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Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care

Published online by Cambridge University Press:  16 April 2020

Katrin Barkow ,
Reinhard Heun ,
T. Bedirhan Üstün ,
Mathias Berger ,
Isaac Bermejo ,
Wolfgang Gaebel ,
Martin Härter ,
Frank Schneider ,
Rolf-Dieter Stieglitz  and
Wolfgang Maier
Katrin Barkow*
Affiliation:
Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105Bonn, Germany
Reinhard Heun
Affiliation:
Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105Bonn, Germany
T. Bedirhan Üstün
Affiliation:
World Health Organization, Geneva, Switzerland
Mathias Berger
Affiliation:
Department of Psychiatry, University of Freiburg, Germany
Isaac Bermejo
Affiliation:
Department of Psychiatry, University of Freiburg, Germany
Wolfgang Gaebel
Affiliation:
Department of Psychiatry, University of Düsseldorf, Germany
Martin Härter
Affiliation:
Department of Psychiatry, University of Freiburg, Germany
Frank Schneider
Affiliation:
Department of Psychiatry, University of Düsseldorf, Germany Department of Psychiatry and Psychotherapy, University Hospital, Aachen, Germany
Rolf-Dieter Stieglitz
Affiliation:
University Psychiatric Outpatient Department, University of Basel, Switzerland
Wolfgang Maier
Affiliation:
Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53105Bonn, Germany
*
*Corresponding author. E-mail address: [email protected] (K. Barkow).
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Abstract

Somatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview—Primary Health Care Version (CIDI—PHC) can improve the detection of depression as compared to the General Health Questionnaire—12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI—PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and—to a smaller extent—diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.

Keywords

DepressionPrimary careDetectionScreening instrumentsSomatisationAnxiety
Type
Original article
Information
European Psychiatry , Volume 19 , Issue 5 , August 2004 , pp. 250 - 257
Copyright
Copyright © 2004 European Psychiatric Association

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References

Andrews, GPeters, LThe psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epide miology 1998;33:80–8.CrossRefGoogle ScholarPubMed
Aneshensel, CSFrerichs, RRHuba, GJDepression and physical illness: a multiwave, nonrecursive causal model. J Health Soc Behav 1984;25:350–71.CrossRefGoogle ScholarPubMed
Angst, JMajor depression in 1998: are we providing optimal therapy? J Clin Psychiatry 1999;60(Suppl 6):5–9.Google ScholarPubMed
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th ed. (DSM-IV). Washington (DC): APA; 1994.Google Scholar
Barsky, AJBorus, JBSomatization and medicalization in the era of managed care. JAMA 1995;274:1931–4.CrossRefGoogle ScholarPubMed
Burnam, MAWells, KBLeake, BLandsverk, JDevelopment of a brief screening instrument for detecting depressive disorders. Med Care 1988;26:775–89.CrossRefGoogle ScholarPubMed
Cadoret, RJWidmer, RBNorth, CDepression in family practice: long term prognosis and somatic complaints. J Fam Pract 1980;10:625–9.Google ScholarPubMed
Cadoret, RJWidmer, RBTroughton, EPSomatic complaints—harbinger of depression in primary care. J Affect Disord 1980;2:61–70.CrossRefGoogle ScholarPubMed
Cheung, FMLau, BWWaldmann, ESomatization among Chinese depressives in general practice. Int J Psychiatry Med 1980–81;10:361–74.CrossRefGoogle Scholar
Coyne, JCFechner-Bates, SSchwenk, TLPrevalence, nature, and comorbidity of depressive symptoms in primary care. Gen Hosp Psychiatry 1994;16:267–76.CrossRefGoogle ScholarPubMed
Diamond, ELGage, LEpting, RSymptoms associated with the diagnosis and treatment of depression in family practice. Fam Pract Res J 1987;6:206–14.Google ScholarPubMed
Division of Mental Health. CIDI-Core. Composite International Diagnostic Interview, Core Version 1.0—November 1990. Geneva: WHO; 1990.Google Scholar
Fishbain, DACutler, RRosomoff, HLRosomoff, RSChronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997;13:116–37.CrossRefGoogle ScholarPubMed
Geerlings, SWBeekman, ATFDeeg, DJHvan Tilburg, W.Physical health and the onset and persistence of depression in older adults: an eight-wave prospective community-based study. Psychol Med 2000; 30:369–80.CrossRefGoogle Scholar
Gerber, PDBarrett, JEBarrett, JAOxman, TEManheimer, ESmith, Ret al.The relationship of presenting physical complaints to depressive symptoms in primary care patients. J Gen Intern Med 1992;7:170–3.CrossRefGoogle ScholarPubMed
Goldberg, DEpidemiology of mental disorders in primary care settings. Epidemiol Rev 1995;7:182–90.CrossRefGoogle Scholar
Goldberg, DPWilliams, PA users guide to the General Health Questionnaire: GHQ. Windsor: NFER-NELSON; 1988.Google Scholar
Goldman, LSNielsen, NHChampion, HCAwareness, diagnosis, and treatment of depression. J Gen Intern Med 1999;14:569–80.CrossRefGoogle ScholarPubMed
Henkel, VMergl, RKohnen, RMaier, WMöller, H-JHegerl, UIdentifying depression in primary care: a comparison of different methods in a prospective cohort study. BMJ 2003;326:200–1.CrossRefGoogle ScholarPubMed
Herrman, HPatrick, DLDiehr, PMartin, MLFleck, MSimon, GEet al.Longitudinal investigation of depression outcomes in primary care in six countries: the LIDO Study. Functional status, health service use and treatment of people with depressive symptoms. Psychol Med 2002;32:889–902.Google ScholarPubMed
Hickie, IHadzi-Pavlovic, DScott, EDavenport, TKoschera, ANaismith, SSPHERE: a national depression project. Australas Psychiatry 1998;6:248–50.CrossRefGoogle Scholar
Hirschfeld, RMKeller, MBPanico, SArons, BSBarlow, DDavid-off, Fet al.The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA 1997;277:333–40.CrossRefGoogle ScholarPubMed
Hurwitz, ELMorgenstern, HCross-sectional association of asthma, hay fever, and other allergies with major depression and low-back pain among adults aged 20–39 years in the United States. Am J Epidemiol 1999;150:1107–16.CrossRefGoogle ScholarPubMed
Janca, ARobins, LNCottler, LBEarly, TSClinical observation of assessment using the Composite International Diagnostic Interview (CIDI): an analysis of the CIDI field trials—wave II at the St Louis site. Br J Psychiatry 1992;160:815–8.CrossRefGoogle ScholarPubMed
Katon, WThe epidemiology of depression in medical care. Int J Psychiatry Med 1987;17:93–112.CrossRefGoogle ScholarPubMed
Katon, WRusso, JSomatic symptoms and depression. J Fam Pract 1989;29:65–9.Google ScholarPubMed
Katon, WSchulberg, HEpidemiology of depression in primary care. Gen Hosp Psychiatry 1992;14:237–47.CrossRefGoogle ScholarPubMed
Kroenke, KJackson, JLChamberlin, JDepressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med 1997;103:339–47.CrossRefGoogle ScholarPubMed
Kroenke, KSpitzer, RLWilliams, JLinzer, MHahn, SRde Gruy, FV IIIet al.Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Arch Fam Med 1994;3:774–9.Google ScholarPubMed
Luber, MPHollenberg, JPWilliams-Russo, PDiDomenico, TNMeyers, BSAlexopoulos, GSet al.Diagnosis, treatment, comorbidity, and resource utilization of depressed patients in a general medical practice. Int J Psychiatry Med 2000;30:1–13.CrossRefGoogle Scholar
Mulrow, CDWilliams, JW JrGerety, MBRamirez, GMontiel, OMKerber, CCase-finding instruments for depression in primary care settings. Ann Intern Med 1995;123:913–21.CrossRefGoogle Scholar
Nisenson, LGPepper, CMSchwenk, TLCoyne, JCThe nature and prevalence of anxiety in primary care. Gen Hosp Psychiatry 1998;20: 21–8.CrossRefGoogle ScholarPubMed
Ormel, JVon Korff, MÜstün, TBPini, SKorten, AOldehinkel, TCommon mental disorders and disability across cultures. Results from the WHO collaborative study on psychological problems in general health care. JAMA 1994;272:1741–8.Google ScholarPubMed
Paterniti, SVerdier-Taillefer, M-HGeneste, CBisserbe, J-CAlpérovitch, A.Low blood pressure and risk of depression in the elderly. A prospective community-based study. Br J Psychiatry 2000;176: 464–7.Google ScholarPubMed
Pini, SPerkonnig, ATansella, MWittchen, H-UPrevalence and 12-month outcome of threshold and subthreshold mental disorders in primary care. J Affect Disord 1999;56:37–48.CrossRefGoogle ScholarPubMed
Rogers, WHWilson, IBBungay, KMCynn, DJAdler, DAAssessing the performance of a new depression screener for primary care (PC-SAD). J Clin Epidemiol 2002;55:164–75.CrossRefGoogle Scholar
Salokangas, RKRPoutanen, OStengard, EScreening for depression in primary care. Development and validation of the Depression Scale, a screening instrument for depression. Acta Psychiatr Scand 1995;92: 10–6.CrossRefGoogle ScholarPubMed
Sartorius, NÜstün, TBCosta e Silva, J-AGoldberg, DLecrubier, YOrmel, Jet al. An international study of psychological problems in primary care. Preliminary report from the World Health Organization collaborative project on ‘Psychological Problems in General Health Care’. Arch Gen Psychiatry 1993;50:819–24.Google Scholar
Sherbourne, CDJackson, CAMeredith, LSCamp, PWells, KBPrevalence of comorbid anxiety disorders in primary care outpatients. Arch Fam Med 1996;5:27–34.CrossRefGoogle ScholarPubMed
Simon, GEVon Korff, MBarlow, WHealth care costs of primary care patients with recognized depression. Arch Gen Psychiatry 1995;52: 850–6.CrossRefGoogle ScholarPubMed
Simon, GEVon Korff, MPiccinelli, MFullerton, COrmel, JAn international study of the relation between somatic symptoms and depression. N Engl J Med 1999;341:1329–35.CrossRefGoogle Scholar
Spitzer, RLWilliams, JBKroenke, KLinzer, Mde Gruy, FV IIIHahn, SRet al.Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;272:1749–56.Google ScholarPubMed
Stewart, RPrince, MRichards, MBrayne, CMann, AStroke, vascular risk factors and depression. Cross-sectional study in a UK Caribbean-born population. Br J Psychiatry 2001;178:23–8.CrossRefGoogle Scholar
Susman, JLCrabtree, BFEssink, GDepression in rural family practice. Easy to recognize, difficult to diagnose. Arch Fam Med 1995;4: 427–31.CrossRefGoogle ScholarPubMed
Turk, DCOkifuji, AScharff, LChronic pain and depression: role of perceived impact and perceived control in different age cohorts. Pain 1995;61:93–101.CrossRefGoogle ScholarPubMed
Tylee, ADepression in the community: physician and patient perspective. J Clin Psychiatry 1999;60(Suppl 7):12–6.Google ScholarPubMed
Üstün, TBSartorius, N editors. Mental illness in general health care An international study. Chichester: Wiley; 1995.Google Scholar
Üstün, TBVon Korff, MPrimary mental health services: access and provision of care. In: Üstün, TBSartorius, N editors. Mental illness in general health care An international study. Chichester: Wiley; 1995. p. 347–60.Google Scholar
Von Korff, MSimon, GThe relationship between pain and depression. Br J Psychiatry 1996;168(Suppl 30):101–8.CrossRefGoogle Scholar
Von Korff, MÜstün, TBMethods of the WHO collaborative study on ‘Psychological Problems in General Health Care’. In: Üstün, TBSartorius, N editors. Mental illness in general health care An international study. Chichester: Wiley; 1995. p. 19–38.Google Scholar
Walker, EAKaton, WJJemelka, RPRoy-Byrne, PPComorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemio-logic Catchment Area (ECA) Study. Am J Med 1992;92(1A):26S–30S.CrossRefGoogle Scholar
Widmer, RBCadoret, RJDepression in primary care: changes in pattern of patient visits and complaints during a developing depression. J Fam Pract 1978;7:293–302.Google ScholarPubMed
Williams, JW JrPignone, MRamirez, GPerez Stellato, CIdentifying depression in primary care: a literature synthesis of case-finding instruments. Gen Hosp Psychiatry 2002;24:225–37.CrossRefGoogle ScholarPubMed
Williamson, HA JrClinical and demographic factors associated with high levels of depression symptoms. Fam Med 1989;21:428–32.Google ScholarPubMed
Williamson, GMSchulz, RPain, activity restriction, and symptoms of depression among community-residing elderly adults. J Gerontol 1992;47:P367–72.CrossRefGoogle ScholarPubMed
Wilson, DRWidmer, RBCadoret, RJJudiesch, KSomatic Symptoms. A major feature of depression in a family practice. J Affect Disord 1983;5:199–207.CrossRefGoogle Scholar
Wittchen, H-UGeneralized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 2002;16:162–71.CrossRefGoogle ScholarPubMed
Wittchen, H-UHoyer, JGeneralized anxiety disorder: nature and course. J Clin Psychiatry 2001;62(Suppl 11):15–9.Google ScholarPubMed
World Health Organization (WHO). The ICD-10 Classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva: WHO; 1992.Google Scholar
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