The Clinical Feature of Depression with Psychosomatic Medicine in Primary Care

Abstract

Recently it is well known that depression is increasing in primary care, which is expanding the opportunity of the depressive patient's consultations. The object of this study was to clarify the clinical feature of depression in new patients (1997-2000) who visited the department of psychosomatic medicine at our clinic (n=330). We regarded the patients who chiefly complained of depressive symptoms, or who scored more than 45 points in self-rating depression scale (SDS) as the depressive symptoms group. This group occupied 48.7% (161 cases) in all cases. Depressive disorders (DSM-VI) were detected in 62.7% of the depressive symptoms group (n=161). In the classification of depressive disorders, major depression was detected in 21.7%, depressive disorder not otherwise specified in 73.2%, and dysthymic disorder in 4.9% of the patients. Regarding which department where the first medical consultation was made in the depressive symptoms group, the most frequent one was internal medicine (64.7%), which was followed by gynecology (9.5%), neurosurgery (8.4%) and psychiatry (5.6%). Diagnoses made at the first consultation included gastrointestinal diseases (23.4%), vegetative disorders (15.7%), stress reaction (12.5%), and depressive disorders (10.5%). Prognosis after 6 months in depressive disorders showed the remission rate of 52.8% in major depression, 62.9% in depressive disorder not otherwise specified, and 33.3% in dysthymic disorder. Depressive symptoms are very common in primary care. Therefore the doctors of primary care, including psychiatrists as well as non-psychiatrists, should identify depressive patients at the first consultation and treat them properly.