Recognition of Depression and Anxiety by Non-Psychiatric Residents in a General Hospital
Nejatisafa, Ali-Akbar, Bajoghli, Hafez, Ale-Agha, Mohammad Sharifi, Rasooli, Fatemeh, Soroush, Ahmad-Reza, Amini, Homayoun, Iranian Journal of Psychiatry
Objective :The objective of this study was to determine the ability of nonpsychiatric (medical and surgical residents) residents on inpatient units to recognize patients with clinically significant depression and anxiety among a cohort admitted to the Dr. Shariati Hospital in Tehran.
Method: Patients within 72 hours of admission underwent screening with the Hospital Anxiety and Depression Scale(HADS). Simultanously the residents caring for the patients was assessed whether they believed that patients had significant depression or anxiety. They should also rate the degree of depression and anxiety of their patients in a 5 point Likert scale.
Results: Assessments were completed for 401 patients. According to HADS score 136(34.25%) patients had probable depressive disorders and 157(39.75%) patients had probable anxiety disorders. The residents only asked from 26(6.4%) and 32(8.2%) patients about depression and anxiety respectively. They identified only 10.2% of patients with probable depressive disorder (HADS-D score>7) and10.8% of patients with probable anxiety disorder(HADS-A score>7). There was no significant correlation of residents' assessment of severity of depression and anxiety with HADS scores. Residents varied in their sensitivity to their patients' depression and anxiety. There was no correlation between residents characteristic (gender and medical or surgical disciplines) and accuracy of probable diagnosis.
Conclusion: Medical and surgical residents routinely under-recognize depression and anxiety among inpatients in medical and surgical wards.
Keywords: Anxiety, Depression, General hospital, Recognition, Residency
Iran J Psychiatry 2009; 4: 41-43
Studies in general hospitals have shown that a high proportion of patients treated for somatic illnesses suffer from a coexisting psychiatric disorder (1-6).
Nevertheless, the majority of patients admitted to general hospitals with symptoms of depression receive no specific treatment (7,8). Furthermore, a diagnosis of depression during a nonpsychiatric hospital stay is linked not only to poorer social performance and quality of life (2,9) but also to a less favorable clinical outcome for the basic medical disorder (whatever the latter's severity) (10,11), to a lengthened hospital stay (12-14) and to increased hospitalization costs (15). A significant proportion of patients presenting with a major depressive disorder during the earlier part of their stay at a general hospital show persistent and severe depression on discharge and during follow-up over several months (16,17). Current and effective therapies for depression are well tolerated and are, by and large, compatible with nonpsychiatric treatment.
Physicians in the nonpsychiatric units of university hospitals overlook about half the cases of depression; the proportion of missed cases, inappropriate diagnoses and absence of treatment is higher in recent studies (1,4,18). When all is said and done, only about one case of depression in four receives appropriate therapy at the general hospital (2).
According to our literature review there wasn't any previous systematic study about ability of nonpsychiatric residents for recognizing depression and anxiety in general hospital inpatients. The objective of this study was to determine the ability of nonpsychiatric (medical and surgical residents) residents on inpatient units to identify patients with clinically significant depression and anxiety among a cohort admitted to the Dr. Shariati Hospital in Tehran.
Materials and Method
Patients who were admitted to Dr. Shariati General Hospital, medical (including general internal medicine, cardiology, endocrinology, rheumatology, nephrology and respiratory disorders units) and surgical (including general surgery, orthopedy, urology and cardiac surgery) wards between February 2006 and march 2007 were recruited for entrance into the study after at least 72 hours from admission. …