Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
The Annals of Family Medicine (Impact Factor: 5.43). 03/2007; 5(2):126-34. DOI: 10.1370/afm.641
Source: PubMed


We undertook a study to confirm and extend preliminary findings that participants with major depressive disorder (MDD) in primary care and specialty care settings have with equivalent degrees of depression severity and an indistinguishable constellation of symptoms.
Baseline data were collected for a distinct validation cohort of 2,541 participants (42% primary care) from 14 US regional centers comprised of 41 clinic sites (18 primary care, 23 specialty care). Participants met broadly inclusive eligibility criteria requiring a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of MDD and a minimum depressive symptom score on the 17-item Hamilton Rating Scale for Depression. The main outcome measures were the 30-item Inventory of Depressive Symptomatology--Clinician Rated and the Psychiatric Diagnostic Screening Questionnaire.
Primary care and specialty care participants had identical levels of moderately severe depression and identical distributions of depressive severity scores. Both primary care and specialty care participants showed considerable suicide risk, with specialty care participants even more likely to report prior suicide attempts. Core depressive symptoms or concurrent psychiatric disorders were not substantially different between settings. One half of participants in each setting had an anxiety disorder (48.6% primary care vs 51.6% specialty care, P = .143), with social phobia being the most common (25.3% primary care vs 32.1% specialty care, P = .002).
For outpatients with nonpsychotic MDD, depressive symptoms and severity vary little between primary care and specialty care settings. In this large, broadly inclusive US sample, the risk factors for chronic and recurrent depressive illness were frequently present, highlighting a clear risk for treatment resistance and the need for aggressive management strategies in both settings.

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Available from: Bradley Gaynes, Jan 28, 2014
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    • "It has been shown that the mood symptoms of depression are more likely to be presented by patients in psychiatry, whereas fatigue is more likely to be presented in general practice (Suh & Gallo, 1997). In addition, studies which have not found any qualitative differences have focused on patients already diagnosed with depression (Gaynes et al., 2007; Thombs et al., 2011). Most patients with depression present in primary care with somatic symptoms. "
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    ABSTRACT: The diagnosis of depression is defined by psychiatrists, and guidelines for treatment of patients with depression are created in psychiatry. However, most patients with depression are treated exclusively in general practice. Psychiatrists point out that general practitioners' (GPs') treatment of depression is insufficient and a collaborative care (CC) model between general practice and psychiatry has been proposed to overcome this. However, for successful implementation, a CC model demands shared agreement about the concept of depression and the diagnostic process in the two sectors. We aimed to explore how depression is understood by GPs and clinical psychiatrists. We carried out qualitative in-depth interviews with 11 psychiatrists and 12 GPs. Analysis was made by Interpretative Phenomenological Analysis. We found that the two groups of physicians differed considerably in their views on the usefulness of the concept of depression and in their language and narrative styles when telling stories about depressed patients. The differences were captured in three polarities which expressed the range of experiences in the two groups. Psychiatrists considered the diagnosis of depression as a pragmatic and agreed construct and they did not question its validity. GPs thought depression was a "gray area" and questioned the clinical utility in general practice. Nevertheless, GPs felt a demand from psychiatry to make their diagnosis based on instruments created in psychiatry, whereas psychiatrists based their diagnosis on clinical impression but used instruments to assess severity. GPs were wholly skeptical about instruments which they felt could be misleading. The different understandings could possibly lead to a clash of interests in any proposed CC model. The findings provide fertile ground for organizational research into the actual implementation of cooperation between sectors to explore how differences are dealt with.
    International Journal of Qualitative Studies on Health and Well-Being 11/2014; 9:24866. DOI:10.3402/qhw.v9.24866 · 0.93 Impact Factor
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    • "These studies showed that among general practice patients suffering from MDD, a depressed mood, diminished interest and pleasure, impaired concentration, and fatigue are very common symptoms [20] [21] [22] [23]. Recurrent thoughts of death have been reported to be present with variable rates from 19% to 63% [20] [21] [22] [23] [24] [25] [26]. In this study we attempted to bring to light the above clinical characteristics of MDD, by analyzing the frequency of depressive symptoms among depressed, Frenchspeaking internal medicine patients using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire as gold standard for the diagnosis of MDD [27] "
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    ABSTRACT: The aim of this study was to investigate the prevalence and clinical characteristics of the DSM IV major depressive disorder (MDD) among patients admitted to the General Internal Medicine Service of the Geneva University Hospital. 557 patients admitted to the IM of the Geneva University Hospital aged 18 to 70 were investigated. Each subject was assessed by a clinical psychologist using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire. 69 patients (12.4%) met diagnostic criteria for MDD (men: 8.8%, women: 16.9%, p=.004). Among subjects with major depression, depressed mood (97%), fatigue (91%), and diminished interest and pleasure (81%) were the most prevalent symptoms. Recurrent thoughts of death were present in 48% of depressed patients. This study raises further evidence that an elevated proportion of patients admitted to an acute care general internal medicine facility meet DSM IV criteria for MDD with nearly half of depressed patients suffering from recurrent thoughts of death. It emphasizes the necessity of a targeted, continuous, and active support given by the psychiatry liaison service in the internal medicine setting.
    European Journal of Internal Medicine 06/2013; 24(8). DOI:10.1016/j.ejim.2013.05.016 · 2.89 Impact Factor
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    • "Co-occurring anxiety symptoms or anxiety disorders among patients with major depressive disorder (MDD) is common. Up to 90% of patients have anxiety symptoms and approximately 40–50% have at least one comorbid anxiety disorder (Gaynes et al., 2007; Howland et al., 2009; Regier et al., 1998). Thus careful assessment of anxiety among patients with depression may be important for intervention decisions. "
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    ABSTRACT: Background: A secondaryanalysiswasconductedtocomparetreatmentoutcomesforanxiousdepres- sion andnonanxiousdepressioninpreviouspublishedOPERATIONtrialsofavarietyofantidepressants and augmentationstrategiesforpatientswithtreatment-resistantdepression(TRD). Methods: A totalof375patientsthatmetDSM-IVcriteriaformajordepressivedisorder(MDD)andthe stage 2TRDcriteria(describedbyThase&Rush)wereenrolled.Anxiousdepressionwasdefined asMDD with aHRSD-17anxiety/somatizationfactorscore ≥7.Datawerederivedfromanearlierstudy,designed to compareefficacy andtolerabilityof fixeddosageofextended-releasevenlafaxine,mitazapine, paroxetine,andrisperidone,sodiumvalproate,buspirone,trazodoneorthyroidhormoneaugmenting to paroxetineinthosepatients.Treatmentoutcomeswerecomparedbetweenpatientswithanxiousand nonanxious TRD. Results: Nearly70%ofparticipantshadanxiousdepression.Remissionratesweresignificantly lowerand ratings ofadverseeventfrequencyweresignificantly greaterinpatientswithanxiousTRDthaninthose with nonanxiousTRD.Presenceofanxiousdepressionpredictedworseoutcomes. Limitations: Lack ofaplacebocontrolarmpreventsusfromrulingoutplaceboeffects.Thetwogroups werenon-randomlyallocatedtomedications.Onlypatientswithstage2TRDwereenrolled,whichmay limit generalizablitytopatientswithoutahistoryofresistance.Comorbidanxietydisordersthatmight confound thespecific treatmenteffectswerenotaddressed. Conclusions: The findingssupportandextendthehypothesisthatanxiousdepressionisassociatedwith pooreroutcomes.Itsuggestsadimensionalassessmentofco-occurringanxiousfeaturesofMDDpatients maybeclinicallyfeasibleforcountrieslikeChinawheredifficultiesinmakingcomorbiditydiagnosisexist.
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