Prevalence and treatment of depression in a hospital department of internal medicine.
BACKGROUND
Depressive disorders are overrepresented among patients admitted to nonpsychiatric units of general hospitals, but the majority of depressed patients are not identified in this setting. Effective and well-tolerated treatments and reliable diagnostic criteria, together with new assessment tools (self-administered or not), have been developed with encouraging results. Nevertheless, few studies have utilized standardized instruments and extensive clinical interviews by well-trained psychiatrists to assess depression. New research should test these tools in a French-speaking environment.


METHODS
The investigation covered 292 patients aged 18-65 who were admitted over a period of 6 months to the internal medicine units of Geneva University Hospitals. Each patient filled in a self-administered questionnaire for depression [Patient Health Questionnaire (PHQ-9)]; 212 patients were also evaluated by a psychiatrist using DSM-IV diagnostic assessment and the Hamilton Depression Rating Scale during the first week of their hospital stay; both assessments were single-blinded.


RESULTS
Psychiatric clinical interviews identified a high proportion (26.9%) of depressive disorders (37% among women) for all diagnoses; 11.3% (17.3% among women) of the patients met the DSM-IV criteria for major depression. The PHQ-9 identified depressive disorders among 34.9% of patients (42% among women) and identified a major depressive syndrome among 18.4% of patients (29.6% among women). Physicians in the internal medicine unit identified only about half the depressive patients; at the time of psychiatric examination, fewer than one in four patients was receiving antidepressant therapy.


CONCLUSIONS
Our findings confirm the results of previous investigations, which showed that the failure to detect and treat depression is a major health problem among patients admitted to nonpsychiatric units of a general hospital.
Rentsch
Denis
D
Service d'accueil, d'urgences et de liaison psychiatriques, Unité de psychiatrie de liaison, University Hospitals of Geneva, 1211 Geneva, Switzerland. denis.rentsch@hcuge.ch
Dumont
Patricia
P
Borgacci
Sandro
S
Carballeira
Yolanda
Y
deTonnac
Nicolas
N
Archinard
Marc
M
Andreoli
Antonio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006748:Hospital Departments; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index; D016037:Single-Blind Method; D011795:Surveys and Questionnaires