How to early recognize mood disorders in primary care: A nationwide, population-based, cohort study.
BACKGROUND
Mood disorders are managed predominantly in primary care. However, general practitioners' (GPs) ability to detect and diagnose patients with mood disorders is still considered unsatisfactory. The aim of the present study was to identify predictors for the early recognition of depressive disorder (DD) and bipolar disorder (BD) in general practice.


METHODS
A cohort of 1,144,622 patients (605,285 women, 539,337 men) was investigated, using the Health Search IMS Health Longitudinal Patient Database. Predictors of DD or BD were identified at baseline encompassing somatization-related features, lifestyle variables, medical and psychiatric comorbidities. Patients were followed up as long as the following events occurred: diagnoses of DD or BD, death, end of the registration with the GP, end of the study period.


RESULTS
We found an incidence rate of DD or BD of 53.61 and 1.5 per 10,000 person-years, respectively. For both the conditions, the incidence rate grew with age. Most of the lifestyle variables and medical comorbidities increased the risk of mood disorders. The strongest effect was found for migraine/headache (HR [95% CI]=1.32 [1.26-1.38]), fatigue (1.32 [1.25-1.39]) irritable bowel syndrome (1.15 [1.08-1.23]), and pelvic inflammation disease (1.28 [1.18-1.38]).


CONCLUSIONS
Several predictors, in particular somatic symptoms, could be interpreted as an early sign of a mood disorder, and represent a valid indication for the GPs diagnostic process of mental disorders.
['Castellini|G|G|', 'Pecchioli|S|S|', 'Cricelli|I|I|', 'Mazzoleni|F|F|', 'Cricelli|C|C|', 'Ricca|V|V|', 'Hudziak|J J|JJ|', 'Brignoli|O|O|', 'Lapi|F|F|']
D000328:Adult D015331:Cohort Studies D042241:Early Diagnosis D005260:Female D006801:Humans D015994:Incidence D007558:Italy D008297:Male D008875:Middle Aged D019964:Mood Disorders D011320:Primary Health Care
Primary care Depressive disorder Bipolar disorder General practice Somatization Public mental health