综合医院门诊肠易激综合征病人抑郁/焦虑影响因素研究

目的 探讨中国大城市消化内科肠易激综合征门诊患者抑郁/焦虑症状可能影响因素.方法 采用现况研究方法,于2004年6月1日到9月1日在北京、广州和成都的6家综合性医院的消化内科门诊连续收集肠易激综合征303例.由经培训的调查员采用统一的调查表进行面对面调查,同时使用综合医院焦虑抑郁量表(HAD)进行心理测评.对数据进行多元无序多分类Logistic回归分析.结果 IBS患者自评的目前健康状况与医疗保险与抑郁、焦虑或两者合并发生均有统计学关联,目前健康状况差的患者相应OR值分别是2.366(95%CI:1.041～5.375)、5.446(95%CI:1.036～28.622)和4.736(95%CI:2.046～10.946);没有医疗保险的患者相应OR值分别是2.705(95%CI:1. 140～6.422)、4.886(95%CI:1.102～21.664)和3.264(95%CI:1.296～8.224);而负性生活事件的发生使得患者更容易发生单纯抑郁(OR=3.680,95%CI:1.491～9.081).结论 自评目前健康状况差和无医疗保险是中国大城市综合医院IBS门诊患者罹患抑郁和/或焦虑症状的可能危险因素,而近期有负性生活事件发生是罹患单纯抑郁症状的可能危险因素,这些病人的抑郁焦虑问题应该在临床诊疗过程中得到更多关注.     

Depressive symptoms predict medical care utilization in a population-based sample

BACKGROUND: Several examinations have detected a relation between depressive symptoms and medical utilization. However, selection biases have been involved in most previous examinations. We sought to test the association between depressive symptoms and prospective, increased medical care utilization, in a population-based Canadian sample, while controlling for utilization due to medical illness and controlling for selection bias. METHODS: Data from the Nova Scotia Health Survey 1995, an age- and sex-stratified random sampling of 3227 Nova Scotian adults, included the Center for Epidemiological Studies-Depression scale and items assessing chronic medical conditions and current limitations in daily activities resulting from medical illness. We linked survey data with medical care utilization measures for the year following the survey, including out-patient visits, reimbursement for out-patient services, hospitalizations, and hospitalization days. RESULTS: After controlling for age, sex, count of medical diagnoses and current medical severity, those with a greater level of depressive symptoms were at greater risk of having increased medical care utilization in the following year. These results remained after removing mental health care utilization costs. CONCLUSIONS: In a population-based sample, depressive symptoms predicted greater medical care utilization, independent of a number of medical severity measures. Whether depressive symptoms are a risk marker or a causal risk factor for increased medical utilization remains to be explored.     

Chronic functional somatic symptoms: a single syndrome?

BACKGROUND: Reliable longitudinal data of patients with functional somatic symptoms in general practice are lacking. AIMS: To identify distinctive features in patients with chronic functional somatic symptoms, and to determine whether these symptoms support the hypothesis of the existence of specific somatic syndromes. DESIGN OF STUDY: Observational study, with a comparison control group. SETTING: Four primary care practices affiliated with the University of Nijmegen in the Netherlands. METHOD: One hundred and eighty-two patients diagnosed between 1998 and 2002 as having chronic functional somatic symptoms and 182 controls matched by age, sex, socioeconomic status, and practice were included. Data on comorbidity, referrals, diagnostic tests, and hospital admissions over a period of 10 years prior to the diagnosis were collected. Medication use and number of visits to the general practitioner (GP) were extracted from the moment computerised registration was started. RESULTS: In the 10 years before the diagnosis of chronic functional somatic symptoms, significantly more patients than controls presented functional somatic symptoms in at least two body systems, and used more somatic and psychotropic drugs. They visited the GP twice as much, statistically had significantly more psychiatric morbidity, and were referred more often to mental health workers and somatic specialists. The number of patients undergoing diagnostic tests was higher for patients with chronic functional somatic symptoms than for controls, but hospital admissions rates were equal. CONCLUSION: Patients with chronic functional somatic symptoms have a great diversity of functional somatic symptoms. They use more somatic and psychotropic drugs than controls in the years before diagnosis. Moreover, they show high rates of referrals and psychiatric morbidity. The diversity of symptoms of patients with chronic functional somatic symptoms supports the concept that symptoms do not cluster in well defined distinct syndromes. Therefore, patients with chronic functional somatic symptoms should preferably not be classified into medical subspecialty syndromes.     

Direct costs associated with depression in old age in Germany

BACKGROUND: Depression in old age is common. Only few studies, exclusively conducted in the USA, have examined the impact of depression on direct costs in the elderly (60+). This study aims to determine the effect of depression on direct costs of the advanced elderly in Germany from a societal perspective. METHODS: 451 primary care patients aged 75+ were investigated face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score) and resource utilisation and costs (cost diary). Resource utilisation was monetarily valued using 2004/2005 prices. RESULTS: Mean annual direct costs of the depressed (euro5241) exceeded mean costs of non-depressed individuals (euro3648) by one third (p<.01). Significant differences were found for pharmaceutical costs, costs for medical supply and dentures, and for home care. Only few costs were caused by depression treatment. Depression has a significant impact on direct costs after controlling for age, gender, education, chronic medical illness and cognitive functions. A one-point increase in the GDS-Score was associated with a euro336 increase in the annual direct costs. LIMITATIONS: Reported costs can be considered as rather conservative estimates. There were no nursing home residents and no patients with dementia disorders in the sample. Furthermore, recall bias cannot be ruled out completely. CONCLUSION: Depression in old age is associated with a significant increase of direct costs, even after adjustment for chronic medical illness. Future demographic changes in Germany will lead to an increase in the burden of old age depression. Therefore health policy should promote the development and use of cost-effective treatment strategies.     

Diabetes, depression, and healthcare utilization among African Americans in primary care

PURPOSE: This study tested for an association between diabetes and depressive symptoms and assessed the effect of co-occurring diabetes and depressive symptoms on healthcare utilization outcomes among African-American patients. PROCEDURE: The sample consisted of 303 adult African-American patients age 40 and over from a primary care clinic serving the low-income population in Nashville, TN. Measures were based on self-reports during a structured interview. Multivariate analyses adjusted for age, gender, socioeconomic status, and comorbid chronic conditions. FINDINGS: African-American patients with and without diabetes did not differ on the presence or severity of depressive symptoms. However, the co-occurrence of major depressive symptoms with diabetes among African Americans was associated with nearly three times more reported emergency room visits and three times more inpatient days, but was only marginally associated with a lower number of physician visits. CONCLUSIONS: In contrast to previous studies with predominantly white samples that found a positive association between diabetes and depression, no association was found in this African-American sample. Nevertheless, the results did concur with research findings based on other samples, in that the co-occurrence of depression with diabetes was associated with more acute care utilization, such as emergency room visits and inpatient hospitalizations. This pattern of utilization may lead to higher healthcare costs among patients with diabetes who are depressed, regardless of race.     

Do Somatic Symptoms Predict the Severity of Depression? A Validation Study of the Korean Version of the Depression and Somatic Symptoms Scale

This study aimed at exploring the psychometric characteristics of the Korean Version of the Depression and Somatic Symptoms Scale (DSSS) in a clinical sample, and investigating the impact of somatic symptoms on the severity of depression. Participants were 203 consecutive outpatients with current major depressive disorders (MDD) or lifetime diagnosis of MDD. The DSSS was compared with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the 17-items Hamilton Depression Rating Scale (HAMD). The DSSS showed a two-factor structure that accounted for 56.8% of the variance, as well as excellent internal consistency (Cronbach’s alpha = 0.95), concurrent validity (r = 0.44–0.82), and temporal stability (intraclass correlation coefficient = 0.79). The DSSS had a high ability to identify patients in non-remission (area under receiver operating characteristic [ROC] curve = 0.887). Maximal discrimination between remission and non-full remission was obtained at a cut-off score of 22 (sensitivity = 82.1%, specificity = 81.4%). The number of somatic symptoms (the range of somatic symptoms) and the scores on the somatic subscale (SS, the severity of somatic symptoms) in non-remission patients were greater than those in remission patients. The number of somatic symptoms (slope = 0.148) and the SS score (slope = 0.472) were confirmed as excellent predictors of the depression severity as indicated by the MADRS scores. The findings indicate that the DSSS is a useful tool for simultaneously, rapidly, and accurately measuring depression and somatic symptoms in clinical practice settings and in consultation fields.     

Comparison of major and minor depression in older medical inpatients with chronic heart and pulmonary disease

Depressed medical inpatients with congestive heart failure (CHF) and/or chronic pulmonary disease (CPD) were examined to determine characteristics distinguishing major depression (N=413) from minor depression (N=587). Consecutively admitted patients age 50 or over were screened for depressive disorder with the Structured Clinical Interview for Depression (SCID-IV). CHF/CPD patients with major depression differed from those with minor depression not only on number and severity of depressive symptoms but also on race/ethnicity, comorbid psychiatric illnesses, dyspnea, life stressors, social support, and previous antidepressant therapy. CHF/CPD patients with major and minor depression have distinct psychosocial and physical characteristics that distinguish one from another.     

抑郁性障碍患者的症状表现与认知情绪调节方式的关系

目的:探讨抑郁性障碍患者的症状表现特征及其与认知情绪调节方式之间的关系。方法:采用结构式临床访谈、认知情绪调节问卷对301例抑郁性障碍患者进行调查。结果:①抑郁性障碍患者最常见的躯体症状是心慌(72.43%)、疲劳(70.76%)、胸闷(65.78%)及失眠(64.45%),最常见的情感症状是情绪低落(92.03%)、焦虑(87.04%)、紧张(71.43%)及兴趣减退(62.46%)。②认知情绪调节方式中的积极重新关注和积极重新评价与躯体症状表现数目呈显著负相关(r=-0.233,r=-0.141),沉思和灾难化与躯体症状表现数目呈显著正相关(r=0.224,r=0.207);积极重新关注和积极重新评价与情感症状表现数目呈显著负相关(r=-0.126,r=-0.145),自我责备、沉思和灾难化与情感症状表现数目呈显著正相关(r=0.131,r=0.211,r=0.320)。③躯体症状组患者在接受、沉思、灾难化及责备他人等消极认知策略上的得分显著高于情感症状组患者。结论:抑郁性障碍患者的认知情绪调节方式与症状表现有关。     

Are there any gender differences in frequency of self-reported somatic symptoms of depression?

BACKGROUND: The purpose of this study was to evaluate whether self-reported somatic symptoms of depression, as measured by the Beck Depression Inventory-II (BDI-II), are more frequent in women than in men with major depressive disorder. METHODS: A sample of 105 male and 105 female adult psychiatric outpatients diagnosed with major depressive disorder was classified according to endorsed changes in appetite, changes in sleeping pattern, and fatigue (i.e., "somatic depression") symptoms on the BDI-II. RESULTS: The female to male ratio of somatic symptoms was approximately 2:1. Subsequent analyses found that change in appetite robustly distinguished between women and men and that fatigue partially distinguished between women and men. LIMITATIONS: The sample was largely Caucasian and composed of patients with high rates of comorbidity who presented to a service known for specializing in cognitive therapy. CONCLUSIONS: In outpatients with major depressive disorder, the higher prevalence of "somatic depression" in women is largely attributable to changes in appetite.     

Does the Aging Males’ Symptoms scale assess major depressive disorder?: A pilot study

OBJECTIVES: The objectives of the study were to find the prevalence of major depressive disorder (MDD) in male climacteric outpatients in Japan, and to determine whether symptoms on the Aging Males' Symptoms (AMS) scale scores differed between patients with and without MDD, with the aim of increasing the specificity of future symptoms scales for partial androgen deficiency of the aging male (PADAM). METHODS: Eighty-three patients aged 40-70 who visited the male-climacteric services as outpatients were assessed using three items: a self-administered questionnaire corresponding to diagnosis for MDD, the Beck Depression Inventory, and the AMS scale. RESULTS: Almost half the patients had MDD. The total AMS score, the scores on the AMS psychological, somatic and sexual subscales, and the scores for all except three questionnaire symptoms were higher in patients with MDD. There were strong correlations between the AMS scale and the Beck Depression Inventory. CONCLUSIONS: There is a higher prevalence of MDD in male-climacteric outpatients and scores on most items of the AMS scale were higher for patients with MDD. We suggest that only those symptoms whose scores did not differ between patients with and without MDD are used to assess symptoms of PADAM in the presence of MDD, or that the current AMS is used only after diagnosis of MDD and elimination of these patients. Then the relevance of each item of the AMS to testosterone levels should be simultaneously examined in the future study, which will determine the items highly specific to PADAM symptoms.     

Prevalence and association of somatic symptoms in patients with Major Depressive Disorder

BACKGROUND: Painful and non-painful somatic symptoms are often reported in patients with depressive disorder. The proper identification of depression-relevant somatic symptoms is important for the accurate diagnosis of depression, development of treatment strategies and measurement of outcome. The objective of this study was to characterize the relationship between somatic symptoms and depression in patients diagnosed with Major Depressive Disorder (MDD), using data from randomized drug trials carried out by a pharmaceutical company. METHODS: Pooled 'blinded' data from 2191 patients enrolled in randomized, multicenter, double-blind placebo-controlled studies for the treatment of MDD were analyzed. Somatic symptoms were assessed using the Somatic Symptoms Inventory (SSI) and the Hamilton Depression Rating Scale (HAMD) was used to assess symptoms of depression. RESULTS: The most common somatic symptom reported by patients with MDD was 'feeling fatigued, weak, or tired all over', with 78% of patients reporting 'moderate' levels or above. This was followed by 'feeling that not in as good physical health as most of your friends' (59%), 'not feeling well most of the time in the past few years' (54%), and 'feeling weak in parts of body' (45%). 'Headache' was the most common pain-related symptom with 43% reporting 'moderate' or above. Pearson's product-moment correlations revealed that somatic symptoms generally increased as a function of overall depressive (r=0.43), with 'feeling fatigued, weak, or tired all over' (r=0.50), 'feeling that not in as good physical health as most of your friends' (r=0.42), 'feeling weak in parts of body' (r=0.41), 'heavy feeling in arms and legs' (r=0.34), 'not feeling well most of the time in the past few years' (r=0.32), and 'headache' (r=0.31) showing the strongest correlation with overall HAMD scores. Non-parametric item response analyses showed that many somatic symptoms demonstrate good relationship between item response and the overall severity of depression. In particular, 'feeling fatigued, weak, or tired all over' exhibited good discriminative properties across the full range of severity for depression. LIMITATIONS: The analysis utilized data from a 'restricted' patient population in drug trials sponsored by a pharmaceutical company. CONCLUSIONS: These results demonstrate a high prevalence and association of somatic symptoms in patients with MDD, including feelings of fatigue, physical malaise and pain-related symptoms, which could be potentially useful in the assessment of depression and in the evaluation of treatment strategies.     

The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms

OBJECTIVE: Somatization is prevalent in primary care and is associated with substantial functional impairment and healthcare utilization. However, instruments for identifying and monitoring somatic symptoms are few in number and not widely used. Therefore, we examined the validity of a brief measure of the severity of somatic symptoms. METHODS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 ("not bothered at all") to 2 ("bothered a lot"). The PHQ-15 was administered to 6000 patients in eight general internal medicine and family practice clinics and seven obstetrics-gynecology clinics. Outcomes included functional status as assessed by the 20-item Short-Form General Health Survey (SF-20), self-reported sick days and clinic visits, and symptom-related difficulty. RESULTS: As PHQ-15 somatic symptom severity increased, there was a substantial stepwise decrement in functional status on all six SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. PHQ-15 scores of 5, 10, 15, represented cutoff points for low, medium, and high somatic symptom severity, respectively. Somatic and depressive symptom severity had differential effects on outcomes. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSIONS: The PHQ-15 is a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research.     

The relation between anger management style and organ system-related somatic symptoms in patients with depressive disorders and somatoform disorders

PURPOSE: The objective of this study was to examine the relation between anger management style and organ system- related somatic symptoms in depressive disorder and somatoform disorder patients. MATERIALS AND METHODS: The subjects included 73 patients with depressive disorders and 47 with somatoform disorders. Anger management styles were assessed by the Anger Expression Scale, while the severity of organ system-related somatic symptoms was evaluated using the Somatic Stress Response Scale (SSRS). The severity of depression and hostility was assessed by the Symptom Checklist-90-Revised (SCL-90-R) depression and hostility subscales. RESULTS: The results of multiple regression analyses showed that, in depressive disorder patients, the level of anger expression was significantly associated with the severity of somatic symptoms related to neuromuscular, cardiorespiratory and gastrointestinal systems. However, in these patients, the level of anger suppression was not significantly associated with the severity of somatic symptoms related to any specific organ systems. In patients with somatoform disorders, there was no significant association between the level of anger suppression or anger expression and the severity of the somatic symptoms related to any specific organ systems. CONCLUSION: These results suggest that, in depressive disorder patients, anger expression is likely to be predominantly involved in the neuromuscular, cardiorespiratory and gastrointestinal organ systems. However, in each of depressive disorder and somatoform disorder patients, anger suppression is not likely to be associated with any specific organ systems.     

Depression profile in patients with and without chronic heart failure

OBJECTIVE: Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF. METHODS: Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders. RESULTS: Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively). LIMITATIONS: Our study population of CHF patients may not be representative for CHF patients recruited in the general population. CONCLUSIONS: The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.     

Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands

BACKGROUND: Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors. METHODS: 330 Turkish, 299 Moroccan, and 304 Dutch elderly (55-74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions. RESULTS: The prevalence of self-reported depressive symptoms (CES-D>or=16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis. CONCLUSIONS: The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.     

Somatic, posttraumatic stress, and depressive symptoms among injured patients treated in trauma surgery

Few investigations have examined the course of somatic complaints among acutely injured trauma survivors. Posttraumatic stress disorder (PTSD), depressive, and somatic symptoms were assessed in trauma surgery inpatients (N=73) interviewed while hospitalized and again 12 months after their injury. Somatic symptoms occurred frequently and were significantly greater in patients with higher levels of PTSD and depressive symptoms, even after the analyses were adjusted for injury severity and medical comorbidity. These findings, when considered in conjunction with data documenting the heterogeneity of treatment providers visited after traumatic injury, suggest that the development of early screening and intervention procedures should incorporate assessments of physical symptoms.     

Depressive Symptoms and Cervical Neoplasia in HIV+ Low-Income Minority Women with Human Papillomavirus Infection

Background  Prior work has related elevated life stress to greater risk of cervical neoplasia in women with human immunodeficiency virus (HIV) and human papillomavirus (HPV). Purpose  This study investigated associations between depressive symptoms and cervical neoplasia in HIV+ HPV+ women. Participants were 58 HIV+ HPV+ women. Method  Participants underwent colposcopy, including HPV screening, Papanicolaou smear, and cervical biopsy to determine study eligibility. Eligible participants completed the Beck Depression Inventory (BDI) and the Center for Epidemiologic Studies-Depression (CES-D) scale. Results  Presence and severity of clinically significant depressive symptomatology were associated with cervical neoplasia. Hierarchical logistic regression analysis revealed that women with greater depressive symptoms had marginally greater odds of presenting with cervical neoplasia (BDI: OR = 1.16, p = 0.092; CES-D: OR = 1.15, p = 0.067. Women with greater somatic depressive symptoms, specifically, had significantly greater odds of presenting with cervical neoplasia (BDI: OR = 1.86, p = 0.027; CES-D: OR = 1.56, p = 0.017). Conclusion  These findings suggest that screening HIV+ women for somatic depression may help identify those at risk for cervical neoplasia. Future depression research with medical populations should discern somatic depressive symptoms from disease symptoms, as they may have important value in independently predicting health outcomes.     

Somatic symptom severity among primary care patients who are obese: examining the unique contributions of anxiety sensitivity,discomfort intolerance,and health anxiety

Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.     

Factors associated with depressive symptoms among 18-year-old boys: a prospective 10-year follow-up study

BACKGROUND: The aim is to study associative and predictive factors for self-reported depressive symptoms among 18-year-old boys. METHODS: The participants in this community-based 10-year follow-up study consisted of 2348 boys born during 1981. At baseline, three informant sources were used: parents, teachers, and the children themselves. At follow-up, self-report questionnaires were used to study boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI). RESULTS: Poor adaptive functioning within family and in education, having fewer than two close friends, somatic health problems, and using illicit drugs were all independently associated with a high level of depressive symptoms in the cross-sectional data at age 18. Self-reported depressive symptoms (Children's Depression Inventory, CDI) at age 8 independently predicted an increased number of depressive symptoms 10 years later. LIMITATIONS: Only self-reported questionnaires were used at follow-up. CONCLUSIONS: The high association between depressive symptoms at age 8 and at age 18 gives grounds for paying special attention to children's own intimations of distress already in the early school years. Using self-report screening questionnaires in school health care may help identify children's depressive symptoms.     

The role of somatic health problems in the recognition of depressive and anxiety disorders by general practitioners

Background

Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problems and GP recognition of depression and anxiety.

Methods

We studied primary care patients with a DSM-IV based psychiatric diagnosis of depressive or anxiety disorder during a face-to-face interview (n=778). GPs′ registrations of depression and anxiety diagnoses, based on medical file extractions, were compared with the DSM-IV based psychiatric diagnoses as reference standard. Somatic health problems were based on self-report of several chronic somatic diseases and pain symptoms, using the Chronic Pain Grade (CPG), during the interview.

Results

Depression and anxiety was recognized in sixty percent of the patients. None of the health problems were negatively associated with recognition. Greater severity of pain symptoms (OR=1.18, p=.02), and chest pain (OR=1.56, p=.02), in particular, were associated with more GP recognition of depression and anxiety. Mediation analyses showed that depression and anxiety in these patients were better recognized through the presence of more severe psychiatric symptoms.

Limitations

Some specific chronic diseases had low prevalence.

Conclusions

This study shows that the presence of particular chronic diseases does not influence GP recognition of depression and anxiety. GPs tend to recognize depression and anxiety better in patients with pain symptoms, partly due to more severe psychiatric symptoms among those with pain.