Depressive Symptomatology and Medical Co-Morbidity in a Primary Care Clinic

• Published in: International journal of psychiatry in medicine 1990-01, Vol.20 (4), p.335-347
• Main Authors: Coulehan, John L., Schulberg, Herbert C., Block, Marian R., Janosky, Janine E., Arena, Vincent C.
• Format: Article
• Language: English
• Subjects: Adjustment Disorders - diagnosis; Adjustment Disorders - drug therapy; Adjustment Disorders - psychology; Adult; Antidepressive Agents - therapeutic use; Cross-sectional studies; Depressive Disorder - diagnosis; Depressive Disorder - drug therapy; Depressive Disorder - psychology; Female; Humans; Male; Mental depression; Middle Aged; Morbidity; Personality Tests; Primary care; Primary Health Care; Psychophysiologic Disorders - diagnosis; Psychophysiologic Disorders - drug therapy; Psychophysiologic Disorders - psychology; Sick Role
• ISSN: 0091-2174; 1541-3527
• DOI: 10.2190/E3QN-9KTR-66CR-Q8TF

Most primary care patients exhibiting significant depressive symptomatology fail to meet DSM-III criteria for a major depressive disorder (MDD). Yet, such patients have substantial morbidity and dysfunction attributable to their affective syndrome. Since surprisingly little is known about this group's clinical characteristics, we studied 618 general medicine patients aged eighteen to sixty-four years. In this population, fifty-seven (9.2%) scored quite high when screened on the Center for Epidemiological Studies Depression Scale (≥ 27) while not meeting MDD criteria on the Diagnostic Interview Schedule. Membership in the “depression symptoms only” (DSO) group was predicted by a logistic regression model including female gender, more severe medical illness, higher likelihood of operative procedures, and less frequent cardiovascular diagnoses. Our findings suggest that the DSO state is associated with substantial “medical” morbidity. Prospective studies of subclinical depression in the primary care setting are urged to clarify etiologic and treatment concerns.