Psychiatric aspects of endocrine disorders in women

Diagnosis of co-morbid axis-I psychiatric disorders among women with newly diagnosed, untreated endocrine disorders

OBJECTIVES

To determine the prevalence of major depressive disorder (MDD) and other selected axis-I disorders among women with newly diagnosed, untreated endocrine disorders.

METHODS

Two hundred and eighteen consecutive women, aged 18-65, with newly diagnosed, untreated endocrine disorders were referred for potential diagnosis of co-morbid axis-I disorders with the use of the Structured Clinical Interview for Axis I-Patient Edition (SCID-P). The SCID-P was re-administered after 12 weeks.

RESULTS

At baseline, 64 (29.3%) women met criteria for at least one axis-I disorder. Women who were diagnosed with hyperthyroidism were more likely to meet criteria for generalized anxiety disorder and panic disorder than women without hyperthyroidism. Nine of 154 (5.8 %) women who did not meet criteria for an axis-I disorder at baseline met criteria for at least one axis-I disorder during follow-up. Among them, the presence of diabetes mellitus was statistically correlated with a higher probability of developing major depressive disorder at follow-up.

CONCLUSIONS

Although preliminary, our findings are consistent with previous studies and suggest an increased prevalence of MDD and other axis-I disorders among women with newly diagnosed endocrine disorders, providing further evidence suggesting that women with endocrine abnormalities may be at increased risk of depression and/or anxiety disorders.

Race disparities in psychiatric rates in emergency departments

Psychiatric diagnoses based on the International Classification of Diseases--Ninth Revision were examined in the medical discharge records of 33,000 emergency department (ED) patients to determine if (a) psychiatric disorders were underdiagnosed, (b) there were race and gender disparities in psychiatric rates, and (c) psychiatric rates varied as a function of type of injury (e.g., self vs. other-inflicted injuries) and medical diagnosis. The observed psychiatric rate of 5.27% was far below the national prevalence rate of 20%-28%. Both race groups were underdiagnosed, but the underdiagnosis was larger for African Americans. Younger patients had fewer psychiatric diagnoses than older patients. Men had more psychiatric diagnoses overall, whereas women had more mood and anxiety diagnoses. Self-injury patients had much higher psychiatric rates than the other injury groups. This psychiatric underdiagnosis contributes to needless emotional suffering, especially for minorities and the poor who rely on EDs for most of their health care.