Depression and social functioning in general hospital in-patients

Abstract

Impairment of social functioning is often associated with depression and contributes to an unfavorable course of the disease. Although it must be suspected that both social maladaptation and depression could obstruct recovery from somatic diseases, little attention has been paid to their interaction in general hospital patients. To assess social integration in depressive and psychiatrically healthy general hospital in-patients, 250 patients were studied with the Composite International Diagnostic Interview (CIDI), a structured clinical interview, and the Social Interview Schedule (SIS). From clinical interviews, it was established that 16.4% of the patients suffered from depressive disorders (ICD-10). When these patients were compared with patients without psychiatric disorder, only a tendency to social dysfunctioning with regard to social management and satisfaction with social situations was observed. But when the depressive sample was divided into three diagnostic groups (depressive episode, dysthymia, depressive adjustment disorder), significant social impairments were found in the dysthymia subsample. Family and other interpersonal problems were most prominent. When depression preceded somatic illness, a higher level of impairment was observed. The majority of dysthymia patients suffered from long-term somatic diseases, often cancer, which were preceded by depression. The results of this study single out a small group of patients who seem to be at an extensive risk of chronic psychiatric and somatic illnesses and should therefore be a focus of consultation/liaison (C/L) interventions.