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Hispanic patients with depression and dysthymia have disproportionately high numbers of somatic symptoms, particularly among women less than 40 years of age. Within primary care, vague or unexplained symptoms such as aches, pain and fatigue are often presenting symptoms of depression. Many patients with comorbid depression and chronic disease may sabotage their own treatment by ‘focusing on the physical’ and delaying treatment of mental health concerns for weeks or months. Such delays in addressing the underlying depression can not only make remission difficult, but can make treatment of the physical condition challenging. Major depression increases the burden of chronic illness by increasing perception of symptoms, causing additional impairment in functioning, and increasing medical cost through over utilization of the health care system.
Methods
Hispanic patients at local health clinics were screened for depression during an investigation of integrated care. Depressed screening and other data collected occurring during baseline assessment were used in the current study. Across all clinics, the PHQ9 and related assessments were completed by 500 patients. To examine possible heterogeneity in the presentation of depression, self-reported items from the PHQ9 were used as indicators in a latent profile analysis (LPA) using Mplus 8.0. Additional analyses examined associations between the latent categorical variable (i.e., depression profiles) and additional patient characteristics and reported scores.
Results
LPA modeling indicated a four-profile solution best fit the data (BIC=10376.316) and was a significant improvement on a model with three profiles (LMR p =.0146). Entropy scores (.894) further supported the latent categorical variable and fit with the data. Profiles were found to be a dysthymic profile, a fatigue profile, a self-worth depression profile, and a severe depression profile. In terms of PHQ-9 severity, the fatigue profile most closely aligned with the self-worth depression profile. Profile membership was not associated with gender, education level, or being solely Spanish-speaking. A MANOVA test indicated significant differences by profile for anxiety scores (F=29.86, p<.001, partial 𝜂2=.155).
Conclusion
Capturing four profiles of depression in a large primary care sample helps characterize the manifestation of depression in four different ways in a Hispanic population. The single item related to fatigue had the greatest variation across groups indicating it might be useful as a screening item. Careful attention to physical descriptions of symptoms could prove important to understanding depression severity and has implications for treatment.