Difference Of Symptoms And Treatment Of First-visit Patients With Major Depressive Disorder In General Hospitals And Psychiatric Hospitals

Background and Objective: Depression is a highly heterogeneous syndrome.Patients with major depressive disorder may have different illness experience and clinical manifestations,which may have an impact on health seeking behavior.We aimed to explore the differences of clinical features between psychiatric and general hospitals patients,compare the treatment strategies,and select predictors of patients’ health seeking behavior.Methods: The cross-sectional,multi-center study relied on National Survey on Symptomatology of Depression.A total of 1,500 first-visit patients diagnosed with major depressive disorder according to DSM-IV-TR were recruited from 16 psychiatric hospitals and 16 general hospitals across China.Demographic characteristics,medication information,and clinical features were collected using a self-made questionnaire.Random forest,chi-square test,t-test,and rank-sum test were used for statistical analysis to compare the difference of clinical features and treatment between first-visit patients in general and psychiatric hospitals.Results: A total of 842 patients from general hospitals and 658 patients from psychiatric hospitals were enrolled.(1)There are differences of symptoms between patients with major depressive disorder in psychiatric and general hospitals.The proportion of patients who present emotional,cognitive,and anxious symptoms was significantly higher in psychiatric hospitals than in general hospitals(p<0.05).The proportion of patients who present psychotic symptoms and suicidal thoughts was significantly higher in general hospitals than in psychiatric hospitals(p<0.05).In terms of specifiers for depressive disorders,the proportion of patients "with anxious distress" is similar,but patients in psychiatric hospitals may have higher levels of anxiety.The proportion of patients "with atypical features" and "with psychiatric features" was significantly higher in general hospitals than in psychiatric hospitals(p < 0.05).(2)According to random forest,"Sensitivity to rejection","Weight loss","Lack of interest","Weight gain","Psychotic symptoms" may have higher importance in the classification of patients in general hospitals and psychiatric hospitals.(3)Treatment strategies are different between general and psychiatric hospitals.The proportions of SSRIs,Na SSAs prescriptions were higher in general hospitals than in psychiatric hospitals(p<0.05),while the proportion of SNRIs prescriptions was higher in psychiatric hospitals than in general hospitals(p<0.05).Conclusions: Clinical features and treatment of first-visit patients diagnosed with major depressive disorder in psychiatric and general hospitals may be different,suggest that evaluation focused on specific symptoms may help to accurately reflect the clinical features of the patients,and then help the development of precision medicine.