UNIVERSITY OF ILLINOIS AT CHICAGO
Department of Psychiatry
Fifth Annual Research Forum – Extravaganza 2014
POSTER TITLE
Do chief complaints of women in primary care settings differ by depression
status?
DISEASE/KEY
WORDS:
Depression, primary care, women
AUTHORS:
Cindy Veldhuis, MS
Graduate Student, Clinical Psychology, University of Illinois at Chicago
MENTEE
CATEGORY:
BACKGROUND:
METHODS:
RESULTS:
Pauline Maki, PhD
Professor of Psychiatry and Psychology
PhD Student
RESEARCH MENTOR:
Pauline Maki, PhD
Depression affects over 20% of women in their lifetime, but is not always the chief
presenting complaint in routine medical visits, which may lead to underdiagnosis and
undertreatment. Although a sizable proportion of people (over 65% in Vasiliadiv, et al.,
2009) with depression may seek care from their PCPs, few overtly cite depression as
a primary concern. Depressed women seeking care from their OB/Gyns cited medical
problems as the chief complaint more often than psychological problems (Cerimele, et
al., 2013). It is unclear, however, whether depressed patients are more likely than
non-depressed patients to rate medical problems as the chief complaint. The current
study examined whether chief complaints differed among women who were identified
by PCPs as depressed vs. non-depressed.
Presenting problems of women with and without depression were evaluated using
2009 data from the National Ambulatory Medical Care Surveys (NAMCS), a nationally
representative database of patient visits within the US. The current study comprised
16,012 physician visits by adult female patients, including 47.8% (n=7661) who sought
care from PCPs. A total of 1125 (14.7%) women were considered to be depressed by
their PCP, determined by entry of depression on the list of chronic illnesses or ICD-9
diagnoses. Primary chief complaints were categorized as: medical (i.e., flu,
hypertension), psychological (i.e., depression, anxiety), appointment-related (i.e.,
pap smear, check up), or injury-related (broken bone, contusion).
Women with depression were significantly more likely than non-depressed women to
have higher numbers of chronic conditions (p<.001), higher BMI (p<.001), more
physician visits in the past 6 months (p<.001), and to spend more time with their
physicians (p<.001). Yet, notably, physicians were less likely to prescribe treatments
for depressed than non-depressed women. Surprisingly, there were no significant
differences in the chief physical complaints of depressed versus non-depressed
women. Women who were depressed were no more likely than non-depressed
women to list a physical chief health complaint (61% vs. 62%; ns); 30% of depressed
women reported their primary reason for care was a routine visit (compared to 36% of
non-depressed women; ns). Depressed women were significantly more likely to list
their chief complaint as psychological (8% compared to 1% of non-depressed women;
p < .05).
UNIVERSITY OF ILLINOIS AT CHICAGO
Department of Psychiatry
CONCLUSIONS:
In a nationally representative sample of women seeking care from PCPs, contrary to
previous research, women with depression were more likely to report physical, rather
than psychological, reasons for seeking care. However, depressed women were no
more likely to report physical reasons than were women without depression.
Diagnosis of depression in primary care is unlikely to be aided by examining patients’
primary reasons for the visit, except that depressed women are more likely to list
psychological reasons for seeking care; however, less than 10% of depressed women
reported psychological concerns as a reason for seeking care.