Cited by 291Psychosomatic Disorders and Their TreatmentsMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Depressive and Anxiety Disorders in Patients Presenting With Physical Complaints

Kroenke, Kurt, Jackson, Jeffrey L, Chamberlin, Judith·1997·The American Journal of Medicine

DOI 10.1016/s0002-9343(97)00241-6

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Abstract

Purpose To identify the predictors of depressive and anxiety disorders in general medical patients presenting with physical complaints and to determine the effect of these mental disorders on patient outcome.Patients and methods In this cohort study, 500 adults presenting to a general medicine clinic with a chief complaint of a physical symptom were interviewed with PRIME-MD to diagnose DSM-IV depressive and anxiety disorders. Clinical predictors were identified by logistic regression analysis. Outcomes were assessed immediately postvisit and at 2 weeks and 3 months. These included symptomatic improvement, functional status, unmet expectations, satisfaction with care, clinician-perceived patient difficulty, and health care utilization and costs.Results A depressive or anxiety disorder was present in 146 (29%) of the patients. Independent predictors of a mental disorder included recent stress, multiple physical symptoms (ie, 6 or more), higher patient ratings of symptom severity, lower patient ratings of their overall health, physician perception of the encounter as difficult, and patient age less than 50. Patients with depressive or anxiety disorders were more likely to have unmet expectations postvisit (20% versus 8%, P < 0.001), be considered difficult (26% versus 11%, P < 0.0001), and report persistent psychiatric symptoms and ongoing stress even 3 months following the initial visit. Psychiatric status was not associated with symptomatic improvement, health care utilization, or costs.Conclusion Simple clinical clues in patients with physical complaints identify a subgroup who may warrant further evaluation for a depressive or anxiety disorder. Such disorders are associated with unmet patient expectations and increased provider frustration.

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Authors: Kroenke, K., Jackson, J. L., & Chamberlin, J.
Affiliations: Regenstrief Institute (US)
Uniformed Services University of the Health Sciences (US)
Corresponding author: Kroenke, Kurt
ORCID: Kroenke, Kurt
Jackson, Jeffrey L
Venue: The American Journal of Medicine
Publisher: Elsevier BV
Published: 1997-11
Volume: 103
Issue: 5
Pages: 339-347
ISSN: 0002-9343 (ISSN-L)
DOI: 10.1016/s0002-9343(97)00241-6
OpenAlex: W2002164712
Cited by: 291
References: 64
Citations by year: 2026: 2 · 2025: 7 · 2024: 9 · 2023: 10 · 2022: 7 · 2021: 9 · 2020: 14 · 2019: 7 · 2018: 4 · 2017: 8 · 2016: 12 · 2015: 4 · 2014: 14 · 2013: 7 · 2012: 13
FWCI: 4.27
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The American Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: depressive disorders, anxiety disorders, somatic symptoms, physical complaints, general medical patients, PRIME-MD, patient satisfaction, health care utilization, health care costs, functional status
MeSH terms: Adult, Aged, Anxiety, Depressive Disorder, Female, Frustration, Humans, Male, Middle Aged, Physicians, Predictive Value of Tests, Prospective Studies, Psychiatric Status Rating Scales, Severity of Illness Index, Stress, Psychological, Odds Ratio, Treatment Outcome, Patient Satisfaction, Mood Disorders

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Depressive and Anxiety Disorders in Patients Presenting With Physical Complaints

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