THE RELATIONSHIP OF PRESENTING PHYSICAL COMPLAINTS TO DEPRESSIVE SYMPTOMS IN PRIMARY CARE PATIENTS

Objective: To assess the relationship of specific patient chief physical complaints to underlying depressive symptoms in primary care practice. Design: A cross-sectional study that was part of a larger prevalence study of depression in primary care. Setting: A general medical primary care practice in a teaching medical center in rural New England. Patients: 1,042 consecutive outpatients screened for depression with the Hopkins Symptom Checklist 49-item depression scale and for whom physicians filled out a form recording both specific chief complaints and two aspects of complaint presentation style, clarity and amplification. Interventions: None. Results: Complaints that discriminated between depressed and non-depressed patients (at the p = 0.05 level) were sleep disturbance (PPV 61%), fatigue (PPV 60%), multiple (3+) complaints (PPV 56%), nonspecific musculoskeletal complaints (PPV 43%), back pain (PPV 39%), shortness of breath (PPV 39%), amplified complaints (PPV 39%), and vaguely stated complaints (PPV 37%). Conclusions: Depressed patients are common in primary care practice and important to recognize. Certain specific complaints and complaint presentation styles are associated with underlying depressive symptoms.