내과 입원환자에서의 우울증상의 양상에 대한 연구

Patterns of Depressive Symptoms in Medical Inpatients

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 depressives although there are other several assumptions. The authors used this suggestion as a hypothesis to settle the question mentioned above. The goals o f this study were to examine what differences o f patterns of depressive symptoms between medical depressives 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 H am ilton Rating Scale for Depression (H R SD ) and Beck Depression Inventory(BD l) 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 m ajor depression(31.3 % ). 3) Significant differences were found among the three study groups in terms of total H RSD and BDI scores. Psychiatric patients scored significantly higher on the affective H RSD and BDI items com bined 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 different items one another among the three study groups were 11 items of H RSD and 9 items of BDI. Differences between medical depressives and psychiatric depressives were higher in the cognitive/affective items than the somatic items of H RSD and BDI. 5) “Hypochodriasis” item of H RSD was only significantly higher in medical depressives than the other two groups, height loss” item of HRSD and BDI was only nonsignificant item among the three groups. Conclusion : Our study indicates that depression is common in medical inpatients and the severity of depression in medical depressives is less severe than psychiatric depressives. It also suggests that the symptom patterns of medical depressive 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 different patterns of depressive symptoms as com pared with psychiatric depressives.