title: Clinical features of depression in outpatients with and without co-occurring general medical conditions in STAR*D: confirmatory analysis.
abstract: BACKGROUND
  Concurrent medical comorbidity influences the accurate diagnosis and treatment of major depressive disorder (MDD).
  
  
  OBJECTIVE
  The objective of this study was to validate previous findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study using a confirmation analysis in a previously unanalyzed cohort.
  
  
  METHODS
  Baseline cross-sectional case-control study of patients enrolling in a prospective randomized multistage treatment study of nonpsychotic MDD.
  
  
  METHODS
  Fourteen regional U.S. centers representing 18 primary care and 23 psychiatric practices.
  
  
  METHODS
  2541 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 general medical comorbidity in this population was 50.0% (95% CI = 48.1% to 52.0%), consistent with findings reported for the first cohort. Concurrent significant medical comorbidity was associated with older age, lower income, unemployment, limited education, and longer duration of index depressive episode. The group with significant medical comorbidity reported higher rates of somatic symptoms, gastrointestinal symptoms, sympathetic arousal, and leaden paralysis. These results were generally consistent between the 2 cohorts from STAR*D.
  
  
  CONCLUSIONS
  Major depressive disorder with concurrent general medical conditions is associated with a specific sociodemographic profile and pattern of depressive symptoms. This association has implications for diagnosis and clinical care.
authors.affiliation: Department of Psychiatry, University of Oklahoma College of Medicine, Tulsa, OK, USA. william-yates@ouhsc.edu
authors.forename: William R
authors.initials: WR
authors.lastname: Yates
authors.forename: Jeff
authors.initials: J
authors.lastname: Mitchell
authors.forename: A
authors.initials: A
authors.lastname: John Rush
authors.forename: Madhukar
authors.initials: M
authors.lastname: Trivedi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Diane
authors.initials: D
authors.lastname: Warden
authors.forename: Charlene
authors.initials: C
authors.lastname: Bryan
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Husain
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes