Diagnosing Depression in Medical Inpatients

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Abstract
In a clinical investigation with 153 general medical inpatients, depression was measured by 4 indices: the medical staff''s clinical diagnoses, the Beck Depression Inventory, the Hamilton Rating Scale, and psychiatrists'' reviews. At least 20% were depressed. Depression varied inversely with severity of medical illness, appeared most frequently in concurrence with gastrointestinal diseases, and was related to object loss. Of 36 conventional symptoms, many were reported so often that they did not discriminate the depressed. However, symptom profiles emerged in socioeconomic class and sex groupings. Clinicians diagnosed depression 4 times as frequently in the upper class as in the lower, but it was equally common in all classes and was manifested as a futility syndrome in the lower which must be distinguished from the appearance of poverty and little education. Females somatized while males showed despair; and it was almost as frequent in males as in females. Depression occurred in all age groupings. A formulation of depression in medical patients is offered; this depression is a quantitative variation on classic melancholia, and unless the differences in the manifestations are appreciated, errors in diagnosis result. The work provides guidelines for diagnoses which include particular symptoms, which emphasize demographic variations, and which help clinicians assess depression in those patients with admixtures of physical illness.

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