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Am J Psychiatry 1991; 148:1688-1696
Copyright © 1991 by American Psychiatric Association
How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study
KB Wells, W Rogers, A Burnam, S Greenfield and JE Ware Jr
RAND Corporation, Santa Monica, CA 90407-2138.
OBJECTIVE: Although depression is one of the most common problems of
medical and psychiatric outpatients, it has not been clear whether the
extent of medical comorbidity among depressed patients varies across major
types of clinical settings in which depressed patients receive
care--especially by type of treating clinician (general medical versus
mental health specialty) or type of payment for services (prepaid versus
fee-for-service). METHODS: The authors examined these issues using data on
1,152 adult outpatients with current depressive symptoms and a lifetime
history of unipolar depressive disorder who received care in one of three
health care delivery systems in three U.S. sites. RESULTS: Depressed
patients had a similarly high prevalence (64.9%- 71.0%) of any of eight
common chronic medical conditions whether they were seen in the general
medical or specialty mental health sector; however, those visiting medical
clinicians had a significantly higher prevalence of the two most common
chronic medical conditions, hypertension and arthritis. Among depressed
patients with hypertension, those visiting the general medical sector were
more likely to be taking antihypertensive medication than were those
visiting the mental health specialty sector. Type of payment (prepaid
versus fee-for-service) was unrelated to either prevalence or severity of
comorbid medical conditions, suggesting that the typical depressed patient
in all types of practices studied had medical comorbidity. CONCLUSIONS:
These data suggest that clinicians in all health care settings must be
prepared to encounter chronic medical conditions and complaints in the
depressed patients who visit them.
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