Major depression in physical illness: Diagnosis, prevalence, and antidepressant treatment (a ten year review: 1982–1992)

The authors conducted a systematic BRS and English-language literature review of the last 10 years of research on the assessment, prevalence, and antidepressant treatment of major depression in the medically ill to determine the current state of knowledge and to make recommendations for future studies. Ninety-three prevalence studies (13,518 patients and 33 conditions or medical settings) met basic methodological inclusion criteria. The great majority (68.8%) of these studies did not describe their methodological approach to the diagnostic assessment of symptoms such as fatigue, which could be due to either a depression or a comorbidphysical disorder. This problem of overlapping symptomatology has been termed the “problem of etiological assessment.” The 29 (31.2%) studies which did describe an approach to this problem used one or more of four different approaches: an “inclusive” approach, an “exclusive” approach, an “etiological” approach, or a “substitutive” approach. Prevalence rates of major depression varied greatly (0-78%). Regarding treatment, of eight controlled studies of antidepressant therapies for major depression, six reported statistically significant differences between medications and placebo. The authors conclude that many recent studies concerning the assessment, prevalence, and treatment of major depression in the medically ill have been inadequate to generate reliable and valid information. Guidelines for future research, especially focusing on the collection of validation data, are proposed. Depression 1:181-204 (1993). © 1993 Wiley-Liss, Inc.