Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR*D

Abstract

Background A significant percentage of patients with major depressive disorder (MDD) suffer from concurrent general medical conditions (GMCs). Objective The objective of this preliminary report was to describe the rates of co-occurring significant GMCs and the clinical correlates and symptom features associated with the presence of GMCs. Design Baseline cross-sectional case–control study of patients enrolling in a prospective randomized multistage treatment study of MDD. Setting Fourteen regional U.S. centers representing 19 primary care and 22 psychiatric practices. Patients One thousand five hundred outpatients with DSM-IV nonpsychotic MDD. Measurements Sociodemographic status, medical illness ratings, psychiatric status, quality of life and DSM-IV depression symptom ratings. Results The prevalence of significant medical comorbidity in this population was 52.8% (95% CI 50.3–55.3%). Concurrent significant medical comorbidity was associated with older age, lower income, unemployment, limited education, longer duration of index depressive episode and absence of self-reported family history of depression. Somatic symptoms common in MDD were endorsed at a higher rate in those with GMCs. Those without a GMC had higher rates of endorsement of impaired mood reactivity, distinct mood quality and interpersonal sensitivity. Conclusions Concurrent GMCs are common among outpatients with MDD in both primary care and specialty settings. Concurrent GMCs appear to influence the severity and symptom patterns in MDD and describe a vulnerable population with sociodemographic challenges to effective assessment and treatment.