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Psychiatric Briefs

Prim Care Companion J Clin Psychiatry 2007;9(6):475-478

Objective: The aim of this study was to identify the indicators of major depressive episode (MDE) in primary care patients with a chief complaint of headache. Headache patients in primary care very frequently also have MDE. However, primary care physicians often fail to identify comorbid MDE. 

Method: The study included 177 consecutive new adult patients who visited 19 primary care clinics from January 2002 to December 2002 with a chief complaint of headache. A self-report questionnaire that included questions regarding the duration and severity of their headaches, changes in headache severity, and other symptoms was completed by all participants. In addition, the questionnaire identified distressed high utilizers (patients who consulted different doctors for the same episode of an illness, without being referred). A module of the Mini- International Neuropsychiatric Interview (MINI) was used to identify MDE. Both univariate analysis and multiple logistic regression analysis were performed to identify potential indicators of depression. 

Results: Forty-five (25.4%) of 177 patients fulfilled the diagnostic criteria for MDE. Severe headache, longer duration of headaches, multiple somatic symptoms, and being a distressed high utilizer were associated with MDE according to univariate analysis. Patients with headaches lasting 6 months or longer and those with multiple somatic symptoms were more likely to be suffering from MDE according to multiple logistic regression analysis (adjusted odds ratios: 3.1, 95% CI = 1.7 to 10.6 and 3.9, 95% CI = 1.2 to 8.1, respectively). 

Conclusions: There is a high prevalence of MDE in headache patients visiting primary care settings. Clinicians will find multiple somatic symptoms and longer duration (≥ 6 months) of headaches particularly useful indicators of MDE.