Abstract
Objective:To establish the frequency of criteria-based depression and anxiety in newly admitted medical inpatients and to determine the natural history of depressive and anxiety symptoms during hospitalization.
Design:Prospective structured assessment of criteria-based depression and anxiety diagnoses within 24 hours of hospitalization with routine follow-up depression and anxiety questionnaires until discharge.
Setting:A tertiary care university hospital and an affiliated Veterans Administration hospital.
Patients:One hundred twenty-eight adult patients admitted to internal medicine inpatient units between May 1990 and August 1990.
Main results:On admission, 43 of the 128 patients inducted met the DSM-III criteria for major depression, while an additional six met the criteria for adjustment disorder with depressed mood. Only six patients met the criteria for panic disorder, generalized anxiety disorder, or adjustment disorder with anxious mood at the time of admission to the study. Patients with high symptom scores on the anxiety and depression scales showed significant decreases in these scores without specific psychiatric intervention. Those who remained in the hospital 20 days or longer showed initial improvement and subsequently returned to baseline symptom levels of depression and anxiety. In approximately 9% of patients, symptoms of depression persisted or worsened.
Conclusions:Major depression occurs more commonly than anxiety disorder in newly admitted medical inpatients but both resolve spontaneously in the majority during the course of hospitalization without specific psychiatric intervention unless the hospitalization is prolonged. One in ten will continue to show symptoms of depression.
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References
Von Korff M, Shapiro S, Burke JD, et al. Anxiety and depression in a primary care clinic. Arch Gen Psychiatry. 1987;44:152–6.
Schulberg HC, Saul M, McClelland M, Ganguli M, Christy W, Frank R. Assessing depression in primary medical and psychiatric practices. Arch Gen Psychiatry. 1985;42:1164–70.
Kessler LG, Cleary PD, Burke JD. Psychiatric diagnoses of medical service users: evidence from the Epidemiology Catchment Area Program. Am J Public Health. 1987;77:18–24.
Burnham A, Wells K, Rogers W, Potts M. Prevalence of depression in general medical and mental health outpatient practices in three health care systems. Paper presented at the annual meeting of the American Psychiatric Association, San Francisco, May 1989.
Hoppe SK, Leon RL, Realini JP. Depression and anxiety among Mexican Americans in a family health center. Soc Psychiatry Psychiatr Epidemiol. 1989;24:63–8.
Coulehan JL, Schulberg HC, Block MR, Janosky JE, Arena VC. Medical comorbidity of major depressive disorder in a primary medical practice. Arch Intern Med. 1990;150:2363–7.
Zich JM, Attkisson CC, Greenfield TK. Screening for depression in primary care clinics: The CES-D and the BDI. Int J Psychiatry Med. 1990;20:259–77.
Hoeper EW, Nycz GR, Cleary PD, Regier DA, Goldberg ID. Estimated prevalence of RDC mental disorder in primary medical care. Int J Ment Health. 1979;8:6–15.
Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry. 1988;45:1100–6.
Blacker CVR, Clare AW. The prevalence and treatment of depression in general practice. Psychopharmacology. 1988;95:514–7.
Ormel J, vanDenBrink W, Koeter MWJ, et al. Recognition, management, and outcome of psychological disorders in primary care: a naturalistic follow up study. Psychol Med. 1990;20:909–23.
Kitchell MA, Barnes RF, Veith RC, et al. Screening for depression in hospitalized geriatric medical patients. J Am Geriatr Soc. 1982;30:174–82.
Koenig HG, Meador KG, Cohen HJ, Blazer DG. Depression in elderly hospitalized patients with medical illness. Arch Intern Med. 1988;148:1929–36.
Rapp SR, Parisi SA, Walsh DA. Psychological dysfunction and physical health among elderly medial inpatients. J Consult Clin Psychol. 1988;56:851–5.
Magni G, de Leo D, Schifano F. Depression in geriatric and adult medical inpatients. J Clin Psychol. 1985;41:337–44.
Ormel J, Koeter MWJ, vanDenBrink W, vandeWillige G. Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry. 1991;48:700–6.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, third edition (DSM-III). Washington, DC: APA, 1980.
Joyce PR, Paykel ES. Predictors of drug response in depression. Arch Gen Psychiatry. 1989;46:89–99.
Brown CS, Rakel RE, Wells BG, Downs JM, Akiskal HS. A practical update on anxiety disorders and their pharmacologic treatment. Arch Intern Med. 1991;151:873–84.
Thase ME, Simons AD, Cahalane J, McGeary J, Harden T. Severity of depression and response to cognitive behavior therapy. Am J Psychiatry. 1991;148(6):784–9.
Lubin MF. Depression in internal medicine. Med Rounds. 1988;1:12–20.
Fulop G, Strain JJ, Fahs MC, Hammer JS, Lyons JS. Medical disorders associated with psychiatric comorbidity and prolonged hospital stay. Hosp Community Psychiatry. 1989;40(1):80–2.
Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients. JAMA. 1989;262:914–9.
Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA. 1990;264:2524–8.
Keitner GI, Ryan CE, Miller IW, Kohn R, Epstein NB. 12-month outcome of patients with major depression and comorbid psychiatric or medical illness (compound depression). Am J Psychiatry. 1991;148(3):345–50.
Saravay SM, Steinberg MD, Weinschel B, Pollack S, Alovis N. Psychological comorbidity and length of stay in the general hospital. Am J Psychiatry. 1991;148(3):324–9.
Levenson JL, Hamer RM, Rossiter LF. Relation of psychopathology in general medical inpatients to use and cost of services. Am J Psychiatry. 1990;147(11):1498–503.
Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–5.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatr. 1960;23:56–62.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, third edition revised (DSM-III-R). Washington, DC: APA, 1987.
Endicott J. Measurement of depression in patients with cancer. Cancer. 1984;53:2243–8.
Spitzer RL, Endicott J, Robins E. Research diagnostic criteria (RDC) for a selected group of functional disorders, third edition. New York: New York State Psychiatric Institute, Biometrics Research, 1977.
Kathol RG, Mutgi A, Williams J, Clamon G, Noyes R Jr. Diagnosis of major depression in cancer patient according to four sets of criteria. Am J Psychiatry. 1990;147(8):1021–4.
Winer BJ. Statistical principles in experimental design. 2nd ed. New York: McGraw-Hill, 1971.
Wald TG, Kathol RG, Noyes R Jr, Carroll BT, Clamon GH. Rapid relief of anxiety in cancer patients with both alprazolam and placebo. Submitted for publication, 1992.
Shaw BF, Vallis TM, McCabe SB. The assessment of the severity and symptom patterns in depression. In: Beckham EE, Leber WR (eds). Handbook of depression: treatment, assessment and research. Homewood, IL: Dorsey Press, 1985;372–407.
Resch D, Kathol RG, Wald TG, Noyes R Jr, Carroll BT. Effect of active medical illness on Hamilton Depression Scale scores. Submitted for publication, 1992.
Koenig HG, Goli V, Shelp F, et al. Antidepressant use in elderly medical inpatients: lessons from an attempted clinical trial. J Gen Intern Med. 1989;4:498–505.
Hall RCW, Beresford TP, Gardner ER, Popkin MK. The medical care of psychiatric patients. Hosp Community Psychiatry. 1982;33(1):25–34.
Gath D, Catalan J. The treatment of emotional disorders in general practice: psychological methods versus medication. J Psychosom Res. 1986;30(3):381–6.
Clark DC, Cavanaugh SV, Gibbons RD. The core symptoms of depression in medical and psychiatric patients. J Nerv Ment Dis. 1983;171(12):705–13.
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Supported by a Veterans Administration Health Services Research and Development Field Program Grant.
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Kathol, R.G., Wenzel, R.P. Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards. J Gen Intern Med 7, 287–293 (1992). https://doi.org/10.1007/BF02598085
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DOI: https://doi.org/10.1007/BF02598085