Abstract
The courses of depressive disorders and factors affecting recovery rates among patients treated in primary medical care facilities have rarely been studied. The authors investigated the clinical status of 274 patients initially and six months after they sought care at one of three primary care sites. Through use of the highly structured Diagnostic Interview Schedule, they found that physicians assigned a depressive diagnosis to only a fourth of the patients so assessed by the structured interview. Nevertheless, the rates of persisting major depressive disorders at follow-up were found to be very similar for patients whom both the structured interview and the physician initially considered depressed and those so diagnosed by structured interview but not by the physician (25% and 31%, respectively). An analysis of factors associated with course of illness suggests that psychiatric status at the initial assessment and the number of assigned medical diagnoses rather than the physician’s recognition and treatment of depression strongly predict continued affective disorder.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schurman R, Kramer P, Mitchell J. The hidden mental health network: treatment of mental illness by nonpsychiatrist physicians. Arch Gen Psychiat 1985;42:89–94
Kamerow D, Pincus H, Macdonald D. Alcohol abuse, other drug abuse, and mental disorders in medical practice. JAMA 1986;255:2054–7
Shapiro S, Skinner E, Kessler L, et al. Utilization of health and mental health services. Three Epidemiologic Catchment Area sites. Arch Gen Psychiat 1984;41:971–8
Schulberg H, Saul M, McClelland M, et al. Assessing depression in primary medical and psychiatric practices. Arch Gen Psychiat 1985;42:1164–70
Kessler L, Burns B, Shapiro S, et al. Psychiatric diagnoses of medical service users: evidence from the Epidemiologic Catchment Area Program. Am J Public Health 1987;77:18–24
Katon W. Depression: relationship to somatization and chronic medical illness. J Clin Psychiat 1984;45:4–10
Weissman M, Klerman G. The chronic depressive in the community: unrecognized and poorly treated. Comp Psychiat 1977;18:523–32
Zis A, Goodwin F: Major affective disorder as a recurrent illness. Arch Gen Psychiat 1979;36:835–9
Lavori P, Keller M, Klerman G. Relapse in affective disorders. A reanalysis of the literature using life table methods. J Psychiat Res 1984;18:13–25
Zung W, Magill M, Moore J, George D. Recognition and treatment of depression in a general medical practice. J Clin Psychiat 1983;44:3–6
Hoeper E, Nycz G, Kessler L, et al. The usefulness of screening for mental illness. Lancet 1984;(Jan 7):33–5
Burns B, Scott J, Burke J, Kessler L. Mental health training of primary care residents: a review of recent literature (1974–1981). Gen Hosp Psychiat 1983;5:157–69
Goldberg D, Steele J, Smith C, Spivey L. Training family practice residents to recognize psychiatric disturbance. Rockville, MD, National Institute of Mental Health, 1983
Runck B. NIMH to launch major campaign on recognition and treatment of depression. Hosp Comm Psychiat 1986;37:779–80
Robins L, Helzer J, Croughan J, Ratcliff K. National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Arch Gen Psychiat 1981;38:381–9
Von Korff M, Anthony J. The NIMH Diagnostic Interview Schedule modified to record mental status. J Affect Dis 1982;4:365–71
Murphy J. Psychiatric instrument development for primary care research: patient self-report questionnaire. Report on Contract Number 80M01428101D. Washington, DC: Division of Biometry and Epidemiology, NIMH, 1981
Weissman M, Bothwell S. Assessment of social adjustment by patient self-report. Arch Gen Psychiat 1976;33:1111–5
Perr I. Medical and legal problems in psychiatric coding under DSM and ICD systems. Am J Psychiat 1982;139:916–8
Psychiatric News. RAND to study outcome of MH care in primary settings. 1985;20(July):1,9
Myers J, Weissman M, Tischler G, et al. Six month prevalence of psychiatric disorders in three communities. Arch Gen Psychiat 1984;41:959–967
Mann A, Jenkins R, Belsey E. The twelve-month outcome of patients with neurotic illness in general practice. Psychol Med 1981;11:535–50
Kessler L, Cleary P, Burke J. Psychiatric disorders in primary care. Results of the follow-up study. Arch Gen Psychiat 1985;42:583–7
Anthony J, Folstein M, Romanoski A, et al. Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Arch Gen Psychiat 1985;42:667–75
Helzer J, Robins L, McEvoy T, et al. A comparison of clinical and Diagnostic Interview Schedule diagnoses. Arch Gen Psychiat 1985;42:657–66
Sireling L, Freeling P, Paykel E, Rao B. Depression in general practice: clinical features and comparison with outpatients. Br J Psychiat 1985;147:119–26
Popkin M, Callies A, MacKenzie T. The outcome of antidepressant use in the medically ill. Arch Gen Psychiat 1985;42:1160–1163
Hankin J, Locke B. Persistence of depressive symptomatology among prepaid group practice enrollees: an exploratory study. Am J Public Health 1982;72:1000–7
Rodin G, Voshart K. Depression in the medically ill: an overview. Am J Psychiat 1986;143:696–705
Schulberg H, McClelland M, Burns B. Depression and physical illness: the prevalence, causation, and diagnosis of comorbidity. Clin Psychol Rev 1987;7:145–67
Schulberg H, McClelland M, Coulehan J, Block M, Werner G. Psychiatric decision-making in family practice: future research directions. Gen Hosp Psychiat 1986;8:1–6
Author information
Authors and Affiliations
Additional information
Received from the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Supported by NIMH Grant MH35352.
Rights and permissions
About this article
Cite this article
Schulberg, H.C., McClelland, M. & Gooding, W. Six-month outcomes for medical patients with major depressive disorders. J Gen Intern Med 2, 312–317 (1987). https://doi.org/10.1007/BF02596165
Issue Date:
DOI: https://doi.org/10.1007/BF02596165