[Depression in General Hospital: a study of 136 cases]

To investigate the depressive symptoms that differentiate patients with and without depression associated to medical disease.

During 1998, 293 consecutive referrals for consultations were studied, 168 (57.5%) of females and 124 (42.5%) males, with ages ranging from 18 to 93 years (47.2 +/- 18.0 years). Psychiatric diagnosis was made by clinical interviews, according to DSM-IV criteria. For statistical analysis the chi-square and logistic regression tests were adopted. RESULTS. Of the 293 patients under study, 230 (78.5%) fulfilled the criteria for psychiatric diagnosis, 136 (59.1%) of them presented disorders within the depressive spectrum: Major Depression (n= 60 - 26.1%), Minor Depression (n = 31 - 13.5%). Secondary Depression (n= 19-8.3%) and Adjustment Disorder with Depressive Mood (n= 26-11.3%). Except for greater appetite, weight gain, agitation and delusions, the occurrence or not of the diagnostic of depression was significantly different (p<0.05) when comparing the presence with the absence of the remaining potential depressive symptoms. The anedonia and morning worsening were detected in 4 and 3 patients without depression respectively, which did not allow the inclusion of these symptoms in the regression analysis model. In accordance with the logistic regression analysis (IC= 95%) the selected variables to explain diagnosis of depression were thoughts of death (OR= 20.6; 2.5-170.5), irritability (OR= 4.5; 1.7-11.9), early awakening (OR=15.0; 1.7-129.3) and weight loss (OR=8.1; 2.6-24.4).

Thoughts of death, irritability, early awakening, loss of weight, anhedonia (loss of pleasure); and morning worsening were the symptoms that strongly supported depression diagnosis. Even symptoms that could be a manifestation of medical condition and/or of depressions (such as sleeplessness, diminished concentration, fatigue and slowing down) were significantly more associated to the diagnosis of depression. These data outline the need for an active clinical investigation of depression by the physician in the case of physical symptoms that could be related to a medical condition or a depression. Owing to its high prevalence, the diagnosis of depression should not be made on an exclusion basis.