Clinical and demographic factors associated with high levels of depression symptoms

Beck Depression Inventory (BDI) scores were analyzed from 427 consecutive, nonpregnant, adult family medicine patients to delimit demographic and clinical parameters which would predict high levels of depression symptoms. BDI scores at or above the chosen cutoff score of 17 were present in 51 patients (12%). Unemployment, less than high school education, high usage of inpatient and outpatient services, complaints of nervousness or of a functional nature, and chronic illness were shown by univariate and multiple regression analyses to be associated with BDI scores in the depressed range. Nearly half of patients with certain combinations of risk factors (eg, less than high school education and functional complaint) scored in the depressed range. The reason for the visit, as stated by the patient, only rarely provided a reason to suspect depression. Whether or not clinicians decide to use a depression screening test, the presence of these demographic and clinical factors should prompt a search for depression. Educational efforts to improve recognition of depression in primary care should focus on awareness of clinical and demographic factors rather than on stereotypic, but rare presentations of depression.