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How to early recognize mood disorders in primary care: A nationwide, population-based, cohort study

Published online by Cambridge University Press:  23 March 2020

G. Castellini ,
S. Pecchioli ,
I. Cricelli ,
F. Mazzoleni ,
C. Cricelli ,
V. Ricca ,
J.J. Hudziak ,
O. Brignoli  and
F. Lapi
G. Castellini
Affiliation:
Psychiatric Unit, Department of Neuroscience, Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, Florence University School of Medicine, Florence, Italy
S. Pecchioli
Affiliation:
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
I. Cricelli
Affiliation:
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
F. Mazzoleni
Affiliation:
Italian College of General Practitioners and Primary Care, Florence, Italy
C. Cricelli
Affiliation:
Italian College of General Practitioners and Primary Care, Florence, Italy
V. Ricca
Affiliation:
Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
J.J. Hudziak
Affiliation:
Vermont Center for Children, Youth, and Families, University of Vermont, Burlington, VT, United States Erasmus University, Sophia Children’s Hospital, Rotterdam, The Netherlands Department of Child Psychiatry, Washington University, Saint-Louis, MO, United States
O. Brignoli
Affiliation:
Italian College of General Practitioners and Primary Care, Florence, Italy
F. Lapi*
Affiliation:
Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
*
* Corresponding author. Health Search, Italian College of General Practitioners. Via Sestese, 61 50141, Florence, Italy. Tel.: +39 55 494 900; fax: +39 55 779 311x66. E-mail address:lapi.francesco@simg.it (F. Lapi).
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Abstract

Background

Mood disorders are managed predominantly in primary care. However, general practitioners’ (GPs) ability to detect and diagnose patients with mood disorders is still considered unsatisfactory. The aim of the present study was to identify predictors for the early recognition of depressive disorder (DD) and bipolar disorder (BD) in general practice.

Methods

A cohort of 1,144,622 patients (605,285 women, 539,337 men) was investigated, using the Health Search IMS Health Longitudinal Patient Database. Predictors of DD or BD were identified at baseline encompassing somatization-related features, lifestyle variables, medical and psychiatric comorbidities. Patients were followed up as long as the following events occurred: diagnoses of DD or BD, death, end of the registration with the GP, end of the study period.

Results

We found an incidence rate of DD or BD of 53.61 and 1.5 per 10,000 person-years, respectively. For both the conditions, the incidence rate grew with age. Most of the lifestyle variables and medical comorbidities increased the risk of mood disorders. The strongest effect was found for migraine/headache (HR [95% CI] = 1.32 [1.26–1.38]), fatigue (1.32 [1.25–1.39]) irritable bowel syndrome (1.15 [1.08-1.23]), and pelvic inflammation disease (1.28 [1.18–1.38]).

Conclusions

Several predictors, in particular somatic symptoms, could be interpreted as an early sign of a mood disorder, and represent a valid indication for the GPs diagnostic process of mental disorders.

Keywords

Depressive disorderBipolar disorderGeneral practicePublic mental healthSomatizationPrimary care
Type
Original article
Information
European Psychiatry , Volume 37 , September 2016 , pp. 63 - 69
Copyright
Copyright © European Psychiatric Association 2016

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