Assessment of the Factors Associated with Psychiatric Comorbidity in Depression Patients in Primary Health Care in Chile

Objective: To identify the clinical and psychosocial factors associated with psychiatric comorbidity in
patients consulting for depression in Primary Health Care (PHC) in Chile.
Methods: 394 patients with a diagnosis of major depression being treated in a Chilean PHC were
evaluated using a sociodemographic and clinical interview, the mini-international neuropsychiatric
interview (MINI), a childhood trauma events (CTEs) screening, the intimate partner violence (IPV)
scale, the Life Experiences Survey (LES), and the Hamilton Depression Rating Scale (HDRS).
Results: Positive correlations were established between higher number of psychiatric comorbidities
and severity of depressive symptoms (r = 0.358), frequency of CTEs (r = 0.228), frequency of IPV
events (r = 0.218), frequency of recent stressful life events (r = 0.188), number of previous depressive
episodes (r = 0.340), and duration of these (r = 0.120). Inverse correlations were determined with age
at the time of the first consultation (r = -0.168), age of onset of depression (r = -0.320), and number of
medical comorbidities (r = -0.140). Of all associated factors, early age of the first depressive episode,
CTEs antecedents and recent stressful life events explain 13.6% of total variability in psychiatric
comorbidities.
Conclusions: A higher prevalence of psychiatric comorbidity among subjects seeking help for
depression in Chilean PHCs is associated with early onset of depression, clinical severity, chronicity,
and interpersonal adversity experienced since childhood. Taking into account the fact that current
therapeutic guidelines for depression still do not provide a specific indication for recognition and
treatment in those patients who present comorbidities [1] and considering that psychiatric
comorbidities and psychosocial factors associated are often underdiagnosed and not adequately
treated in the PHC [2,3], this study gives more evidence on the importance of incorporating new
strategies, aimed at the recognition and adequate treatment of comorbidities and the factors
associated in depressed patients consulting in PHC.