Depressive disorders, pathogenesis, clinical presentation and medical-legal evaluation in the field of social assistance

Depressive disorders represent a major cause of disability worldwide, but their etiopathogenetic mechanisms have not yet been fully explained. The interaction between psychosocial and biological vulnerability factors however plays a major role in determining depression. The multiple and variable clinical characteristics of depression, as well as its variable course and response to treatment, present a great difficulty within a rigorous assessment of the individual degree of disability. The medical-legal evaluation within the state social assistance system, if based just on a status, categorical diagnostic approach, could be inadequate to define the actual impact on the functioning of the citizen-patient and to ensure a fair evaluation. A psychopathological dimensional/functional approach, combined with the use of standardized psychometric and clinimetric tools could guarantee greater evaluation validity and reliability. In this paper, the most recent pathogenetic evidence of depressive disorders, clinical manifestations and related functional assessment tools will be discussed first. Their possible use in the specific medical-legal context will then be discussed in light of the need to overcome the discrepancy between a diagnostic system in line with the scientific literature and the outdated table entries currently provided by the Law for the allocation of the degree of disability in the context of the state social assistance system.