Factors Associated with Psychiatric Comorbidity in Depression Patients in Primary Health Care in Chile

Abstract

Objective To identify the clinical and psychosocial factors associated with psychiatric comorbidity in patients consulting for depression in Primary Health Care (PHC) in Chile. Methods 394 patients with a diagnosis of major depression being treated in a Chilean PHC were evaluated using a sociodemographic and clinical interview, the mini-international neuropsychiatric interview (MINI), a childhood trauma events (CTEs) screening, the intimate partner violence (IPV) scale, the Life Experiences Survey (LES), and the Hamilton Depression Rating Scale (HDRS). Results Positive correlations were established between higher number of psychiatric comorbidities and severity of depressive symptoms (r = 0.358), frequency of CTEs (r = 0.228), frequency of IPV events (r = 0.218), frequency of recent stressful life events (r = 0.188), number of previous depressive episodes (r = 0.340), and duration of these (r = 0.120). Inverse correlations were determined with age at the time of the first consultation (r = -0.168), age of onset of depression (r = -0.320), and number of medical comorbidities (r = -0.140). Of all associated factors, early age of the first depressive episode, CTEs antecedents, and recent stressful life events explain 13.6% of total variability in psychiatric comorbidities. Conclusions A higher prevalence of psychiatric comorbidity among subjects seeking help for depression in Chilean PHCs is associated with early onset of depression, clinical severity, chronicity, and interpersonal adversity experienced since childhood.

Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R)

“…Parental impairment due to mental health problems, which is associated with both PTSD and DTD , is a consistent predictor of poorer outcomes in treatment for childhood anxiety disorders (Norris & Kendall, 2020) and obsessive-compulsive disorder (Kemp, Barker, Benito, Herren, & Freeman, 2020). Adolescents with co-occurring addictive and disruptive behaviour disorders have poorer outcomes in substance abuse treatment unless the treatment is intensive and involves parents as well as their youth (Bachrach & Chung, 2020).…”

“…Children who experience traumatic victimization and psychiatric comorbidity (with or without a diagnosis of PTSD) are at risk for revictimization (Cuevas, Finkelhor, Clifford, Ormrod, & Turner, 2010) and substance use disorders (Carliner et al, 2016;Conway et al, 2016). Moreover, traumatized children with psychiatric comorbidities who as adults develop PTSD (Gekker et al, 2018a), or depression symptoms and negative memory bias (Cancino et al, 2018;Vrijsen et al, 2017), are at risk for additional lifetime psychiatric comorbidity.…”

Latent Class Analysis in Depression, Including Clinical and Functional Variables: Evidence of a Complex Depressive Subtype in Primary Care in Chile

“…A last clinical implication of this research is the relationship between psychiatric comorbidity and recurrence. Most of the psychiatric comorbidities observed in this population correspond to the anxious spectrum [ 8 , 9 ]. The importance of anxiety in depression is recognized in the DSM-5 [ 21 , 57 , 58 ].…”

“…In the Chilean health system, most of MD patients (90%) are diagnosed and treated at primary health care (PHC) [ 2 , 6 ]. At this level of care, among patients with MD, the prevalence of anxiety comorbidity and adverse life experiences is higher than 80% [ 7 – 9 ], associated with greater symptom severity [ 10 ] and lower clinical remission at 12 months [ 11 ]. These findings are consistent with the current knowledge in the field, [ 12 – 17 ], which also shows that neither psychiatric comorbidities nor adverse life experiences are adequately screened in PHC clinical samples [ 18 – 20 ].…”

Психотерапевтические Симптомы-Мишени У Комбатантов С Органическими Заболеваниями Головного Мозга, Сочетанными С Расстройством Адаптации

“…Высокий удельный вес смешанных заболеваний отмечается и в общей структуре психической патологии. Подобные заболевания характеризуются полиморфизмом клинической картины из-за их взаимовлияния -высокой вероятностью негативных последствий для жизнедеятельности пациентов [6,12]. Актуальность проблем сочетанной патологии предопределена ощутимым вкладом коморбидных расстройств в общую структуру психической патологии, её социальным звучанием, значимостью для клинической психиатрии в целом.…”