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How to early recognize mood disorders in primary care: A nationwide, population-based, cohort study

Published online by Cambridge University Press:  23 March 2020

G. Castellini ,
S. Pecchioli ,
I. Cricelli ,
F. Mazzoleni ,
C. Cricelli ,
V. Ricca ,
J.J. Hudziak ,
O. Brignoli  and
F. Lapi
G. Castellini
Affiliation:
Psychiatric Unit, Department of Neuroscience, Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, Florence University School of Medicine, Florence, Italy
S. Pecchioli
Affiliation:
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
I. Cricelli
Affiliation:
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
F. Mazzoleni
Affiliation:
Italian College of General Practitioners and Primary Care, Florence, Italy
C. Cricelli
Affiliation:
Italian College of General Practitioners and Primary Care, Florence, Italy
V. Ricca
Affiliation:
Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
J.J. Hudziak
Affiliation:
Vermont Center for Children, Youth, and Families, University of Vermont, Burlington, VT, United States Erasmus University, Sophia Children’s Hospital, Rotterdam, The Netherlands Department of Child Psychiatry, Washington University, Saint-Louis, MO, United States
O. Brignoli
Affiliation:
Italian College of General Practitioners and Primary Care, Florence, Italy
F. Lapi*
Affiliation:
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
*
* Corresponding author. Health Search, Italian College of General Practitioners. Via Sestese, 61 50141, Florence, Italy. Tel.: +39 55 494 900; fax: +39 55 779 311x66. E-mail address:[email protected] (F. Lapi).
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Abstract

Background

Mood disorders are managed predominantly in primary care. However, general practitioners’ (GPs) ability to detect and diagnose patients with mood disorders is still considered unsatisfactory. The aim of the present study was to identify predictors for the early recognition of depressive disorder (DD) and bipolar disorder (BD) in general practice.

Methods

A cohort of 1,144,622 patients (605,285 women, 539,337 men) was investigated, using the Health Search IMS Health Longitudinal Patient Database. Predictors of DD or BD were identified at baseline encompassing somatization-related features, lifestyle variables, medical and psychiatric comorbidities. Patients were followed up as long as the following events occurred: diagnoses of DD or BD, death, end of the registration with the GP, end of the study period.

Results

We found an incidence rate of DD or BD of 53.61 and 1.5 per 10,000 person-years, respectively. For both the conditions, the incidence rate grew with age. Most of the lifestyle variables and medical comorbidities increased the risk of mood disorders. The strongest effect was found for migraine/headache (HR [95% CI] = 1.32 [1.26–1.38]), fatigue (1.32 [1.25–1.39]) irritable bowel syndrome (1.15 [1.08-1.23]), and pelvic inflammation disease (1.28 [1.18–1.38]).

Conclusions

Several predictors, in particular somatic symptoms, could be interpreted as an early sign of a mood disorder, and represent a valid indication for the GPs diagnostic process of mental disorders.

Keywords

Depressive disorderBipolar disorderGeneral practicePublic mental healthSomatizationPrimary care
Type
Original article
Information
European Psychiatry , Volume 37 , September 2016 , pp. 63 - 69
Copyright
Copyright © European Psychiatric Association 2016

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References

Reed, CHong, JNovick, DLenox-Smith, AHappich, MHealth care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database. Clinicoecon Outcomes Res 2013; 5: 37–47CrossRefGoogle ScholarPubMed
Wittchen, HUJacobi, FRehm, JGustavsson, ASvensson, MJönsson, Bet al.The size and burden of mental disorders and other disorders of the brain in Europe 2010 Eur Neuropsychopharmacol 2011; 21: 655–679CrossRefGoogle ScholarPubMed
Pini, Sde Queiroz, VPagnin, DPezawas, LAngst, JCassano, GBet al.Prevalence and burden of bipolar disorders in European countries Eur Neuropsychopharmacol 2005; 15: 425–434CrossRefGoogle ScholarPubMed
Mitchell, PBBall, JRBest, JAGould, BMMalhi, GSRiley, GJet al.The management of bipolar disorder in general practice Med J Aust 2006; 184: 566–570CrossRefGoogle ScholarPubMed
Vedavanam, SSteel, NBroadbent, JMaisay, SHowe, ARecorded quality of care for depression in general practice: an observational study. Br J Gen Pract 2009; 59: 32–37CrossRefGoogle ScholarPubMed
Fleury, MJImboua, AAubé, DFarand, LLambert, YGeneral practitioners’ management of mental disorders: a rewarding practice with considerable obstacles. BMC Fam Pract 13 2012 19CrossRefGoogle ScholarPubMed
Walters, PTylee, AGoldberg, DMurray, RMKendler, KSMcGuffin, Pet al.Psychiatry in Primary Care. Essential Psychiatry 4th ed.UK: Cambridge University Press; 2008.479–497CrossRefGoogle Scholar
Bair, MJRobinson, RLEckert, GJStang, PECroghan, TWKroenke, KImpact of pain on depression treatment response in primary care. Psychosom Med 2004; 66: 17–22CrossRefGoogle ScholarPubMed
Bair, MJRobinson, RLKaton, WKroenke, KDepression and pain comorbidity: a literature review. Arch Intern Med 2003; 163: 2433–2445CrossRefGoogle ScholarPubMed
Ohayon, MMSchatzberg, AFChronic pain and major depressive disorder in the general population. J Psychiatr Res 2010; 44: 454–461CrossRefGoogle ScholarPubMed
Kroenke, KWu, JBair, MJKrebs, EEDamush, TMTu, WReciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain 2011; 12: 964–973CrossRefGoogle ScholarPubMed
Cosci, FFava, GASonino, NMood and anxiety disorders as early manifestations of medical illness: a systematic review. Psychother Psychosom 2015; 84: 22–29CrossRefGoogle ScholarPubMed
Garcia-Cebrian, AGandhi, PDemyttenaere, KPeveler, RThe association of depression and painful physical symptoms – a review of the European literature. Eur Psychiatry 2006; 21: 379–388CrossRefGoogle ScholarPubMed
Pasquali, RThe biological balance between psychological well-being and distress. Psychother Psychosom 2006; 75: 69–71CrossRefGoogle ScholarPubMed
Simon, GEVonKorff, MPiccinelli, MFullerton, COrmel, JAn international study of the relation between somatic symptoms and depression. N Engl J Med 1999; 341: 1329–1335CrossRefGoogle Scholar
Agüera, LFailde, ICervilla, JADíaz-Fernández, PMico, JAMedically unexplained pain complaints are associated with underlying unrecognized mood disorders in primary care. BMC Family Pract 2010 11–17CrossRefGoogle Scholar
Cricelli, CMazzaglia, GSamani, FMarchi, MSabatini, ANardi, Ret al.Prevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databases. J Public Health Med 2003; 25: 254–257CrossRefGoogle ScholarPubMed
Lapi, FSimonetti, MMichieli, RPasqua, ABrandi, MLFrediani, Bet al.Assessing 5-year incidence rates and determinants of osteoporotic fractures in primary care. Bone 2012; 50: 85–90CrossRefGoogle ScholarPubMed
Trifirò, GMorabito, PCavagna, LFerrajolo, CPecchioli, SSimonetti, Met al.Epidemiology of gout and hyperuricaemia in Italy during the years 2005–2009: a nationwide population-based study. Ann Rheum Dis 2013; 72: 694–700CrossRefGoogle ScholarPubMed
Vilagut, GForero, CGPinto-Meza, AHaro, JMde Graaf, RBruffaerts, Ret al.The mental component of the short-form 12 health survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods. Value Health 2013; 16: 564–573CrossRefGoogle ScholarPubMed
Wittchen, HUMhlig, SPezawas, LNatural course and burden of bipolar disorders. Int J Neuropsychopharmacol 2003; 6: 145–154CrossRefGoogle ScholarPubMed
Brugha, TSMatthews, RAlonso, JVilagut, GFouweather, TBruffaerts, Ret al.Gender differences in mental health expectancies in early- and midlife in six European countries. BJP 2013; 202: 294–300CrossRefGoogle ScholarPubMed
Fryers, TBrugha, TMorgan, ZSmith, JHill, TCarta, Met al.Prevalence of psychiatric disorder in Europe: the potential and reality of meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 899–905CrossRefGoogle ScholarPubMed
Gabilondo, ARojas-Farreras, SVilagut, GHaro, JMFernández, APinto-Meza, Aet al.Epidemiology of major depressive episode in a Southern European Country: results from the ESEMeD-Spain Project. J Affect Disord 2010; 120: 76–85CrossRefGoogle Scholar
Alonso, JBruffaerts, RGabilondo, AHaro, JMKovess, VVilagut, GESEMED/MHEDEA Investigators. European Commission Task Force on Major and Chronic Diseases of DG SANCO’s Health Information Strand Major and Chronic Diseases Report 2007. Luxembourg: European Commission. Depression 2008 101–116Google Scholar
Saroglou, VDelpierre, VDernelle, RValues and religiosity: a meta-analysis of studies using Schwartz’s model. Pers Individ Dif 2004; 37: 721–734CrossRefGoogle Scholar
Fernandez-Cordon, JASgritta, GBThe southern countries of the European Union: a paradox? Paper presented at the Annual seminar of The European Observatory on the Social Situation, Demography and Family. Low Fertility, families and public policies 2000 15–16Google Scholar
Levi, FLaVecchia, CLucchini, FNegri, ESaxena, SMaulik, PKet al.Trends in mortality from suicide, 1965–99. Acta Psychiatr Scand 2003; 108: 341–349CrossRefGoogle ScholarPubMed
Stegmann, MEOrmel, Jde Graaf, RHaro, JMde Girolamo, GDemyttenaere, Ket al.Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. J Affect Disord 2010; 124: 38–44CrossRefGoogle ScholarPubMed
Patten, SBLong-term medical conditions and major depression in a Canadian population study at waves 1 and 2. J Affect Disord 2001; 63: 35–41CrossRefGoogle Scholar
McIntyre, RSSoczynska, JKKonarski, JZWoldeyohannes, HOLaw, CWMiranda, Aet al.Should depressive syndromes be reclassified as “metabolic syndrome type II”?. Ann Clin Psychiatry 2007; 19: 257–264CrossRefGoogle ScholarPubMed
Schulz, RBeach, SRIves, DGMartire, LMAriyo, AAKop, WJAssociation between depression and mortality in older adults: the Cardiovascular Health Study. Arch Intern Med 2000; 160: 1761–1768CrossRefGoogle ScholarPubMed
Joynt, KEWhellan, DJO’Connor, CMDepression and cardiovascular disease: mechanisms of interaction. Biol Psychiatry 2003; 54: 248–261CrossRefGoogle ScholarPubMed
Ormel, JRijsdijk, FVSullivan, Mvan, SEKempen, GITemporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. J Gerontol B Psychol Sci Soc Sci 2002; 57: 338–347CrossRefGoogle ScholarPubMed
Eckhardt, MDvan Venrooij, GEvan Melick, HHBoon, TAPrevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol 2001; 66: 563–568CrossRefGoogle Scholar
Stensland, MDSchultz, JFFrytak, JRDepression diagnoses following the identification of bipolar disorder: costly incongruent diagnoses. BMC Psychiatry 2010 10–39CrossRefGoogle Scholar
Smith, DJThapar, ASimpson, SBipolar spectrum disorders in primary care: optimising diagnosis and treatment. Br J Gen Pract 2010; 60: 322–324CrossRefGoogle ScholarPubMed
Smith, DJCourt, HMcLean, GMartin, DLangan Martin, JGuthrie, Bet al.Depression and multimorbidity: cross-sectional study of 1,751,841 patients in primary care. J Clin Psychiatry 2014; 75(11): 1202–1208CrossRefGoogle ScholarPubMed
Smith DJ, Martin, DMcLean, GLangan, JGuthrie, BMercer, SWMultimorbidity in bipolar disorder and under-treatment of cardiovascular disease: cross sectional study. BMC Med 2013; 11(1): 263CrossRefGoogle Scholar
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