Original articles Depression and physical comorbidity in primary care Enric Aragone `s a, 4 , Josep L. Pin ˜ol b , Antonio Labad c a Constantı ´ Primary Care Centre, Catalan Health Institute, Spain b Reus-Altebrat Primary Health Care Service, Catalan Health Institute, Spain c Unit of Psychiatry, Rovira i Virgili University, Reus, Spain Received 24 August 2006; received in revised form 17 April 2007; accepted 1 May 2007 Abstract Objective: To analyse how clinical characteristics in depressed patients, as well as the management of their depression, are related to the presence of significant physical comorbidity. Methods: This is a two-phase cross-sectional study that took place in 10 primary care centres in Tarragona (Spain). A total of 906 consecutive patients were screened for depression with a self-rating question- naire and 306 were subject to a structured interview that contained the diagnoses of major depression and dysthymia (DSM-IV), and the severity of the physical comorbidity (Duke Severity of Illness Scale: DUSOI). The association of several clinical variables with the presence of physical comorbidity was evaluated. Results: The comorbidity was of moderate to extreme severity (DUSOI N50) in 31.7% of cases. The patients with comorbidity visited the physician more often. There were no differences in the consump- tion of antidepressants, reason for the consultation (psychological/ somatic), or the probability of being detected as depressed. Neither were there any differences in the severity or disability between both groups. Conclusion: Physical comorbidity is frequent in primary care depressed patients. In general, the characteristics of depression and the handling by the doctor are similar in patients with and without comorbidity. D 2007 Elsevier Inc. All rights reserved. Keywords: Depressive disorder; Dysthymic disorder; Primary health care; Comorbidity; Chronic disease Introduction Depression and physical illness are closely related, particularly in medical settings such as primary care. Depression is particularly prevalent in those patients who suffer from chronic physical diseases. In a previous article, we reported that the prevalence of major depression in primary care patients who suffered from two chronic diseases or more was 23%, while in those who did not suffer from a chronic disease it was 11% [1]. In some cases, depression may be related or caused by specific physiopa- thological effects (e.g., cerebrovascular diseases) but this association is often mediated by disability, pain, or stress derived from physical disease [2]. It has been clearly shown that physical comorbidity influences the detection, diagnosis, and outcomes of the treatment of depression. The presence of medical comorbid- ity seems to be a barrier for diagnosing depression [3]. The doctor may think that the patient has a good reason to be depressed because of the presence of physical disease [4] and erroneously believe that it would be neither appropriate nor effective to treat it. During primary care visits, and particularly in patients with comorbidity, numerous demands and complaints compete for the doctor’s attention and, since time is limited, the detection of and the therapeutic approach to depression mean that this health problem must be actively prioritized over other problems [5]. In an eminently medical context such as primary care, the priorities and expectations of the patient tend to lean towards physical disease [6] and doctors tend to be more interested in the physical complaints than in the emotional distress. Even if doctors are sensitive to the detection and handling of depression, they have to cope with the difficulty 0022-3999/07/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2007.05.008 4 Corresponding author. Centre d’Atencio ´ Prima `ria de Constantı ´, C/ dels Horts, 6, 43120 Constantı ´, Tarragona, Spain. Tel.: +34 977 524109; fax: +34 977 521873. E-mail address: earagones.tarte.ics@gencat.net (E. Aragone `s). Journal of Psychosomatic Research 63 (2007) 107 – 111