Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR*D.
BACKGROUND
A significant percentage of patients with major depressive disorder (MDD) suffer from concurrent general medical conditions (GMCs).


OBJECTIVE
The objective of this preliminary report was to describe the rates of co-occurring significant GMCs and the clinical correlates and symptom features associated with the presence of GMCs.


METHODS
Baseline cross-sectional case-control study of patients enrolling in a prospective randomized multistage treatment study of MDD.


METHODS
Fourteen regional U.S. centers representing 19 primary care and 22 psychiatric practices.


METHODS
One thousand five hundred outpatients with DSM-IV nonpsychotic MDD.


METHODS
Sociodemographic status, medical illness ratings, psychiatric status, quality of life and DSM-IV depression symptom ratings.


RESULTS
The prevalence of significant medical comorbidity in this population was 52.8% (95% CI 50.3-55.3%). Concurrent significant medical comorbidity was associated with older age, lower income, unemployment, limited education, longer duration of index depressive episode and absence of self-reported family history of depression. Somatic symptoms common in MDD were endorsed at a higher rate in those with GMCs. Those without a GMC had higher rates of endorsement of impaired mood reactivity, distinct mood quality and interpersonal sensitivity.


CONCLUSIONS
Concurrent GMCs are common among outpatients with MDD in both primary care and specialty settings. Concurrent GMCs appear to influence the severity and symptom patterns in MDD and describe a vulnerable population with sociodemographic challenges to effective assessment and treatment.
Yates
William R
WR
Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa, OK 74135, USA. william-yates@ouhsc.edu
Mitchell
Jeff
J
Rush
A John
AJ
Trivedi
Madhukar H
MH
Wisniewski
Stephen R
SR
Warden
Diane
D
Hauger
Robert B
RB
Fava
Maurizio
M
Gaynes
Bradley N
BN
Husain
Mustafa M
MM
Bryan
Charlene
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011613:Psychotherapy; D011788:Quality of Life / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012803:Sick Role; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors