ABSTRACT
To estimate the rate of hidden psychiatric morbidity [HPM] among the study population and to compare the assessment of the primary health care [PHC] physician with that of the psychiatrist. Design: All patients seen on two weekly sessions were rated by a PHC physician according to a pre-designed 5-point severity rating scale and diagnostic classification. One third of them, selected on the basis of systematic random sampling, were interviewed by a psychiatrist using the clinical interview schedule [CIS]. The same diagnostic and severity rating scales were filled by the psychiatrist. Setting: A primary care center in Riyadh, the capital of Saudi Arabia. Participants - 114 patients seen by the PHC physician and 38 of them interviewed by the psychiatrist. The hidden psychiatric morbidity [HPM] is high [31%], representing 67% of the total psychiatric morbidity [46%]. This is due to the low identification index of the physician [33%]. The higher the severity of the illness as rated by the PHC physician, the more likely to be a clinically significant psychiatric case. On the other hand, the specificity [95%] and predictive value [86%] are high, i. e. he is likely to be correct when he makes a positive diagnosis. There is a significant difference in the ratings of the psychiatrist and the physician, [McNamar's test, P < 0.01] and the agreement is low, [Cohen's Kappa = 0.26]. Psychiatric illness with somatic symptoms constituted the largest proportion of diagnostic categories as judged by the psychiatrist [31%. 6%]. Patients labeled by the PC physician to have physical illness in a neurotic personality were usually missed psychiatric cases