Major depression symptoms in primary care and psychiatric care settings: A cross-sectional analysis

被引:78
作者
Gaynes, Bradley N.
Rush, A. John
Trivedi, Madhukar H.
Wisniewski, Stephen R.
Balasubramani, G. K.
Spencer, Donald C.
Petersen, Timothy
Klinkman, Michael
Warden, Diane
Nicholas, Linda
Fava, Maurizio
机构
[1] Univ N Carolina, Dept Psychiat, Sch Med, Chapel Hill, NC 27599 USA
[2] Univ Texas, SW Med Ctr, Dept Psychiat, Dallas, TX 75230 USA
[3] Univ Pittsburgh, Epidemiol Data Ctr, Grad Sch Publ Hlth, Pittsburgh, PA USA
[4] Massachusetts Gen Hosp, Depress Clin & Res Program, Boston, MA 02114 USA
[5] Univ Michigan, Dept Family Med, Ann Arbor, MI 48109 USA
关键词
primary care; depression; suicide; psychiatric comorbidity;
D O I
10.1370/afm.641
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE We undertook a study to confirm and extend preliminary findings that participants with major depressive disorder (MDD) in primary care and specialty care settings have with equivalent degrees of depression severity and an indistinguishable 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 moderately 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.
引用
收藏
页码:126 / 134
页数:9
相关论文
共 62 条
  • [31] Evidence-based models of integrated management of depression in primary care
    Oxman, TE
    Dietrich, AJ
    Schulberg, HC
    [J]. PSYCHIATRIC CLINICS OF NORTH AMERICA, 2005, 28 (04) : 1061 - +
  • [32] A reevaluation of the exclusion criteria used in antidepressant efficacy trials
    Posternak, MA
    Zimmerman, M
    Keitner, GI
    Miller, IW
    [J]. AMERICAN JOURNAL OF PSYCHIATRY, 2002, 159 (02) : 191 - 200
  • [33] Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders
    Regier, DA
    Rae, DS
    Narrow, WE
    Kaelber, CT
    Schatzberg, AF
    [J]. BRITISH JOURNAL OF PSYCHIATRY, 1998, 173 : 24 - 28
  • [34] Comorbid psychiatric disorders in depressed outpatients: Demographic and clinical features
    Rush, AJ
    Zimmerman, M
    Wisniewski, SR
    Fava, M
    Hollon, SD
    Warden, D
    Biggs, MM
    Shores-Wilson, K
    Shelton, RC
    Luther, JF
    Thomas, B
    Trivedi, MH
    [J]. JOURNAL OF AFFECTIVE DISORDERS, 2005, 87 (01) : 43 - 55
  • [35] Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design
    Rush, AJ
    Fava, M
    Wisniewski, SR
    Lavori, PW
    Trivedi, MH
    Sackeim, HA
    Thase, ME
    Nierenberg, AA
    Quitkin, FM
    Kashner, TM
    Kupfer, DJ
    Rosenbaum, JF
    Alpert, J
    Stewart, JW
    McGrath, PJ
    Biggs, MM
    Shores-Wilson, K
    Lebowitz, BD
    Ritz, L
    Niederehe, G
    [J]. CONTROLLED CLINICAL TRIALS, 2004, 25 (01): : 119 - 142
  • [36] The Inventory of Depressive Symptomatology (IDS): Psychometric properties
    Rush, AJ
    Gullion, CM
    Basco, MR
    Jarrett, RB
    Trivedi, MH
    [J]. PSYCHOLOGICAL MEDICINE, 1996, 26 (03) : 477 - 486
  • [37] MAJOR DEPRESSION IN PRIMARY-CARE PRACTICE - CLINICAL CHARACTERISTICS AND TREATMENT IMPLICATIONS
    SCHULBERG, HC
    MADONIA, MJ
    BLOCK, MR
    COULEHAN, JL
    SCOTT, CP
    RODRIGUEZ, E
    BLACK, A
    [J]. PSYCHOSOMATICS, 1995, 36 (02) : 129 - 137
  • [38] Differences between detected and undetected patients in primary care and depressed psychiatric patients
    Schwenk, TL
    Coyne, JC
    FechnerBates, S
    [J]. GENERAL HOSPITAL PSYCHIATRY, 1996, 18 (06) : 407 - 415
  • [39] Simon G E, 1995, Arch Fam Med, V4, P99, DOI 10.1001/archfami.4.2.99
  • [40] Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians
    Simon, GE
    Von Korff, M
    Rutter, CM
    Peterson, DA
    [J]. ARCHIVES OF GENERAL PSYCHIATRY, 2001, 58 (04) : 395 - 401