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The relationship of presenting physical complaints to depressive symptoms in primary care patients

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Abstract

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.

Interventions:None.

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.

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References

  1. Klerman GL, Weissman MM. Increasing rates of depression. JAMA. 1989;261:2229–334.

    Article  PubMed  CAS  Google Scholar 

  2. 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.

    PubMed  CAS  Google Scholar 

  3. 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.

    PubMed  CAS  Google Scholar 

  4. Nielsen A, Williams T. Depression in ambulatory medical patients. Arch Gen Psychiatry 1980;37:999–1004.

    PubMed  Google Scholar 

  5. Zung W, Magill M, Moore J, Georges D. Recognition and treatment of depression in a family practice. J Clin Psychiatry. 1983;44:3–6.

    PubMed  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  7. 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.

    PubMed  CAS  Google Scholar 

  8. 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.

    Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. Mark SJ, Goldberg D, Hillier V. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979;9:337–53.

    Article  Google Scholar 

  12. 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.

    PubMed  CAS  Google Scholar 

  13. PR Jencks SF. Recognition of mental distress and diagnosis of mental disorder in primary care. JAMA. 1985;253:1903–7.

    Article  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Prestidge BR, Lake CR. Prevalence and recognition of depression among primary care outpatients. J Fam Pract. 1987;25:67–72.

    PubMed  CAS  Google Scholar 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. 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.

    PubMed  CAS  Google Scholar 

  18. 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.

    Article  CAS  Google Scholar 

  19. Stoeckle JD, Zola IK, Davidson GE. The quantity and quality of psychological distress in medical patients. J Chron Dis. 1964;17:959–70.

    Article  PubMed  CAS  Google Scholar 

  20. Lipman RS, Covi L, Shapiro AK. The Hopkins Symptoms Checklist (HSCL): factors derived from HSCL-90. J Affective Disord. 1979;1:9–24.

    Article  CAS  Google Scholar 

  21. 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.

    Google Scholar 

  22. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA. 1989;262:1479–84.

    Article  PubMed  CAS  Google Scholar 

  23. Kroenke K, Wood DR, Maugelsdorff AD, Meier NJ, Powell JB. Chronic fatigue in primary care. JAMA. 1988;260:929–34.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. Katon W, Kleinman A, Rosen G. Depression and somatization: A review. Part I. Am J Med. 1982;72:127–35.

    Article  PubMed  CAS  Google Scholar 

  26. Katon W, Kleinman A, Rosen G. Depression and somatization: a review. Part II. Am J Med. 1982;82:214–7.

    Google Scholar 

  27. Barsky AJ. Patients who amplify bodily sensations. Ann Intern Med. 1979;91:63–70.

    PubMed  Google Scholar 

  28. Katon W, Ries RK, Kleinman A. The prevalence of somatization in primary care. Compr Psychiatry. 1984;25:208–15.

    Article  PubMed  CAS  Google Scholar 

  29. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988;145(11):1358–66.

    PubMed  CAS  Google Scholar 

  30. Kirmayer LJ. Culture, affect and somatization. Transcultural Psychiatr Res Rev. 1984;21:159–88.

    Article  Google Scholar 

  31. 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.

    Article  PubMed  CAS  Google Scholar 

  32. 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.

    CAS  Google Scholar 

  33. Anda RF, Williamson DE, Escobero LG, et al. Depression and the dynamics of smoking. JAMA. 1990;264:1541–5.

    Article  PubMed  CAS  Google Scholar 

  34. Glassman AH, Helzer JE, Covey LS, et al. Smoking, smoking cessation and major depression. JAMA. 1990;264:1546–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Clinical Medicine, General Internal Medicine, The Hitchcock Clinic, 2 Maynard Street, 03756, Hanover, NH

    Paul D. Gerber MD (Associate Professor)

  2. the Section of General Internal Medicine, Mary Hitchcock Memorial Hospital, Desk 100, 03756, Hanover, NH

    Paul D. Gerber MD (Associate Professor)

Authors
  1. Paul D. Gerber MD
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  2. James E. Barrett MD
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  3. Jane A. Barrett MSc
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  4. Thomas E. Oxman MD
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  5. Eric Manheimer MD
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  6. Robert Smith MD
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  7. Richard D. Whiting MD
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Additional information

Received from the Section of General Internal Medicine, Department of Medicine, and the Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire.

Supported by NIMH Grant No. MH-3752.

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Gerber, P.D., Barrett, J.E., Barrett, J.A. et al. The relationship of presenting physical complaints to depressive symptoms in primary care patients. J Gen Intern Med 7, 170–173 (1992). https://doi.org/10.1007/BF02598007

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