ANXIETY AND DEPRESSION IN FAMILY PRACTICE PATIENTS WITH CO-MORBIDITIES

Vojislav Ivetic, M.D. 1 Zalika Klemenc-Ketis, M.D. 1

Darinka Novak-Glavac, M.D. 2

Prof. Janko Kersnik , M.D. PhD. 1

1 Department of Family Medicine, University of Maribor, SLOVENIA 2 PHC Ljubljana, SLOVENIA

AIMS AND PURPOSE 1/2

Symptoms of mental and physical illnesses overlap in family practice

In family practice many patients present with co-morbidities rather than simple cases

Depression and anxiety account for a great part of all psychiatric diseases in family practice and they are associated with each other in 50 to 70% of the patients (Kaplan 1996).

EVERYDAY CHALLENGE WITH CO-MORBIDITIES IN FAMILY PRACTICE

AIMS AND PURPOSE 2/2

The aim of this study was to establish how often depression and anxiety are encountered by family practitioners and especially determine those risk groups where both disorders occur more often.

We hypothesized that anxiety and depression correlate with socio-demographic factors (age, gender, social status) and presence of chronic physical condition

DESIGN AND METHODS

We conducted a cross-sectional survey in 16 Slovenian family practices

A total of 800 patients of both sexes, aged 18 to 90, were included in the sample.

They were asked to fill in an anonymous Zung self-rating form (Zung 1971), which besides anxiety and depression question included questions regarding age, sex, marital status, education, employment, as well as the presence of chronic pain and chronic somatic disease.

STATISTICAL ANALYSIS

We used the SPSS 13.0 package (SPSS Inc, Chicago, IL, USA)

To identify the statistically significant differences between different variables independent samples t-test and χ2 test were calculated

To determine associations between the presence of anxiety and depression and patients’ characteristics, binary logistic regression was used

P value<0.05 was considered statistically significant

RESULTS 1/4:

712 forms were returned (response rate 89%)).

386 (54.2%) patients reported to have at least one chronic disease

Chronic pain was reported by 444 (62.4%) of the patients

Analysis showed that 16.2 % of general practice visitors have depressive disorders, while 11.4 % have anxiety disorders.

ONE OF THE IMPROPER REASON FOR THE CHRONIC PAIN !

RESULTS 2/4:

The following patients’ characteristics were found to be statistically significant in the presence of depression: female vs. male (χ2=7.259, p=0.007), patients with elementary and vocational

education vs. others (χ2=9.910, p=0.002), widowed and divorced patients vs. others

(χ2=25.670, p<0.001), patients with the presence of physical chronic

disease vs. others (χ2=16.840, p<0.001) and patients with higher degree of chronic pain

(χ2=53.091, p<0.001).

RESULTS 3/4:

The following patients’ characteristics were found to be statistically significant in the presence of anxiety: female vs. male (χ2=3.905, p=0.048), patients with elementary and vocational

education vs. others (χ2=8.053, p=0.005), widowed and divorced patients vs. others

(χ2=17.647, p<0.001), unemployed patients vs. others (χ2=8.981,

p=0.011), patients with the presence of physical chronic

disease vs. others (χ2=17.259, p<0.001) and patients with higher degree of chronic pain

(χ2=57.824, p<0.001)

RESULTS 4/4:

Women are twice as likely to develop depressive disorders, while anxiety is present in 13.2 % women and 8.0 % of men.

Loss of spouse or partner, social hardship (poverty, unemployment) and low level of education increase the risk for the development of a mental disorder.

Chronic pain increases the prevalence of anxiety and depression, with only 2.8 % of patients without chronic pain having anxiety disorders, while 26.8 % of subjects who rated their pain as 8 or more (VAS SCORE) had anxiety disorders.

ONE OF THE IMPROPER SOLUTIONS !

CONCLUSIONS:

Patients with chronic somatic illnesses have twice the risk to develop depressive disorders, especially those with a pronounced debilitating, repeating, advancing and life-threatening somatic illness (myocardial infarction, stroke, cancer, rheumatic disease).

The main limitations of this study are a non-random patients’ sample and a non-random sample of family practice settings, which can attribute to a selection bias. The other limitation is also patients’ self-reporting of chronic diseases.

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