DEPRESSIVE AND ANXIETY DISORDERS IN PATIENTS PRESENTING WITH PHYSICALCOMPLAINTS - CLINICAL PREDICTORS AND OUTCOME

PURPOSE: TO identify the predictors of depressive and anxiety disorder s 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 anxie ty disorders. Clinical predictors were identified by logistic regressi on analysis. Outcomes were assessed immediately postvisit and at 2 wee ks and 3 months. These included symptomatic improvement, functional st atus, 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 patient s. 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, phys ician perception of the encounter as difficult, and patient age less t han 50. Patients with depressive or anxiety disorders were more likely to have unmet expectations postvisit (20% versus 8%, P < 0.001), be c onsidered difficult (26% versus 11%, P < 0.0001), and report persisten t 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 cli nical clues in patients with physical complaints identify a subgroup w ho may warrant further evaluation for a depressive or anxiety disorder . Such disorders are associated with unmet patient expectations and in creased provider frustration. (C) 1997 by Excerpta Medica, Inc.