Impact of Somatic Symptoms on Identification of Depression among General Outpatients by Family Physicians in North-Western Nigeria

In many places in the world, General Practitioners are only able to identify depression in a small fraction of depressed patients presenting to general outpatient department. The effect of somatic symptoms on its recognition was investigated. The study determines the identification rate of depression by general practitioners among outpatients with somatic symptoms and those without somatic symptoms. This descriptive cross sectional study was conducted in Family Medicine Department, Aminu Kano Teaching Hospital, Kano, Nigeria. The Hospital Anxiety and Depression Scale (HADS) was used to screen selected participants. Forms were used by GPs to itemize medical and psychiatric symptoms elicited as well as medical and psychiatric diagnoses made. Schedule for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1, was used to confirm the diagnosis of depression. Hamilton Depression Rating Scale (HDRS) was used for severity using items 11-14 of Hamilton Depression Rating Scale. Those with somatic symptoms score of 1-3 were rated as having low and those with 4-10 were rated as having high. Of the 410 outpatients recruited, 402 participated in the study. Two hundred and thirteen were screened depressed (HADS). Two hundred were confirmed depressed using SCAN (49.8%). The GPs identified 31.3% of those participants diagnosed depressed without somatic symptoms compared to 15.2% of those who were diagnosed depressed with somatic symptoms. However, no significant association was found between GPs ability to identify depression in the presence or absence of somatic symptoms (p = 0.09). This study found no association between GPs ability to identify depression and presence or absence of somatic symptoms (χ2 = 2.75, p = 0.09). However, this study found that the higher the level of somatic symptoms the more unlikely it’s for GPs to identify depression. To reduce the burden of depression by early detection and treatment, continuing medical education of GPs should include skills in identification of depression.