[Prevalence and recognition of depression among inpatients of non-psychiatric hospital departments]. / Prävalenz und Erkennen der Depression an nicht-psychiatrischen Krankenhausabteilungen.

PURPOSE: The purpose of this study is to compare the prevalence of depression among different types of hospital departments. Furthermore, it compares different methods for assessment of its recognition by non-psychiatric physicians. METHODS: 993 inpatients of internal, surgical, gynecological and physical rehabilitation wards of community hospitals were interviewed by research psychiatrists using the Clinical Interview Schedule. Ward physicians were asked to fill in a short questionnaire in order to assess whether they could correctly identify patients with mental illnesses. In addition, routine discharge diagnoses were assessed. RESULTS: Of the total sample, 13.3 % suffered from depression. Depression was most frequent on physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. On gynecological wards, prevalence of depression was lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, which equals less than half of those identified by questionnaire. RESULTS: Of the total sample, 13.3 % of patients suffered from depression. Depression was most frequent in physical rehabilitation units (24.2 %), followed by surgical (9.8 %) and internal (9.5 %) wards. In gynecological wards, the prevalence of depression was the lowest (8.7 %). Of those suffering from depression, 45.7 % were identified as mentally ill by non-psychiatric ward physicians when using questionnaire data. Only 21.0 % of the depressed received a psychiatric discharge diagnosis, less than half of those identified by the questionnaire. CONCLUSIONS: Depression is very common among inpatients of physical hospital departments. Unfortunately, depression is frequently overlooked in everyday clinical work. Routine discharge diagnoses give only very limited information about how often ward physicians recognize mental disorders. Furthermore, hospital discharge diagnoses should not be used for planning mental health services.

[Alcohol- and substance abuse among mentally ill patients with migration background in Austria]. / Alkohol- und Drogenmissbrauch bei psychisch kranken PatientInnen mit Migrationshintergrund in Österreich.

The refugee movements of the recent years are confronting the health care with new challenges. However, it has turned out that in Austria data on the mental health of migrants are nearly not available. Especially data on the frequency and patterns of comorbid substance abuse of migrants with mental disorders do not exist even from international studies. We analyzed data from 1819 patients (1726 first generation, 93 second generation) treated in the outpatient clinic for transcultural psychiatry and migration related disorders at the Vienna General Hospital: In first-generation migrants the cultural and religious background of the region of origin has the greatest impact on the frequency and the patterns of misused substances. In second-generation migrants the consumer habits approximate to those of the majority of the society. The primary diagnosis plays a minor role. Only patients with personality disorders exhibit higher rates of illicit substance compared with other diagnoses.

[Pain Symptoms as Predictors of Depressive or Anxiety Disorders in Patients with Physical Illness]. / Schmerzsymptome als Hinweis auf Depressionen und Angsterkrankungen bei PatientInnen an somatischen Krankenhausabteilungen.

OBJECTIVE: The aim of this study was to investigate the frequency of pain symptoms reported by patients of non-psychiatric hospital departments and to explore their association with affective and anxiety disorders. METHODS: Patients of non-psychiatric hospital departments (n = 290) reported pain symptoms by filling in a self-rating questionnaire. Psychiatric examinations were performed by psychiatrists using a structured diagnostic interview. The sum-scores of self-reported pain symptoms were tested for their screening accuracy for anxiety and depression. RESULTS: Patients suffering from affective or anxiety disorders reported significantly more often three or more pain symptoms (63 % vs. 28 %). Using a cut-off value of ≥ 3 of self-reported pain symptoms yielded a sensitivity of 63.1 % and a specificity of 71.7 %. CONCLUSIONS: These findings highlight the relevance of a higher number of pain symptoms as a possible indicator for affective and anxiety disorders. The use of pain symptoms as pre-screening for depression and anxiety might be a useful tool, but needs further research before it can be recommended.

ICD-10 or DSM-IV? Anhedonia, fatigue and depressed mood as screening symptoms for diagnosing a current depressive episode in physically ill patients in general hospital.

OBJECTIVE: To explore the usefulness of "anhedonia", "fatigue" and "depressed mood" as screening symptoms for predicting a depressive episode in physically ill patients. METHOD: 290 patients filled in a modified version of the Patient Questionnaire and were subsequently assessed by psychiatrists with the Composite International Diagnostic Interview (CIDI; ICD-10 version). RESULTS: 63 patients suffered from a current depressive episode according to the CIDI. If at least two of the three symptoms were used for screening positively (ICD-10 algorithm), the sensitivity was 93.2% and the specificity 72.7%, while the simpler algorithm of DSM-IV - requiring depressed mood or anhedonia to be present - yielded a slightly higher sensitivity (95.2%) and a slightly lower specificity (66.5%). One in five patients with a depressive episode did not report "depressed mood". LIMITATION: It remains unclear how relevant the three core symptoms of depression are for the diagnosis of an ICD-10 depression in people who are not physically ill. CONCLUSION: The fact that both diagnostic algorithms yielded comparable results suggests that the more parsimonious DSM-IV algorithm is preferable and "fatigue" could be left out as a screening symptom. Since "depressed mood" was absent in a substantial proportion of patients, special attention has to be paid to "anhedonia". Medical students and non-psychiatric clinicians should be especially trained to ask for anhedonia, so that cases of depression will not be overlooked.