appointment. The GP notes record that the claimant 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, which was not only related to pain, they reported reduced motivation and negative cognitions. As such the clinical condition meets the diagnosis of Major Depressive Disorder.

There is no specific hyperarousal not hypervigilance and therefore does not meet the diagnosis for PTSD.

Minor Injury

Section 1.6(3) of 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)

The following injury is not a minor injury

  • Major Depressive Disorder

The claimant meets the diagnosis for Major Depressive Disorder which results in the injury not being certified as minor injury.