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Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis

¹ Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
² Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex
³ Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa
⁴ The Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Mass
⁵ Department of Family Medicine, University of Michigan, Ann Arbor, Mich

CORRESPONDING AUTHOR: Bradley N. Gaynes, MD, MPH Department of Psychiatry, CB #7160, University of North Carolina School of Medicine Chapel Hill, NC 27599-7160 bngaynes{at}med.unc.edu

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.

Key Words: Primary care • depression • suicide • psychiatric comorbidity

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