Prim Care Companion J Clin Psychiatry 2007;9(6):475-478
© Copyright 2014 Physicians Postgraduate Press, Inc.
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