Abstract
PURPOSE: To identify the predictors of depressive and anxiety disorders in general
medical patients presenting with physical complaints and to determine the effect of
these mental disorders on patient outcome.
PATIENTS AND METHODS: In this cohort study, 500 adults presenting to a general medicine
clinic with a chief complaint of a physical symptom were interviewed with PRIME-MD
to diagnose DSM-IV depressive and anxiety disorders. Clinical predictors were identified
by logistic regression analysis. Outcomes were assessed immediately postvisit and
at 2 weeks and 3 months. These included symptomatic improvement, functional status,
unmet expectations, satisfaction with care, clinician-perceived patient difficulty,
and health care utilization and costs.
RESULTS: A depressive or anxiety disorder was present in 146 (29%) of the patients.
Independent predictors of a mental disorder included recent stress, multiple physical
symptoms (ie, 6 or more), higher patient ratings of symptom severity, lower patient
ratings of their overall health, physician perception of the encounter as difficult,
and patient age less than 50. Patients with depressive or anxiety disorders were more
likely to have unmet expectations postvisit (20% versus 8%, P < 0.001), be considered difficult (26% versus 11%, P < 0.0001), and report persistent psychiatric symptoms and ongoing stress even 3 months
following the initial visit. Psychiatric status was not associated with symptomatic
improvement, health care utilization, or costs.
CONCLUSION: Simple clinical clues in patients with physical complaints identify a
subgroup who may warrant further evaluation for a depressive or anxiety disorder.
Such disorders are associated with unmet patient expectations and increased provider
frustration.
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Article Info
Publication History
Accepted:
May 16,
1997
Received:
October 11,
1996
Footnotes
☆The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Identification
Copyright
© 1997 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
