SOMATIZATION AND THE RECOGNITION OF DEPRESSION AND ANXIETY IN PRIMARYCARE

Objective: The authors examined the effect of patients' style of clini cal presentation on primary care physicians' recognition of depression and anxiety. Method: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured i nterviews assessing presenting complaints, self-report measures of sym ptom and hypochondriacal worry, the Diagnostic Interview Schedule (DIS ), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric co ndition in the medical chart over the ensuing 12 months. Results: The authors identified three progressively more persistent forms of somati c presentations, labeled ''initial,'' ''facultative,'' and ''true'' so matization. Of 215 patients with CES-D scores of 16 or higher, 80% mad e somatized presentations; of 75 patients with DIS-diagnosed major dep ression or anxiety disorder, 76% made somatic presentations. Among pat ients with DIS major depression or anxiety disorder, somatization redu ced physician recognition from 77%, for psychosocial presenters, to 22 %, for true somatizers. The same pattern was found for patients with h igh CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of l ifetime medically unexplained symptoms each increased the likelihood o f recognition, while somatized presentations decreased the rate of rec ognition. While physician recognition of psychiatric distress in prima ry care varied widely with different criteria for recognition, the sam e pattern of reduction of recognition with increasing level of somatiz ation was found for all criteria. In contrast, hypochondriacal worry a nd medically unexplained somatic symptoms increased the rate of recogn ition.