Clinical StudiesDepressive and Anxiety Disorders in Patients Presenting With Physical Complaints: Clinical Predictors and Outcome☆
Section snippets
Patients
Eligible subjects were patients presenting to the Walter Reed Army Medical Center general medicine walk-in clinic with a chief complaint of a physical symptom. Patients were excluded if they had upper respiratory infection complaints (eg, cough, coryza, sore throat), dementia, or inability to understand English, although no subjects were excluded for language reasons. Of 528 patients approached, 500 provided informed consent; participants were similar to nonparticipants in terms of age, race,
Patient Characteristics
Patients had a mean age of 54.7 years, half were women, and 49% were white, 45% African-American, and 6% other. Patients presented with a variety of symptoms (15% with more than one complaint) which we collapsed into 14 major categories (Table 1). Pain of some type was present 65% of the time, and the leading symptom category was musculoskeletal complaints. More than half of the patients had experienced their symptom for less than 2 weeks, and 68% less than a month.
Psychiatric Disorders
A depressive or anxiety
Discussion
Depressive and anxiety disorders were present in 29% of patients presenting with physical complaints. Such disorders were associated with unmet patient expectations and increased provider frustration. Moreover, psychiatric symptoms persisted in many patients even months after their initial clinic visit. Clinical clues emerged from our analysis that should raise the suspicion of co-existing mental disorders in symptomatic patients.
Of six predictors identified, we favor a fourpredictor model for
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The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.