내과 입원환자에서의 우울증상의 양상에 대한 연구 = Patterns of Depressive Symptoms in Medical Inpatients

다국어 초록 (Multilingual Abstract)

Objects : Depressive symptoms are common in the medically ill patients although depressive disorders are considerably underdiagnosed and undertreated. Concern regarding missed diagnoses of depression in medical settings has reached the suggestion in which patterns of depressive symptoms in medical patients are different from those of psychiatric depressive although there are other several assumptions. The authors used this suggestion as a hypothesis to settle the question mentioned above. The goals of this study were to examine what difference of patterns of depressive symptoms between medical depressive and psychiatric depressives are.
Methods : The subjects were 155 medical inpatients and 112 depressed psychiatric outpatients. The medical inpatients were divided into medical depressed and nondepressed groups by using DSM-Ⅲ-R criteria for depression. The Hamilton Rating Scale for Depression(HRSD) and Beck Depression Inventory(BDI) were administered to measure severity of depression and to compare patterns of depressive symptoms in the three study groups.
Results :
1) The proportion of female in medical depressives is significantly lower than the other two groups.
2) 80 of medical inpatients(51.6%) met DSM-Ⅲ-R criteria for depression : 55 with dysthymia (68.7%) and 25 with major depression (31.3%).
3) Significant difference were found among the three study groups in terms of total HRSD and BDI scores. Psychiatric patients scored significantly higher on the affective HRSD and BDI items combined as well as that of the somatic items combined. Medical depressives tended to report more somatic symptoms than cognitive/affective symptoms of depression.
4) Significantly difference items one another among the three study groups were 11 items of HRSD and 9 items of BDL. Differences between medical depressive and psychiatric depressives were higher in the cognitive/affective items than the somatic items of HRSD and BDI.
5) “Hypochodriasis” item of HRSD was only significantly higher in medical depressives than the other two groups. “Weight loss” item of HRSD and BDI was only nonsignificant item among the three groups.
Conclusion : Our study indicates that depression is common in medical inpatient and the severity of depression in medical depressives is less severe than psychiatric depressives. It also suggests that the symptom pattern of medical are similar to psychiatric depressives but generally less severe except hypochodriasis item. We can not find any evidence to support the above hypothesis that medical depressives are underrecognized because they will present difference patterns of depressive symptoms as compared with psychiatric depressives.