Somatization and recognition of depression and anxiety in primary care
KIRMAYER, L. J. et al. Somatization and recognition of depression and anxiety in primary care. AMERICAN JOURNAL PSYCHIATRY. , v. 150, 734-741, 1993.
Transtornos de ansiedade, Competência clínica, Transtorno depressivo, Hipocondriase, Escalas de graduação psiquiátrica.
OBJECTIVE: The authors examined the effect of patient's stlye of clinical presentation on primary care physicians' recognition of depression and anxiety. METHOD: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. RESULTS: The authors indentified three progressively more persistent forms of somatic presentation, labeled "initial", "facultative", and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. CONCLUSIONS: While physician recognition of psychatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.