Rm. Crum et al., DEPRESSIVE SYMPTOMS AMONG GENERAL MEDICAL PATIENTS - PREVALENCE AND ONE-YEAR OUTCOME, Psychosomatic medicine, 56(2), 1994, pp. 109-117
Using prospective data from the National Institute of Mental Health (N
IMH) Epidemiologic Catchment Area surveys, we examined the relationshi
p of depressive symptoms among patients seen by general medical practi
tioners, with the subsequent development of major depressive disorder.
The goals of the analysis were to determine 1) the 1-year psychiatric
status of these individuals, and 2) to evaluate factors associated wi
th the risk of major depressive disorder (MDD) or dysthymia. Between 1
980 and 1984, collaborators of the NIMH Epidemiologic Catchment Area p
rogram recruited 18,571 adult participants after probability sampling
of census tracts and households in five metropolitan areas. To assess
the occurrence of psychiatric conditions over time, staff administered
the Diagnostic Interview Schedule soon after sampling and again at fo
llow-up 1 year later. For this analysis, the study sample was limited
to respondents who reported seeing a general medical physician in the
previous 6 months and who were free of current depressive disorder at
the baseline interview. Overall, 41% of the general medical patients r
eported experiencing at least one depressive symptom in the past 6 mon
ths. Between 3 and 5% of the individuals with depressive symptoms deve
loped MDD or dysthymia at the follow-up interview. Although individual
s with depressed mood had a slightly higher estimated relative risk co
mpared with individuals with vegetative, or nonvegetative (cognitive)
depressive symptoms, no single classification of symptoms was apprecia
bly more likely to signal MDD or dysthymia 1 year later. However, the
risk of depression increased with the number of depressive symptoms re
ported. Other characteristics which signalled an increased risk for MD
D/dysthymia included gender (female sex); age (between 18 and 44 years
); and yearly household income (less than $10,000). Hispanic-Americans
were more likely, and African-Americans tended to be less likely to d
evelop MDD or dysthymia relative to Caucasians.