Psychiatric–Medical ComorbidityPrevalence and treatment of depression in a hospital department of internal medicine
Introduction
Depression is the main reason for contacting consultation–liaison psychiatric services [1]. Nevertheless, the majority of patients admitted to general hospitals with symptoms of depression receive no specific treatment [2], [3]. Physicians in the nonpsychiatric units of university hospitals overlook about half the cases of depression (Table 3); the proportion of missed cases, inappropriate diagnoses and absence of treatment is higher in recent studies [4], [5], [6]. When all is said and done, only about one case of depression in four receives appropriate therapy at the general hospital [5]. This is an important issue since patients with medical problems have a high prevalence of affective disorders [7] and a high proportion develop clinically significant depressive disorders during nonpsychiatric hospitalizations [3], [4], [5], [6], [7], [8], especially in comparison with the proportion among the general population and among those followed up in primary care [2]. Furthermore, a diagnosis of depression during a nonpsychiatric hospital stay is linked not only to poorer social performance and quality of life [5], [9], [10] but also to a less favorable clinical outcome for the basic medical disorder (whatever the latter's severity) [11], [12], to a lengthened hospital stay [13], [14], [15] and to increased hospitalization costs [3]. A significant proportion of patients presenting with a major depressive disorder during the earlier part of their stay at a general hospital show persistent and severe depression on discharge and during follow-up over several months [16], [17]. Current and effective therapies for depression are well tolerated and are, by and large, compatible with nonpsychiatric treatment. A review of several investigations [18] highlights the need to develop more effective evaluation methods and decision processes [19] for those patients hospitalized with depression in general hospitals [3].
Numerous studies based on the above observations have attempted to develop psychometric instruments for the detection of major depression — and of depressive disorders in general — among these subjects [20]. Results have not been entirely satisfactory: important differences persist according to the type of instrument, the way these instruments are applied and the training level of the evaluators. Standard interviews are reliable and efficient but require considerable time and are not readily accessible to standard practice in a nonpsychiatric environment. Conversely, self-administered questionnaires are easier to handle but tend to result in overdiagnosis for depression when compared with structured interviews and do not discriminate well when it comes to the clinical importance of the disorder [21]. In addition, self-administered questionnaires are responsive to different linguistic or cultural contexts.
Depression diagnosis should be therefore performed by well-trained psychiatrists using standard interviews as well as accomplishing a full clinical examination in order to control two important factors: the level of training and the gathering of all necessary information to achieve a complete diagnosis. In view of the above, the general purpose of the present investigation is to assess the prevalence and severity of depression among French-speaking patients admitted to internal medicine units, with the use of various diagnostic tools, including a full clinical examination by a psychiatrist — in addition to the gamut of DSM-IV criteria for mood disorders, the Hamilton Depression Rating Scale (HDRS) and the self-administered French version of Patient Health Questionnaire (PHQ-9) [22], [23]. There is extensive prior work in the area of detection of depression of inpatients, but few investigations use diagnoses provided by well-trained psychiatrists as the gold standard. Furthermore, as far as we know, there are no other prevalence studies investigating French-speaking inpatients in Switzerland that are grounded on DSM-IV criteria established by well-trained psychiatrists as the gold standard. At the same time, this study is the first test of the French translation of the PHQ-9 [24]. Results about sensitivity and specificity of the French language version of the PHQ-9 compared with the gold standard of the diagnosis from psychiatric interview are reported elsewhere [25].
Section snippets
General framework and patient selection
The study was undertaken among patients aged 18 to 65 who were admitted to internal medicine units at the University Hospitals of Geneva (Hôpitaux Universitaires de Genève), a large community hospital (with 2200 beds and 47,000 admissions a year and where all medical specialties are available) that is affiliated with the University of Geneva Medical School. The French version was compiled, according to the state of the art, through several steps of translation and blind back-translation by
Results
The majority of persons investigated were men (61.8%), and the average age was 49.5 years (S.D.=12). Table 2 shows high levels for major depression and for “all depressive disorders.” It also shows a higher prevalence of depression among women, regardless of the assessment tool used. The proportion of major depressive syndromes limited to DSM-IV Criterion A (18.4% for self-assessment with PHQ-9 and 19.8% for assessment by a psychiatrist with DSM-IV) is greater than that of DSM-IV major
Discussion
Our data (Table 2) complete earlier findings (Table 3) and similarly show that, among patients admitted to the internal medicine departments of a major public hospital, standard clinical assessment by a psychiatrist reveals that an important proportion (26.9%) of persons fulfill the criteria for at least one DSM-IV depressive disorder — more among women (37%) than among men (20.6%). Furthermore, about one quarter of depressive subjects have a score greater than 20 on the HDRS — an indication
Conclusions
The present study confirms, in a sample of French-speaking patients, the results of earlier research that had shown high levels of major depression and of depressive disorders as a whole among patients admitted to internal medicine departments of a major general hospital. It also shows that nonpsychiatrist physicians overlook a marked proportion of depression diagnoses recorded by well-trained psychiatrists who perform extensive clinical interviews and use standardized instruments. Our results
Acknowledgments
We acknowledge the support of Professor A. Junod, Director of Internal Medicine Service I. We thank Valerie Burnet and Monique Pascale, psychologists, who ensured the recruitment of patients and Pfizer and the Fonds de péréquation of the University Hospitals, Geneva, which contributed to the costs of this investigation. There are no conflicts of interest.
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Health-related quality of life in hospitalized non-psychiatric medical patients: The impact of depressive symptoms
2021, Journal of Affective Disorders ReportsCitation Excerpt :Our results found that depressive symptoms were strongly associated with health status outcomes as the HRQoL, extending to a transdiagnostic sample previous observations in cardiac patients reported in The Heart and Soul Study (Ruo et al., 2003). Considering that 50% of patients who suffer comorbid depressive symptoms when hospitalized are not detected by clinicians (Rentsch et al., 2007), an essential factor that negatively impacts the HRQoL is overlooked. As previously recommended in cardiovascular diseases (Lichtman et al., 2008), routine screening for depression should be considered mandatory to improve the outcome and prognosis of patients hospitalized for any medical condition.
Prevalence and clinical characteristics of the DSM IV major depression among general internal medicine patients
2013, European Journal of Internal MedicineCitation Excerpt :Depressive symptoms are the most common cause for soliciting the psychiatry liaison services [14]. However the majority of depressed patients admitted to a general hospital, who might benefit from a specific treatment are not detected [9,11,15,16] nor treated adequately [9,17,18]. In this context the number and characteristics of depressive symptoms have been proposed as determinants of recognition of MDD by general practitioners.
Prevalence, risk factors and recognition rates of depressive disorders among inpatients of tertiary general hospitals in Shanghai, China
2013, Journal of Psychosomatic ResearchCitation Excerpt :Furthermore, depression could increase the risk of death by suicide in patients receiving inpatient treatment at general hospitals [11]. In addition, despite the high prevalence and importance of depression in inpatients, its recognition rate remained low or very low [1,12–15]. Although the clinical significance of comorbidity of depression and physical illnesses has been well accepted by consultation-liaison psychiatry (CLP) services at general hospitals in western countries, it remains under-estimated in China [16].
Ability of nurses to identify depression in primary care, secondary care and nursing homes-A meta-analysis of routine clinical accuracy
2011, International Journal of Nursing Studies
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