Article Figures & Data
Figures
- Figure 1.
Distribution of IDS-C30 by setting. IDS-C30 = 30-item Inventory of Depressive Symptomatology.
Tables
- Table 1.
Baseline Characteristics by Setting: Clinical Severity and Sociodemographic Features, by Recruitment Setting
Primary Care Specialty Care Total Baseline Characteristics n = 1,063 (41.8%) n = 1,478 (58.2%) N = 2,541 Mean (SD) Mean (SD) Mean (SD) PValue HRSD17 = 17-item Hamilton Rating Scale for Depression; ROA = research outcome assessor; IDS-C30: 30-item Inventory of Depressive Symptomatology, Clinician Rating. * Public Insurance includes both Medicare and Medicaid. HRSD17 (ROA) 19.6 (6.5) 19.7 (6.4) 19.6 (6.5) .839 IDS-C30 (ROA) 35.2 (11.6) 35.4 (11.3) 35.3 (11.4) .699 Age, years 43.7 (13.3) 38.2 (13.0) 40.5 (13.4) <.001 Years of schooling 12.8 (3.5) 13.8 (2.9) 13.4 (3.2) <.001 Race, % .866 White 73.9 74.6 74.3 Black or African American 17.6 16.8 17.1 Others 8.5 8.6 8.6 Ethnicity, Hispanic, % 22.0 9.3 14.6 <.001 Sex, female, % 68.0 59.0 62.8 <.001 Marital Status, % <.001 Never married 25.3 34.6 30.7 Married 42.9 39.4 40.8 Divorced 26.1 24.2 25.0 Widowed 5.7 1.8 3.5 Employment status, % .029 Unemployed 38.0 38.3 38.2 Employed 55.1 57.2 56.3 Retired 6.9 4.4 5.5 Insurance Status, % <.001 Private insurance 44.2 52.3 48.9 Public insurance* 22.1 8.4 15.5 No insurance 30.7 39.3 35.6 Level of education, % <.001 Less than completed college 80.1 72.6 75.7 Completed college or more 19.9 27.4 24.3 - Table 2.
Current General Medical Conditions and Function/Quality of Life, by Recruitment Setting
Primary Care Specialty Care n = 1,063 (41.8%) n = 1,478 (58.2%) Baseline Characteristics Mean (SD) Adjusted Mean (SE) Mean (SD) Adjusted Mean (SE) Total N = 2,541 Mean (SD) UnadjustedPValue AdjustedPValue* CIRS = Cumulative Illness Rating Scale; SF-12 = 12-Item Health Survey; WSAS = Work and Social Adjustment Scale; Q-LES-Q = Quality of Life Enjoyment and Satisfaction Questionnaire. * Adjusted for age, sex, education, marital status, employment status, ethnicity, length of current episode, and CIRS total score. CIRS, total score 5.1 (4.1) – 3.9 (3.7) – 4.4 (3.9) <.001 – SF-12 Physical 46.4 (12.3) 47.6 (0.5) 51.1 (11.6) 49.5 (0.5) 49.2 (12.1) <.001 .004 Mental 28.9 (9.8) 28.7 (0.4) 25.5 (8.3) 26.2 (0.4) 26.9 (8.8) <.001 <.001 WSAS 22.3 (9.8) 21.8 (0.5) 24.4 (8.9) 24.2 (0.4) 23.5 (9.3) <.001 <.001 Q-LES-Q 42.7 (15.9) 44.0 (0.7) 41.0( 14.9) 41.2 (0.7) 41.7 (15.4) 0.013 <.001 Primary Care Specialty Care Unadjusted Adjusted* n = 1,063 n = 1,478 Type and No. of Psychiatric Comorbidity (41.8%) % (58.2%) % OR PValue OR PValue Type of psychiatric comorbidity Anxiety disorders 48.6 51.6 1.06 .143 1.23 .019 Social phobia 25.3 32.1 1.39 .001 1.37 .002 Generalized anxiety disorder 2.3 21.2 1.05 .604 1.26 .037 Posttraumatic stress disorder 16.5 17.6 1.08 .494 1.26 .054 Obsessive compulsive disorder 15.1 13.4 0.87 .228 0.96 .755 Panic 14.5 11.1 0.74 .012 0.88 .333 Agoraphobia 12.2 11.7 0.96 .729 1.33 .046 Nonanxiety disorders 29.3 33.0 1.13 .051 1.21 .043 Alcohol abuse 1.4 13.1 1.30 .044 1.21 .411 Drug abuse 6.0 9.1 1.57 .005 1.22 .245 Somatoform 3.0 1.8 0.59 .05 0.98 .947 Hypochondriasis 6.1 3.3 0.52 .001 0.79 .285 Bulimia 1.8 13.4 1.27 .056 1.36 .025 Prevalence of any psychiatric comorbidity 59.2 64.1 1.23 .014 1.31 .003 Unadjusted Adjusted* No. No. PValue PValue ns = not significant. * Adjusted for age, sex, education, employment status, marital status, ethnicity, length of current episode and CIRS (total score). No. of psychiatric comorbidities Mean 1.4 1.5 .041 .002 Median 1.0 1.0 ns ns
Supplemental Table
Supplemental Table: Percentage of Patients With Specific Depressive Symptoms (IDS-C30 by ROA)
Files in this Data Supplement:
- Supplemental data: Table - PDF file, 1 page, 82 KB
The Article in Brief
Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis
Bradley N. Gaynes, MD, MPH, and colleagues
Background Depressed patients are more likely to see a primary care doctor than a mental health specialist for diagnosis and treatment of depression. This study compares characteristics and conditions of depressed patients in primary care and psychiatric specialty care settings.
What This Study Found Patients with major depression in primary care and specialty care settings have similar symptoms and similar levels of depression. Risk factors for suicide are commonly seen in both settings, although they are more frequent in specialty care. In each setting, more than half of depressed patients had another psychiatric illness, in addition to depression.
Implications
- These findings challenge the suggestion that depressed patients in primary care settings are less depressed than those in specialty care settings.
- Research results based on similar patient populations may be applicable to both primary care and specialty care practices.
- The care of major depression increasingly falls on primary care doctors as better treatments become available and as community mental health clinics begin restricting treatment to patients with more
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