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.
physical complaints depression physician recognition primary care
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