Indicators of a major depressive episode in primary care patients with a chief complaint of headache

Objective - To identify the indicators of major depressive episode (MDE) in primary care patients with a chief complaint of headache. Background - MDE is very frequent among headache patients in primary care. However, primary care physicians often fail to recognize the coexistence of MDE. Methods - A total of 177 consecutive new adult patients who visited 19 primary care clinics from January 2002 to December 2002 with a chief complaint of headache were enrolled in the study. All subjects completed a self-report questionnaire that included questions regarding the duration and severity of their headaches, changes in headache severity, and other symptoms. The questionnaire also identified distressed high utilizers (patients who consulted different doctors for the same episode of an illness, without being referred). MDE was diagnosed using a module of the mini international neuropsychiatric interview (MINI). To identify potential indicators of depression, both univariate analysis and multiple logistic regression analysis were performed. Results - Forty-five of 177 patients (25.4%) fulfilled the diagnostic criteria for MDE. Univariate analysis revealed that severe headache, longer duration of headaches, multiple somatic symptoms, and being a distressed high utilizer were associated with MDE. Multiple logistic regression analysis revealed that patients with headaches lasting 6 months or longer and those with multiple somatic symptoms were more likely to be suffering from MDE (adjusted odds ratios: 3.1, 95% CI: 1.7-10.6; and 3.9, 95% CI: 1.2-8.1, respectively). Conclusions - MDE is highly prevalent in headache patients visiting a primary care setting. Multiple somatic symptoms and longer duration (≥6 months) of headaches are particularly useful indicators of MDE.