The researchers believe that such new clues to anxiety and depression can contribute to an improved diagnostic profile that will help family physicians identify patients most at risk for anxiety and depression and help those patients receive appropriate care.

"Primary care physicians see a wide range of patients, from those needing routine health check ups to those with chronic disease and disabilities," said lead author Lawrence Wu, M.D. "We know the traditional symptoms of anxiety and depression -- crying, fatigue, feelings of hopelessness -- but not all patients exhibit these symptoms or report them to their family practitioner. Also, some symptoms such as fatigue can be a symptom of depression or heart disease, so it can be difficult to isolate symptoms and reach a definitive diagnosis."

"We wanted to see whether there are physical symptoms in addition to the emotional symptoms that all patients with anxiety and depression report," said Wu. "Then we can begin to identify patients that fit the profile and refer them to mental health specialists who can treat their anxiety and depression."

In the current study, adult patients ages 18 years and older were recruited at a university-based family practice clinic that has approximately 50,000 patient visits each year. Eligible patients completed the Duke Health Profile, a 17-item questionnaire that measures health status and health-related quality of life during a one-week period. Patients also completed the Duke Anxiety-Depression Scale, a seven-item questionnaire that asks about nervousness, feeling depressed or sad, getting tired easily, trouble sleeping, being comfortable around people, difficulty concentrating and giving up on a task too easily.

Providers completed the Duke Severity of Illness Checklist within 24 hours of patient visits. The Checklist measures severity of illness by assessing the severity of symptom level, complications, prognosis without treatment, and the expected response to treatment. Providers recorded age, gender, race, payer, and diagnoses as well.

The study, which was funded by Duke University Medical Center, examined the responses of 1,822 patients. The average age of respondents was 46.1 years; 67 percent were female.

Analysis revealed that such medical diagnoses as headache, osteoarthritis, and abdominal pain were not significantly associated with anxiety or depression when adjustments were made for other health measures. Rather, researchers found that perceptions of poor health, high levels of pain or disability, and female gender were more closely linked to anxiety or depression than any specific medical diagnosis.

"Female gender is often considered a risk factor for depression," Wu said, "but that may be because women exhibit more traditional symptoms of depression and anxiety and it is more easily recorded. However, in general, males tend to be irritable and more easily angered when they are depressed, and this may not be reflected in the analysis."

Physical symptoms may also have implications for how physicians select antidepressant treatments. "Everyone is aware of the emotional symptoms of depression and most current therapies seem to work equally well for this," said P. Murali Doraiswamy, M.D., co-author of the study. "What is less appreciated is that depression and anxiety can just as frequently present with painful and debilitating physical symptoms. Failure to treat such symptoms can reduce the chances of a full recovery."