Depression Screening and Wellbeing Support
Your Role — Nurse
Community Health Centre
Your 45-year-old patient presented to the GP with fatigue, poor sleep, and low mood. The GP has completed a PHQ-9 questionnaire which scored 16 (moderate depression). The patient has been signed off work for two weeks and has been referred to you for initial mental health nursing assessment and support planning. The patient has no previous history of depression.
- •Establish rapport in a private, confidential setting. Use open questions to explore the patient's current situation: 'Tell me about what's been happening.'
- •Explore symptoms in more detail: sleep (difficulty falling/staying asleep, early morning waking), appetite (increase/decrease), energy levels, concentration, interest in activities (anhedonia), feelings of hopelessness, tearfulness, irritability.
- •Conduct a risk assessment: suicidal ideation, self-harm thoughts, plan or intent. If any risk identified, escalate immediately to GP or crisis team.
- •Discuss treatment options: psychological therapies (CBT, counselling — IAPT referral), antidepressant medication (SSRI — explain they take 2-4 weeks to work and may have initial side effects), lifestyle interventions (exercise — evidence strongly supports this, sleep hygiene, routine, social connection).
- •Develop a shared wellbeing plan: daily routine, small achievable goals, physical activity (e.g., 15-min walk daily), reducing isolation, identifying early warning signs. Arrange follow-up in 1-2 weeks. Provide crisis helpline numbers.
The Interlocutor
Played by the actor / assessor
You are 45 years old and have been struggling for about three months. You feel exhausted all the time, can't sleep properly, and have lost interest in things you used to enjoy. Your GP diagnosed depression and referred you to the practice nurse for support. You've never experienced this before.
- •When asked, say you've been feeling low for about three months. It started gradually and you're not sure why. You feel tired all the time but can't sleep properly — you wake up at 3am and can't get back to sleep.
- •Say you've lost interest in gardening and cooking, which used to be your favourite hobbies. You've been off work for two weeks and you're worried about letting your team down.
- •Say you've had thoughts that life isn't worth living but you haven't made any plans to harm yourself. You wouldn't do anything because of your children.
- •When asked, say you're not keen on medication — you've heard it changes your personality. You'd prefer to try talking therapy first.
- •Say you'll try the exercise and the sleep routine. You're willing to be referred for counselling.
Sample Role-play
Hello, thank you for coming to see me today. I understand from your GP that things have been feeling difficult lately. I am here to listen and help. Can you tell me what has been happening for you?
I have been feeling really low for about three months now. I am tired all the time, I cannot sleep properly, and I have lost interest in everything I used to really enjoy doing.
That sounds very difficult to cope with. Can you tell me a bit more about how your sleep has been affected?
I fall asleep okay because I am so exhausted, but I wake up at three o'clock every single morning and then I cannot get back to sleep. I just lie there worrying about everything.
That pattern of waking up early and being unable to get back to sleep, called early morning waking, is actually a very classic symptom of depression. I want to say clearly that this is a medical condition — it is not a sign of weakness and it is not something you can just snap out of by trying harder. Depression is very treatable and with the right support, the vast majority of people make a full recovery.
I have been struggling to even get out of bed some mornings.
That lack of motivation and energy is another core symptom of depression, and it is completely understandable. Before I talk about the different treatment options available, I need to ask you something important, and I ask every patient I see about this. Have you had any thoughts about harming yourself or ending your life?
Should I tell my employer about my depression?
I have thought sometimes that life does not feel worth living. But I have not made any plans to hurt myself. I would not do anything because I have my children to think about.
Thank you for being so honest with me — I know that is a very difficult question to answer. It is good that you have your children as a strong reason to stay safe. If those thoughts ever become stronger, or if you start to think about how you might harm yourself, it is crucial that you seek help immediately. You can call NHS 111, the Samaritans on 116 123 any time day or night, or go to your nearest A and E department. Do you feel you could do that if you needed to?
Yes, I can do that. I am not keen on taking medication — I have heard that antidepressants change your personality and I do not want that.
I completely understand your concern and I respect your preference. Antidepressants do not change your personality — they help correct the underlying chemical imbalance in your brain that is contributing to the depression. However, talking therapy is an excellent first option for moderate depression. I can refer you to our local IAPT service for cognitive behavioural therapy, which is very effective and is typically delivered weekly over several months. In the meantime, there are some things you can start doing today that evidence shows make a significant difference.
What things can I do right now to help?
Three things that research consistently shows help with depression. First, physical activity — even a fifteen-minute walk each day can be as effective as an antidepressant for mild to moderate depression. Second, establishing a regular sleep routine — going to bed and waking up at the same time each day, even at weekends. Third, reconnecting with one small activity you used to enjoy, even if you do not feel like doing it at first. Start with just ten minutes. Would you be willing to try these for the next two weeks and see how you feel?
I think I could manage a short walk every day. I used to enjoy walking in the park.
That is an excellent starting point. I would like to see you again in two weeks to see how you are getting on with the walk and the sleep routine. In the meantime, here is a crisis card with the helpline numbers we discussed — please keep it in your wallet or on your phone. Remember, recovery from depression takes time, but you have already taken the most important and courageous step, which is asking for help.
Thank you. I will try the walking and see you in two weeks.
Useful Phrases
Clinical Background
Depression is a leading cause of disability worldwide. PHQ-9 scoring: 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. NICE guidelines recommend stepped care: mild (watchful waiting, exercise, sleep hygiene), moderate (CBT or antidepressant), severe (antidepressant + high-intensity psychological therapy). Risk assessment MUST be conducted at every contact. IAPT services provide evidence-based psychological therapies.
Common Mistakes to Avoid
- ✕Telling the patient to 'think positively' or 'look on the bright side' — this is invalidating.
- ✕Skipping the risk assessment due to discomfort — this is a patient safety issue.
- ✕Presenting medication or therapy as the 'only' option — a collaborative approach works best.