Major depression symptoms in primary care and psychiatric care settings: a cross-sectional analysis
| Autor: | Maurizio Fava, Diane Warden, Goundappa K. Balasubramani, Michael S. Klinkman, Timothy Petersen, Linda M. Nicholas, Madhukar H. Trivedi, A. John Rush, Donald C. Spencer, Bradley N. Gaynes, Stephen R. Wisniewski |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Mental Health Services medicine.medical_specialty Health Status Specialty Poison control Suicide Attempted Comorbidity Severity of Illness Index Quality of life (healthcare) Age Distribution Recurrence Severity of illness medicine Humans Psychiatry Depression (differential diagnoses) Original Research Depressive Disorder Major Primary Health Care business.industry Depression Mental Disorders Racial Groups Hamilton Rating Scale for Depression medicine.disease United States Cross-Sectional Studies Socioeconomic Factors Chronic Disease Quality of Life Major depressive disorder Female Family Practice business |
| Zdroj: | Annals of family medicine. 5(2) |
| ISSN: | 1544-1717 |
| Popis: | PURPOSE We undertook a study to confi rm and extend preliminary fi ndings that participants with major depressive disorder (MDD) in primary care and specialty care settings have with equivalent degrees of depression severity and an indistin- guishable constellation of symptoms. METHODS Baseline data were collected for a distinct validation cohort of 2,541 participants (42% primary care) from 14 US regional centers comprised of 41 clinic sites (18 primary care, 23 specialty care). Participants met broadly inclusive eligibility criteria requiring a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of MDD and a minimum depressive symptom score on the 17-item Hamilton Rating Scale for Depression. The main outcome measures were the 30-item Inventory of Depressive Symptomatology - Clinician Rated and the Psychiatric Diagnostic Screening Questionnaire. RESULTS Primary care and specialty care participants had identical levels of mod- erately severe depression and identical distributions of depressive severity scores. Both primary care and specialty care participants showed considerable suicide risk, with specialty care participants even more likely to report prior suicide attempts. Core depressive symptoms or concurrent psychiatric disorders were not substantially different between settings. One half of participants in each setting had an anxiety disorder (48.6% primary care vs 51.6% specialty care, P = .143), with social phobia being the most common (25.3% primary care vs 32.1% specialty care, P = .002). CONCLUSIONS For outpatients with nonpsychotic MDD, depressive symptoms and severity vary little between primary care and specialty care settings. In this large, broadly inclusive US sample, the risk factors for chronic and recurrent depressive illness were frequently present, highlighting a clear risk for treatment resistance and the need for aggressive management strategies in both settings. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|