The development of depressive symptoms in elderly following onset of severe physical illness.

This study followed a group of elderly patients (ill group) with recent onset of life-threatening or severely debilitating illness to determine development of depressive symptoms. Age- and sex-matched control patients were included for comparison. Depressive symptoms increased significantly in the group of ill male patients when compared with controls. Depressive symptoms did not show an increase in the group of ill female patients. Other variables also predicted increased depression: (1) an initial placement in nursing home, (2) a prior history of depression or higher initial level of depressive symptoms, (3) the presence of larger numbers of additional medical illnesses, and (4) following the occurrence of stressful life events. The increase in depression in the male test group was still present and significant when controlling for these additional four factors.

Suicide attempts in antisocial alcoholics.

The dual diagnoses of alcoholism and antisocial personality are frequently associated with suicide attempts. A group of 94 alcoholics with antisocial personality were divided on the basis of a previous suicide attempt. A variety of symptoms, including depression, alcohol and drug abuse, conduct disorder, and violence were found more frequently in the suicide attempter group as reported on the structured interview. These emotional problems were additionally found to have an earlier onset. The results were consistent with the concept of secondary sociopathy and indicated that higher psychopathology may be associated with suicide behavior.

Factors associated with suicide attempts in alcohol abusers.

Alcoholics with and without previous suicide attempts were compared on a variety of clinical variables. Drug abuse and major depression especially if accompanied by crying spells, hopelessness, or seeking psychiatric help were found more frequently in the suicide attempter group. Additionally, total psychiatric symptoms were found to be higher in the suicide attempters in various categories including somatic, obsessive-compulsive, and total number of psychiatric symptoms reported on the structured interview. These results indicate that certain psychopathological symptoms are associated with suicide attempts in alcoholics and may be predictive of completed suicide.

Incidence and detection of bulimia in a family practice population.

In a study of a family practice population, 20 percent of the 176 participants, ranging in age from 14 to 42 years, showed abnormal eating concerns and habits as indicated by their responses on a modified version of the Eating Attitudes Test (EAT). Clinically these patients had more visits to a physician per year and more complaints per visit, but these differences were not statistically significant. Over 10.9 percent of the sample population appeared to fulfill the criteria for the eating disorder bulimia. These patients were also significantly heavier than patients who did not have abnormal eating concerns and habits.

Compliance characteristics of 291 hypertensive patients from a rural midwest area.

Patient compliance with treatment regimens has been a concern of both researchers and clinicians. Research studies on compliance have generally originated in large city clinics and teaching institutions. The results paint a dismal picture. The question is, are the compliance percentages found in the literature applicable to the hypertensive population in the semirural Midwest who receive long-term care from their family physician? This study was carried out in the practices of seven midwestern family physicians. The 291 patients in the study had a mean compliance percentage of 87 percent. By-product data indicate that outcome results were good. Research on compliance traditionally has conceived of the problem in large part as one of defective behavior by both the patient and the health care system. The physician-patient relationship in a family practice should contribute to better medication compliance. In this study semirural patients with hypertension who receive continuing care from their family physician had better compliance than national figures suggest it should have been.

Depression: the great imitator in family practice.

Psychiatric problems, especially depression, are common in primary care and can usually be treated successfully by family physicians if the diagnosis is made. Unfortunately, there is as yet no simple, definitive test for detecting depression. Family physicians must be aware that depression is very often masked by somatic or anxiety complaints. A pattern of increased office visits, with a constellation of varied functional somatic complaints, perhaps accompanied by disturbances in social relationships, often indicates the presence of a developing depression. Although hospitalization or psychiatric referral or both are in order for complex psychiatric diagnoses or for suicidal patients, the morbidity and the mortality of depression can be reduced by the alert family physician who provides both carefully managed antidepressant treatment and supportive therapy early in the course of the illness.

Somatic symptoms. A major feature of depression in a family practice.

The complaints of depressed patients were investigated in a private, single-physician family practice clinic. Complaints and visits of depressives were compared to those of age- and sex-matched non-depressed controls over a period of 3 years beginning 18 months prior to the diagnosis of depression. Pain, functional and anxiety complaints signalled the onset and paralleled the course of depression. Somatic complaints were a conspicuous mode of presentation in this family practice. These somatic features are not among the usual diagnostic and research criteria for depression (DSM-III, Feighner Criteria and RDC) although they appear to be a major feature in the natural history of depression.

Depression in family practice: long-term prognosis and somatic complaints.

Somatic pain, functional, and anxiety complaints of 154 depressed patients were followed during the course of their initial depression and were found to parallel the depression: these complaints increased in number just prior to diagnosis of depression and decreased to normal levels after one year's treatment of the depression. Persistence of these types of somatic symptoms after one year's treatment predicted eventual chronicity of the depression. Older patients were also more likely to develop chronic depressions, and there was some indication that those individuals who had an initial remission of a depression followed by a second depression which then became chronic had longer first depressions.

Somatic complaints -- harbinger of depression in primary care.

The pattern of patient visits and type of complaints relating to depressive illness was investigated in a University family practice clinic. Complaints and visits of depressives were compared to those made by age and sex-matched controls over 6 time periods which spanned a period of 2 years starting 6 months prior to the diagnosis of depression. Functional, pain, anxiety, and social complaints appeared to parallel the course of the depression, rising before the diagnosis of depression and returning to control levels 15-18 months after the depression was diagnosed. Somatic complaints were a prominent part of the depressive presentation.

Depression in family practice: some effects on spouses and children.

Medical complaints and office visits of spouses and children of depressed patients were examined and compared to a matched comparison group of spouses and children of nondepressed patients. Both spouses and children of depressed patients showed increased numbers of visits and complaints which returned to control levels one year after the depression was diagnosed and treated. Infection, pain, functional, and anxiety complaints showed significant increases in spouses over controls. Definite diagnoses, infections, pain, and anxiety complaints were significantly increased in children compared to controls. In both spouses and children these complaints returned to control levels by the third period of the study, one year after the depression had been diagnosed (and treatment for depression started). The pain, functional, and anxiety complaints of spouses and children were very similar qualitatively to those of the depressed patients. The results demonstrate the validity of the family as a unit of medical care.

Depression in family practice: changes in pattern of patient visits and complaints during subsequent developing depressions.

This study was done to characterize changes in patient behavior during specific time periods immediately before first, second, third, and fourth episodes of depression. Forty-three patients from a group of 154 depressed patients examined in an earlier study developed 59 subsequent episodes of depression, and these were the patients used in this study. Suitable age and sex matched controls were also examined for the same time periods. The depressed patients and controls were patients in a rural solo practice. The depressed patients showed increased number of patient initiated visits, increased incidence of hospitalization, increased number of functional complaints, increased number of pain complaints, and increased feelings of tension as compared to controls during the seven months prior to the diagnosis date of the first and each succeeding episode of depression. The study results indicate that increased numbers of office visits, functional complaints, pain complaints, and anxiety complaints can be harbingers of a clinical depression, whether it be the index (first) or a subsequent depressive illness.

Depression in primary care: changes in pattern of patient visits and complaints during a developing depression.

The purpose of this study was to characterize changes in patient behavior associated with a developing depression. The records of 154 depressed patients from a solo family practice were examined for type and number of complaints, number of visits, and amount of hospitalization during two periods of time. In addition, 154 patients were used as controls and matched to the depressive patients by age, sex, and season of year seen. Two similar time periods were examined in the controls. The depressed group in comparisons both with itself and with the control group showed, in the seven months prior to the diagnosis of depression, these changes: (1) increase in number of patient-initiated office and home visits; (2) increased incidence of hospitalization; and (3) increased number of presenting complaints of three types: ill-defined "functional" complaints; pain of undetermined etiology in a wide variety of sites: head, chest, abdomen, and extremities; and "nervous" complaints, mainly increased tension and feelings of anxiety. The study results indicate that increased number of office visits and "functional" somatic complaints or anxiety-tension feelings should suggest depression.