What psychological state is most likely reflected in a patient who is usually well-groomed but arrives wearing old jeans and avoiding eye contact?

The patient’s change in grooming habits and avoidance of eye contact are significant indicators that point towards depression. Individuals who are depressed often experience a decline in self-care and may neglect their appearance. The act of wearing old jeans, which signifies a lack of attention to personal grooming, coupled with avoiding eye contact—a common behavior seen in those suffering from depression—indicates a possible withdrawal from social interactions and a diminished sense of self-worth.

While other states such as lack of sleep, fatigue from work, or financial difficulties could potentially explain some changes in behavior or appearance, they typically do not encompass the comprehensive psychological withdrawal that is characteristic of depression. Lack of sleep or work-related fatigue usually does not lead to such a notable change in personal grooming or interaction style. Financial difficulties could cause stress, but again, they are less likely to manifest as the specific symptoms shown in this scenario, particularly the overt avoidance of eye contact. Thus, the signs presented are most congruent with a depressive state.