The relationship of presenting physical complaints to depressive symptoms in primary care patients
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Objective:To assess the relationship of specific patient chief physical complaints to underlying depressive symptoms in primary care practice.
Design:A cross-sectional study that was part of a larger prevalence study of depression in primary care.
Setting:A general medical primary care practice in a teaching medical center in rural New England.
Patients:1,042 consecutive outpatients screened for depression with the Hopkins Symptom Checklist 49-item depression scale and for whom physicians filled out a form recording both specific chief complaints and two aspects of complaint presentation style, clarity and amplification.
Results:Complaints that discriminated between depressed and non-depressed patients (at the p=0.05 level) were sleep disturbance (PPV 61%), fatigue (PPV 60%), multiple (3+) complaints (PPV 56%), nonspecific musculoskeletal complaints (PPV 43%), back pain (PPV 39%), shortness of breath (PPV 39%), amplified complaints (PPV 39%), and vaguely stated complaints (PPV 37%).
Conclusions:Depressed patients are common in primary care practice and important to recognize. Certain specific complaints and complaint presentation styles are associated with underlying depressive symptoms.
- Klerman GL, Weissman MM. Increasing rates of depression. JAMA. 1989;261:2229–334. CrossRef
- Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry 1988;45:1100–6.
- Regier DA, Goldberg ID, Taube CA. The de factor U.S. mental health service septem: a public health perspective. Arch Gen Psychiatry. 1978:35:685–93.
- Nielsen A, Williams T. Depression in ambulatory medical patients. Arch Gen Psychiatry 1980;37:999–1004.
- Zung W, Magill M, Moore J, Georges D. Recognition and treatment of depression in a family practice. J Clin Psychiatry. 1983;44:3–6.
- Parker G, Holmes S, Manicevasagar V. Depression in general practice attenders: casiness, natural history, and predictors of outcome. J Affective Disord. 1986;10:27–8. CrossRef
- Myers JK, Weisman MM, Tischler GL, et al. The prevalence of psychiatric disorders in three communities, 1980–1982. Arch Gen Psychiatry. 1984;41:959–67.
- Goldberg ID, Bahigian HM, Locke BA, Rosen EM. Role of nonpsychiatrist physicians in the delivery of mental health services: implications from three studies. Public Health Rep. 1978;92(3):240.
- Jones L, Badger L, Ficken R, Leeper J, Anderson R. Inside the modern mental health network. Examining mental health care delivery of primary care physicians. Gen Hosp Psychiatry. 1987;9:287–93. CrossRef
- Gerber PD, Barrett J, Barrett J, Manheimer E, Whiting R, Smith R. Recognition of depression by internists in primary care: a comparison of internist and “gold standard” psychiatric assessments. J Gen Intern Med 1989;4:7–13. CrossRef
- Mark SJ, Goldberg D, Hillier V. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979;9:337–53. CrossRef
- Goldberg D, Steele J, Johnson A, Smith C. Ability of primary care physicians to make accurate ratings of psychiatric symptoms. Arch Gen Psychiatry. 1982;39:829–33.
- PR Jencks SF. Recognition of mental distress and diagnosis of mental disorder in primary care. JAMA. 1985;253:1903–7. CrossRef
- German PS, Shapiro S, Skinner EA, et al. Detection and management of mental health problems of older patients by primary care providers. JAMA. 1987;257:489–93. CrossRef
- Prestidge BR, Lake CR. Prevalence and recognition of depression among primary care outpatients. J Fam Pract. 1987;25:67–72.
- Schulberg HC, McClelland M. A conceptual model for educating primary care providers in the diagnosis and treatment of depression. Gen Hosp Psychiatry. 1987;9:1–10. CrossRef
- Widmer RB, Cadoret RJ, North CS. Changes in pattern of patient visits and complaints during a developing depression. J Fam Pract. 1978;7:293–302.
- Wilson DR, Widmer RB, Cadoret RJ, Judiesch K. Somatic symptoms, a major feature of depression in a family practice. J Affective Disord. 1983;5:199–207. CrossRef
- Stoeckle JD, Zola IK, Davidson GE. The quantity and quality of psychological distress in medical patients. J Chron Dis. 1964;17:959–70. CrossRef
- Lipman RS, Covi L, Shapiro AK. The Hopkins Symptoms Checklist (HSCL): factors derived from HSCL-90. J Affective Disord. 1979;1:9–24. CrossRef
- Spitzer RS, Endicott J, Robins E. Research diagnostic criteria for a selected group of functional disorders. New York: Biometrics Research, New York State Psychiatric Institute, 1975.
- Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA. 1989;262:1479–84. CrossRef
- Kroenke K, Wood DR, Maugelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care. JAMA. 1988;260:929–34. CrossRef
- Manu P, Mathews DA, Lane TJ. The mental health of patients with a chief complaint of chronic fatigue. Arch Intern Med. 1988;148:2213–7. CrossRef
- Katon W, Kleinman A, Rosen G. Depression and somatization: A review. Part I. Am J Med. 1982;72:127–35. CrossRef
- Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Part II. Am J Med. 1982;82:214–7.
- Barsky AJ. Patients who amplify bodily sensations. Ann Intern Med. 1979;91:63–70.
- Katon W, Ries RK, Kleinman A. The prevalence of somatization in primary care. Compr Psychiatry. 1984;25:208–15. CrossRef
- Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988;145(11):1358–66.
- Kirmayer LJ. Culture, affect and somatization. Transcultural Psychiatr Res Rev. 1984;21:159–88. CrossRef
- Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989;262:914–9. CrossRef
- Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. HAMA. 1990;264:2524–8.
- Anda RF, Williamson DE, Escobero LG, et al. Depression and the dynamics of smoking. JAMA. 1990;264:1541–5. CrossRef
- Glassman AH, Helzer JE, Covey LS, et al. Smoking, smoking cessation and major depression. JAMA. 1990;264:1546–9. CrossRef
- The relationship of presenting physical complaints to depressive symptoms in primary care patients
Journal of General Internal Medicine
Volume 7, Issue 2 , pp 170-173
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- physical complaints
- physician recognition
- primary care
- Industry Sectors
- Author Affiliations
- 1. Clinical Medicine, General Internal Medicine, The Hitchcock Clinic, 2 Maynard Street, 03756, Hanover, NH
- 2. the Section of General Internal Medicine, Mary Hitchcock Memorial Hospital, Desk 100, 03756, Hanover, NH