Depressive disorders occurs in 3.7% to 6.7% of general population. In general medical inpatients, the proportion increases to 10% to 14% and 9% to 16% in general medical outpatients. Major depression is an independent risk factor for mortality in patients hospitalized for heart attack at 6 month follow up. About 47% of depressed patients with acute life threatening medical illnesses, either died or had complications compared to 10% of non depressed patients.
Various forms of distress are common in medically ill people. Unless these are recognized and managed appropriately, medical management alone will be less effective. Depression is not the most common distress state, but the most visible one. It is often not diagnosed and insufficiently treated. It will cause the person for decreased survival, marked disability and increased healthcare cost.
In physically ill people depression
- Can be a coincidental association.
- Can be a complication of physical illness.
- Cause or make worse somatic symptoms (such as fatigue, malaise, or pain).
Depressed patients with physical illness
- Consider themselves as more sick and visit their doctors more frequently than non-depressed physically ill person.
- Have longer hospital stay.
- Poor compliance with medication and medical advice.
- They undergo more medical and surgical procedures.
- Depressive illness may be associated with increased mortality (excluding suicide) in patients with physical illness, such as heart attack.
Specific medical conditions with likelihood of developing depression
- Heart attack.
- End stage kidney disease.
- Cancer.
- Chronic pain.
- Neurological disorders such a stroke, Parkinson’s disease,multiple sclerosis.
- Hormonal disorders.
- HIV.
Features to suggest a medical origin of the psychiatric symptoms are the following
- Late onset of initial presentation of symptoms.
- Known underlying medical condition.
- A typical presentation of a specific psychiatric illness.
- Absence of personal or family history.
- Illicit (forbidden by law) substance use.
- Medication use.
- Treatment resistance or unusual response.
- Sudden onset of mental symptom.
- Abnormal vital signs.
- Waxing and waning mental status.
- Sphincter disturbances in the form of bowel and bladder dysfunction
