The initial presentation of depression in family practice and psychiatric outpatients

Most reports characterizing the initial presentation of depression are based on patients seen in psychiatric settings. It is not clear whether the difficulty in identifying depression in medical clinic outpatients is due to physician unfamiliarity with the diagnostic criteria or because the psychiatric syndrome is not the same in early, mild cases that present with somatic symptoms. In this study, depressed patients choosing the medical clinic for care presented the same somatic symptoms as nondepressed medical patients. In comparison to depressed patients who presented to the psychiatric clinic, depressed medical patients' chief complaints were more somatic, obscure, and less psychologically focused. Depressed psychiatric patients had more symptoms on a medical review of systems checklist than did medical patients with an equivalent level of depression. When DSM-III criteria were applied, depressed patients from each clinic tended to fulfill the major and minor criteria in a similar pattern. However, the prevalence of depression in the medical setting was much lower and milder than was that presenting to the psychiatry clinic. Once present at a diagnosable stage, however, the syndrome appeared to be the same in both patient groups.