The long-term objective of this application is to investigate minor depression in the ambulatory primary care setting. In particular, we will study its prevalence, the functional health outcomes, medical and psychiatric comorbid conditions, its course in the primary care outpatient setting, and how primary care providers manage minor depression. For purposes of this application, minor depression will be defined in the following way: a) presence of mood disturbance and/or anhedonia plus one or more other DSM-III-R symptoms of major depression for a period of two weeks or more, and b) case does not meet the criteria for major depression or dysthymia.
The specific aims are: 1) describe the functional outcomes of minor depression in terms of functional health status, disability, and medical care utilization; 2) establish the time course of these functional outcomes over one year of follow-up; 3) describe and control for associated features that may complicate the diagnosis of minor depression particularly medical comorbidity, anxiety symptoms, and somatization; and 4) describe the differences between minor depressives and major depressives in primary care in terms of functional outcomes and associated features. This is a longitudinal descriptive study of 70 minor depressives, 70 major depres- sives, and 70 normals in a single primary care clinic. Study patients will be selected in a two-step procedure. First, patients will be screened with the Center for Epidemiologic Studies Depression Scale (CES-D) to define groups at high (CES-D > = 16) or low (CES-D < 16) risk of depression. Next, CESD positive patients and a sample of CES-D negative patients will be administered the Diagnostic Interview Schedule (DIS) to establish the three study groups: the asymptomatic control group, the minor depression group, and the major depression group. Somatization and anxiety symptoms will also be assessed with the DIS. Depressive symptoms, functional status, and disability will be assessed for all study patients using standardized self-report at baseline, and at 6 and 12 months. Medical comorbidity' will be determined by standardized physician ratings after each encounter. Health services utilization will be determined by manual and computerized record audits. The results of this study should improve our knowledge of the prevalence, nature, and course of minor depression in primary care patients, and will provide a beginning for future studies of primary care diagnostic criteria.
| Gaynes, B N; Magruder, K M; Burns, B J et al. (1999) Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? Gen Hosp Psychiatry 21:158-67 |
