Depressive and anxiety disorders in patients presenting with physical complaints

Clinical predictors and outcome

Kurt Kroenke, Jeffrey L. Jackson, Judith Chamberlin

Research output: Contribution to journalArticle

199 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)339-347
Number of pages9
JournalThe American Journal of Medicine
Volume103
Issue number5
DOIs
StatePublished - Nov 1997

Fingerprint

Depressive Disorder
Anxiety Disorders
Patient Acceptance of Health Care
Mental Disorders
Health Care Costs
Psychiatry
Frustration
Diagnostic and Statistical Manual of Mental Disorders
Patient Care
Cohort Studies
Logistic Models
Regression Analysis
Medicine
Physicians
Health

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Depressive and anxiety disorders in patients presenting with physical complaints : Clinical predictors and outcome. / Kroenke, Kurt; Jackson, Jeffrey L.; Chamberlin, Judith.

In: The American Journal of Medicine, Vol. 103, No. 5, 11.1997, p. 339-347.

Research output: Contribution to journalArticle

@article{e07af518d95a4ffa98fc8ed3e84a321c,
title = "Depressive and anxiety disorders in patients presenting with physical complaints: Clinical predictors and outcome",
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.",
author = "Kurt Kroenke and Jackson, {Jeffrey L.} and Judith Chamberlin",
year = "1997",
month = "11",
doi = "10.1016/S0002-9343(97)00241-6",
language = "English",
volume = "103",
pages = "339--347",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Depressive and anxiety disorders in patients presenting with physical complaints

T2 - Clinical predictors and outcome

AU - Kroenke, Kurt

AU - Jackson, Jeffrey L.

AU - Chamberlin, Judith

PY - 1997/11

Y1 - 1997/11

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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0030707629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030707629&partnerID=8YFLogxK

U2 - 10.1016/S0002-9343(97)00241-6

DO - 10.1016/S0002-9343(97)00241-6

M3 - Article

VL - 103

SP - 339

EP - 347

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 5

ER -