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Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome.
Am J Med 1997; 103(5):339-47AJ

Abstract

PURPOSE

To identify the predictors of depressive and anxiety disorders 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 anxiety disorders. Clinical predictors were identified by logistic regression analysis. Outcomes were assessed immediately postvisit and at 2 weeks and 3 months. These included symptomatic improvement, functional status, 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 patients. 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, physician perception of the encounter as difficult, and patient age less than 50. Patients with depressive or anxiety disorders were more likely to have unmet expectations postvisit (20% versus 8%, P < 0.001), be considered difficult (26% versus 11%, P < 0.0001), and report persistent 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 clinical clues in patients with physical complaints identify a subgroup who may warrant further evaluation for a depressive or anxiety disorder. Such disorders are associated with unmet patient expectations and increased provider frustration.

Authors+Show Affiliations

Regenstrief Institute for Health Care and Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-2859, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9375700

Citation

Kroenke, K, et al. "Depressive and Anxiety Disorders in Patients Presenting With Physical Complaints: Clinical Predictors and Outcome." The American Journal of Medicine, vol. 103, no. 5, 1997, pp. 339-47.
Kroenke K, Jackson JL, Chamberlin J. Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med. 1997;103(5):339-47.
Kroenke, K., Jackson, J. L., & Chamberlin, J. (1997). Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. The American Journal of Medicine, 103(5), pp. 339-47.
Kroenke K, Jackson JL, Chamberlin J. Depressive and Anxiety Disorders in Patients Presenting With Physical Complaints: Clinical Predictors and Outcome. Am J Med. 1997;103(5):339-47. PubMed PMID: 9375700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. AU - Kroenke,K, AU - Jackson,J L, AU - Chamberlin,J, PY - 1997/12/31/pubmed PY - 1997/12/31/medline PY - 1997/12/31/entrez SP - 339 EP - 47 JF - The American journal of medicine JO - Am. J. Med. VL - 103 IS - 5 N2 - PURPOSE: To identify the predictors of depressive and anxiety disorders 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 anxiety disorders. Clinical predictors were identified by logistic regression analysis. Outcomes were assessed immediately postvisit and at 2 weeks and 3 months. These included symptomatic improvement, functional status, 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 patients. 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, physician perception of the encounter as difficult, and patient age less than 50. Patients with depressive or anxiety disorders were more likely to have unmet expectations postvisit (20% versus 8%, P < 0.001), be considered difficult (26% versus 11%, P < 0.0001), and report persistent 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 clinical clues in patients with physical complaints identify a subgroup who may warrant further evaluation for a depressive or anxiety disorder. Such disorders are associated with unmet patient expectations and increased provider frustration. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/9375700/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(97)00241-6 DB - PRIME DP - Unbound Medicine ER -