Depressive disorders among somatizing patients in primary health care.
Unrecognized, untreated and undertreated depressive disorders incur inordinate human and economic costs, despite the availability of an exclusive array of clinical interventions. The aim of this study was to identify cases of masked depression in primary health care, employing a two-stage design. In the first stage, involving a study of 442 patients, the prevalence of recognized depression was 1.8%. In the second step, 62 patients from stage 1 were investigated further because of their high score on somatization tendency. In total, 41 of the 62 patients were found to have a mood disorder according to DSM-III-R, i.e. a major depressive disorder or dysthymia. Two patients were found to have already had a diagnosis of major depression assigned to them in stage 1, but they were joined by 13 more patients. A further 26 patients were found to be suffering from dysthymia, nine had adjustment disorders with depressed mood, and 12 patients showed no signs of depressed mood. For the group suffering from a current episode of major depression or dysthymia, the prevalence rate increased to 11.7% in the initial total population after stage 2. The diagnostic category with the highest rate of depressed patients was 'musculoskeletal diseases'. Patients with masked depression had higher scores for alexithymia and psychasthenia than depressed patients who were directly diagnosed.
Department of Clinical Neuroscience and Family Medicine, Karolinska Institute at Huddinge Hospital, Sweden.
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Posse
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Hällström
D000275:Adjustment Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D000328:Adult; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010348:Patient Care Team; D010555:Personality Inventory / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D013548:Sweden / Q000453:epidemiology