William R. Yates, MD; Jeff Mitchell, MD; A. John Rush, MD; Madhukar Trivedi, MD; Stephen R. Wisniewski, PhD; Diane Warden, PhD, MBA; Charlene Bryan, BS, MPH; Maurizio Fava, MD; Mustafa M. Husain, MD; and Bradley N. Gaynes, MD, MPH
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Background: Concurrent medical
comorbidity influences the accurate diagnosis and treatment
of major depressive disorder (MDD).
Objective: The objective of this study was
to validate previous findings from the Sequenced Treatment Alternatives to Relieve
Depression (STAR*D) study using a confirmation analysis
in a previously unanalyzed cohort.
Design: Baseline cross-sectional
case-control study of patients enrolling in a prospective
randomized multistage treatment study of nonpsychotic MDD.
Setting: Fourteen regional U.S. centers
representing 18 primary care and 23 psychiatric practices.
Participants: 2541 outpatients with
DSM-IV nonpsychotic MDD.
Measurements: Sociodemographic
status, medical illness ratings, psychiatric status,
quality of life, and DSM-IV depression symptom ratings.
Results: The prevalence of significant
general medical comorbidity in this population was 50.0% (95% CI = 48.1% to 52.0%),
consistent with findings reported for the first cohort.
Concurrent significant medical comorbidity was
associated with older age, lower income, unemployment, limited education, and longer duration
of index depressive episode. The group with
significant medical comorbidity reported higher rates
of somatic symptoms, gastrointestinal symptoms, sympathetic arousal, and leaden paralysis.
These results were generally consistent between the
2 cohorts from STAR*D.
Conclusions: Major depressive disorder
with concurrent general medical conditions is
associated with a specific sociodemographic profile
and pattern of depressive symptoms. This
association has implications for diagnosis and clinical care.
Prim Care Companion J Clin Psychiatry 2007;9(1):7-15
https://doi.org/10.4088/PCC.v09n0102
© Copyright 2007 Physicians Postgraduate Press, Inc.