Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients

Coyne, James C.; Klinkman, Michael S.; Gallo, Susan; Schwenk, Thomas L.

doi:10.1016/s0163-8343(97)00055-8

Cited by 64 publications

(43 citation statements)

References 37 publications

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“…In fact, on the one hand, recent research has shown that referring to life events or social difficulties offers most acceptable access to psychological symptoms [38], even if confiding or not confiding is related to the patients’ attitude and trust towards their GPs [39]. On the other hand, even when GPs are able to recognize psychiatric symptoms, this is not per se necessarily associated with a better outcome [40, 41, 42]. This supports the notion that psychological morbidity is a multidetermined problem [43]which needs to be approached in a psychosocial sense rather than a symptomatic one.…”

Section: Discussionmentioning

confidence: 99%

Social Support and Psychological Distress in Primary Care Attenders

Grassi

Rasconi

Pedriali

et al. 2000

Psychother Psychosom

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Background: Growing evidence has been collected about the high prevalence of psychological distress in primary care. The role of psychosocial variables, namely the role of support from the patients’ interpersonal ties, has not been extensively explored. Methods: The study investigated the relationship between perceived social support, as evaluated by the Multidimensional Scale of Perceived Social Support, and psychological distress, as measured by the Brief Symptom Inventory, in 1,341 primary care attenders. Results: In comparison with highly supported patients, lowly supported subjects showed higher scores on distress dimensions (e.g. depression, anxiety, phobia) and a higher prevalence of psychological morbidity (‘caseness’ = 37.3 vs. 11%). Conclusion: The findings suggest that, in the setting of primary care, the GPs’ assessment of their patients’ social support system may be useful in identifying those more vulnerable to psychological stress.

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Section: Discussionmentioning

confidence: 99%

Social Support and Psychological Distress in Primary Care Attenders

Grassi

Rasconi

Pedriali

et al. 2000

Psychother Psychosom

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“…Results of multiple studies have indicated that depression has high prevalence but is underdiagnosed in the general medical care sector [Coyne et al, 1997;Freeling and Tylee, 1992;Gilbody et al, 2002;Maier et al, 1996]. One reason could be the high rate of comorbidity with anxiety and/or somatoform disorders, which may hide depressive symptoms, because patients with anxiety and especially somatoform disorders tend to report multiple unexplained somatic symptoms but may not express psychological distress.…”

Section: Introductionmentioning

confidence: 99%

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

et al. 2007

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Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).

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“…Whereas some suggest that undetected depression in primary care is mild and does not necessarily require intervention (Coyne et al, 1995;Coyne, Klinkman, Gallo, & Schwenk, 1997), others maintain that undetected patients manifest serious symptomatology that persists over time (Rost et al, 1998). Findings that detected patients evince greater improvement in depression symptoms than undetected patients argue that increased detection represents a necessary first step toward improvement of primary care depression treatment .…”

Section: Introductionmentioning

confidence: 99%

“…For instance, procedures for identification of depression cases and treatment have ranged from surveillance of the medical chart (Charboneau, Rosen, Ash, Owen, Kader, Spiro et al, 2003;Rost et al, 1998) to specific questions posed to providers or patients (Burns, Ryan Wagner, Gaynes, Wells, & Schulberg, 2000;Coyne et al, 1997;Simon et al, 1999). In comparison to existing studies, the present analysis is unique in its combination of self-report and administrative data.…”

Section: Introductionmentioning

confidence: 99%

Depression Diagnosis and Antidepressant Treatment among Depressed VA Primary Care Patients

Liu

Campbell

Chaney

et al. 2006

Adm Policy Ment Health

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This study examined the extent to which 3559 VA primary care patients with depression symptomatology received depression diagnoses and/or antidepressant prescriptions. Symptomatology was classified as mild (13%), moderate (42%) or severe (45%) based on SCL-20 scores. Diagnosis and treatment was related to depression severity and other patient characteristics. Overall, 44% were neither diagnosed nor treated. Only 22% of those neither diagnosed nor treated for depression received treatment for other psychopathology. Depression treatment performance measures dependent on diagnoses and antidepressant prescriptions from administrative databases exclude undiagnosed patients with significant, treatable, symptomatology.

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Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients

Cited by 64 publications

References 37 publications

Social Support and Psychological Distress in Primary Care Attenders

Social Support and Psychological Distress in Primary Care Attenders

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

Depression Diagnosis and Antidepressant Treatment among Depressed VA Primary Care Patients

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