Abstract
Objetivos
Investigar la prevalencia de depresión y su relación con el motivo de la consulta y el diagnóstico médico.
Diseño
Descriptivo transversal.
Emplazamiento
Unidades de atención primaria de una comunidad de Brasil.
Pacientes u otros participantes
Individuos entre 13 y 19 años, que acudieron a 10 unidades de atención primaria para consultar con médico no psiquiatra entre octubre del 1997 y enero del 1998 (n = 463).
Mediciones y resultados principales
Se utilizó el CET-DE (Alonso-Fernández, 1986) para medir la depresión y un cuestionario para evaluar datos sociodemográficos y relativos a la consulta. La prevalencia fue del 26,5% (intervalo de confianza [IC] del 95%: 22,6–30,4%). Hubo un 99,2% de casos de depresión no identificados. Las quejas estuvieron dispersas en el campo somático (61,1%) y relacionadas con la sexualidad (49,5%), principalmente el embarazo (31,7%), sobre todo entre los deprimidos (p < 0,001). Hubo pocas quejas psicosociales (1,5%). Los diagnósticos con frecuencia estuvieron de acuerdo con las quejas: un 59,9% somáticos; un 38,4% relacionados con la sexualidad (embarazo, el 21,6%), y un 1,7% de tipo psicosocial.
Conclusiones
La depresión en adolescentes es frecuente en atención primaria, y no suele ser identificada. La razón se puede atribuir al tipo de depresión, que suele ser leve o focalizada en una sola dimensión de la vitalidad humana; por una tendencia del médico a centrar su atención en la queja sin ampliar el espectro clínico, o incluso porque el joven apenas expresa sus problemas emocionales, lo que contribuye para que la depresión pase con frecuencia sin ser diagnosticada.
Palabras clave: Adolescencia, Depresión, Atención primaria, Brasil
Abstract
Objectives
To investigate the prevalence of depression and its relationship to the reason for the consultation and to the medical diagnosis.
Design
Descriptive, cross-sectional design.
Setting
Primary care units of a community in Brazil.
Patients and other participants
Individuals between 13 and 19 years old, who attended 10 primary care units to consult with a non-psychiatric doctor between October 1997 and January 1998 (n = 463).
Main measurements and results
The CETDE (Alonso-Fernández, 1986) was used to measure depression, jointly with a questionnaire for evaluating social and demographic details and data pertinent to the consultation. Prevalence ran at 26.5% (95% CI: 22.6–30.4%). 99.2% cases of depression had not been identified. Complaints were spread over the somatic field (61.1%), or were sex-related (49.5%), mainly pregnancy (31.7%), especially among the cases of depression (p < 0.001). There were few psychiatric-social complaints (1.5%). Diagnoses often coincided with complaints: 59.9% somatic, 38.4% sex-related (pregnancy = 21.6%) and 1.7% psychiatric-social.
Conclusions
Adolescent depression is common in primary care, but is not usually identified. The reason for this may be the kind of depression, which is usually light or focused on just one dimension of human vitality; the doctor´s tendency to centre his/her attention on the complaint without broadening the clinical spectrum; or even because the adolescent expresses his/her emotional problems poorly, which often contributes to the depression not being diagnosed.
Key words: Adolescence, Depression, Primary care, Brazil
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