Background. Since depressive disorders are now eminently
treatable and early detection and
treatment could bring substantial benefits, it is critical to address
alternative presentations of depression in the general medical setting.
Concern regarding under-diagnosis of depression in
general medical settings has given rise to the question of whether the
clinical disorder of
depression differs qualitatively or only quantitatively across care settings.
Methods. Symptom profiles of depression were compared across
sectors to investigate how
the presentation of depression among general medical service users might
from speciality mental health service users. Data on depression symptoms
within 6 months of interview gathered in three community surveys that were
part of the NIMH Epidemiologic Catchment Area Program were analysed using
methods developed to assess item bias. The subjects
were 4931 and 363 persons who reported a visit to the general medical sector
or to speciality
mental health respectively, within 6 months of interview.
Results. Compared with speciality mental health service users,
general medical service users were
less likely to present dysphoria (adjusted Odds Ratio, aOR=0·57;
CI=0·38–0·84) and feeling worthless, sinful, or guilty
(aOR=0·63; 95% CI=0·40–0·98), but
were more likely to present fatigue (aOR=1·71; 95%
CI=1·09–2·69), even after holding
constant other characteristics that might influence reporting of symptoms
as well as level of depression.
Conclusions. These results suggest that there are qualitative
differences in depression presenting
in general medical care compared with speciality mental health care and
call for a reconceptualization of depression in the general medical setting.