How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study
American Journal of PsychiatryPublished 1 December 1991
Kenneth B. Wells, W Rogers, Audrey Burnam, Sheldon Greenfield, John E. Ware
Citations159
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SJR score5.27
SNIP3.68
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TL;DR
Clinicians in all health care settings must be prepared to encounter chronic medical conditions and complaints in the depressed patients who visit them, suggesting that the typical depressed patient in all types of practices studied had medical comorbidity.
Abstract
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.
Keywords
PsychologyMedicineHealth Professions
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Archives of General PsychiatryThe De Facto US Mental Health Services System
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The LancetNORTRIPTYLINE TREATMENT OF POST-STROKE DEPRESSION: A DOUBLE-BLIND STUDY
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JAMADetection of Depressive Disorder for Patients Receiving Prepaid or Fee-for-Service Care
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American Journal of PsychiatryThe NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis
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Archives of General PsychiatryPhysical Illness Presenting as Psychiatric Disease
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Archives of General PsychiatryRelapse in Major Depressive Disorder
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International Journal of Mental HealthEstimated Prevalence of RDC Mental Disorder in Primary Medical Care
240 Citations1979Edwin W. Hoeper, Greg Nycz +3 more
Studies of patients receiving services from specialized medical settings such as hospital-based general medical clinics and emergency rooms have reported significantly higher rates of mental disorder among their patients than those reported for office-based practices.
Journal of Psychiatric ResearchAgreement between face-to-face and telephone-administered versions of the depression section of the NIMH diagnostic interview schedule
237 Citations1988Kenneth B. Wells, M. Audrey Burnam +2 more
To increase the feasibility of identifying persons with depressive disorders in a large-scale health policy study, the concordance between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule (DIS) was tested.
Diabetes CareDepression in Adults with Diabetes
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Diabetes CareDepression in Adults With Diabetes: Results of 5-yr Follow-Up Study
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Archives of General PsychiatryPrevalence of Major Depression, Simple Phobia, and Other Psychiatric Disorders in Patients With Long-standing Type I Diabetes Mellitus
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The data suggest that increased rates of psychiatric disorder in type I diabetics have both gender-independent and gender-related components.
Annals of Internal MedicineDiagnosing Depression in Medical Inpatients
196 Citations1967John J. Schwab, MARTIN BIALOW +2 more
Excerpt Since the days of hippocrates, depression has been recognized as a distinctive psychobiologic mode as well as a basic biologic mode.
Archives of General PsychiatryThe Outcome of Antidepressant Use in the Medically Ill
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The trials of antidepressants in medical-surgical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions in psychiatric patients with primary affective disorder, and judgments regarding response were a function of routine clinical observation and care.
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Somatic symptoms are powerful determinants of medical utilization, even after controlling for medical morbidity, and depression, disease fear, and bodily preoccupation are also important predictors of utilization.
American Journal of PsychiatryChronic medical conditions in a sample of the general population with anxiety, affective, and substance use disorders
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Archives of Internal MedicineMedical Comorbidity of Major Depressive Disorder in a Primary Medical Practice
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American Journal of PsychiatryA format for DSM-III diagnostic formulation: experience with 1,111 consecutive patients
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Comprehensive PsychiatryDepression in diabetics: A critical appraisal
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American Journal of PsychiatryDepressions secondary to other psychiatric disorders and medical illnesses
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PubMedCost-sharing and the use of general medical physicians for outpatient mental health care.
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PubMedCo-occurrence of psychiatric and medical morbidity in primary care.
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The results indicate that persons with mental disorder diagnoses have significantly more morbidity for the one-year study period.
General Hospital PsychiatryMental illness and ischemic heart disease: Analysis of psychiatric morbidity
26 Citations1985J.L. Vázquez-Barquero, Jesús Acero Acero +2 more
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