Prevalence of Mental Disorders in Family Practice Centers in Korea and the Utility of a Diagnostic Tool

BACKGROUND: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ). METHODS: Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ. RESULTS: The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P <0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49~82) in major depressive disorders, 70% (50~90) in panic disorders, 70% (56~83) in somatoform disorders, 84% (75~92) in alcohol abuse, and 68% (62~74) in any mental disorders. Patients' response to the PHQ was overall very receptive. CONCLUSION: One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.

The relationship between osteoarthritis and bone mineral density in the lumar spine

BACKGROUND: Osteoporosis is becoming major health problem in old age and menopausal women, and osteoarthritis is most common joint disease in both ages. The inverse relationship between osteoporosis and osteoarthritis was first noticed 20years ago. However the subject had not been studied in korea. Thus, our objectives is to examine the influence of osteoarthritis on bone density measurements. METHODS: The study group consisted of 120 women, aged over 40 years, who visited for health examination in Health Center of Poondang Jesaeng general hospital from October 1998 to April 1999. Bone mineral density(BMD) of the lumar spine was measured, using dual energy X ray absorptiometry(Lunar, Expert XL), and lateal lumbar spine radiograph was taken. Severity of osteoarthritis were scored on osteophytes, disk space narrowing and vertebral body sclerosis. RESULTS: Postmenopausal women had signifcantly lower BMD than premenopausal women(p<0.001). Age(r= 0.545, p<0.001), body mass index(r=0.264, p<0.01) and education(r=0.284, p<0.01) were significantly correlated with BMD, but smoking, exercise, radiogrphic OA variables not correlated. However, stepwise multiple regression analysis using osteoporosis related variables and OA variables is indicated that menopausal status, body mass index, age, osteophytes were significantly associated factor with BMD, and lumbar osteophytes explained 2.7% of variation in lumbar spine BMD. CONCLUSION: We conclude that, among women, lumbar BMD is highier in those with osteophytosis of the lumbar spine. The effect is largely directed by osteophytes being included in the BMD measurement.

The propensity to depression and anxiety in children

BACKGROUND: The goals of this study are to investigate the propensity to depression and anxiety in children, and also, to investigate its relationship to the family structure, their life events, and school achievement. We have attempted to aid the continuous and comprehensive management of children with depression and anxiety in a field of family practice. METHODS: A group of 797 boys and girls in 5th and 6th were selected grades a elementary school in their, In the area of ll-san and In-cheon city in August, 1997. Making use of the Kovacs' Children's Depression Inventory(CDI, 1977) and the Spielberger's State-Trait Anxiety Inventory for Children(STAIC, 1973), we investigated the propensity to depression and anxiety by self-rating. At the same time, the general characteristics(gender, age, resideuce, family structure), life events(death single parent, divorced family, death of a sibling, family discord between husband), and school achievement were investigated and assessed their relationship. RESULTS: The Children's Depression Inventory score was 11.69, the State Anxiety Inventory score was 31.51, and the Trait Anxiety Inventory score was 31.49. The CDI score were significantly higher in females, sixth year students, residents execpt for those living in an apartment or villa, and low school achievement group(P<0.01, P<0.05), There was no significance between CDI score and age, whether or not a dual-income family, death of a sib, hospitalization within 6 months, and family discord between husband and wife. The STAIC score was significantly higher for old age, female, sixth year students, and low school achieve menu group(P<0.01), and there was no significance between the STAIC score and residence, whether or not a dual-income family, death of a sibling, hospitalization within 6 months, and family discord between husband and wife. CONCLUSIONS: According to our results, there was a significant correlation between gender, school years, school achievement and a propensity to depression and anxiety. Therefore, family physician should be more involved in family intervention and anticipatory guidance upon medical examination and treatment, if he or she has a symptoms of anxiety and depression.

Relationship between control measurement point (CMP) value of Electroacupucture according to Voll(EAV) and clinical laboratory findings and subjective symptoms of patients

BACKGROUND: The objective confirmation of subjective symptom of patient is important in the primary care consisted largely by functional disorders of which mechanisn could not explain the symptoms clearly. Definite diagnostic method is not established yet for the functional disorders desptie the fact that various investigations have been done. So, we tried to reveal the relationship between the value of indicator drop(ID) from electroacupunctrure point accordint to Voll and the clinical diagnosis and subjective symptom by using noninvasive electroacupuncture diagnosis according to Voll. METHODS: Among the patients of three university level hospital health care center from April to June 1997, consenting 203 persons were enrolled. Various laboratory finding and ID from EAV were measured by double blind test method. In parallel, Subjective symptom was classified by each organ. Validity was tested by the relationship between the gastrofiberscopy finding and the stomach control measurement point ID. RESULTS: There were statistically significant ID increases in the CMPs of endocrine, lung, circulation system, gastrointestinal system, kidney and bladder compared to alboratory findings or subjective symptom by the comparison between the variables of the assessed clinical or laboratory findings and organ specific CMP score. Especially, the ID increase of stomach shows 79.3%-90.9% positive predictive value to positve findings of gastrofiberscopy when gastofiberscopy is defined to confirmation test of gastritis, gastric ulcer and duodenal ulcer. CONCLUSION: Our results show that the noninvasive electrodiagnostic method result by measuring EAV of organ system is related statistically to subjective symptoms and laboratory findings. Also they show that it could be useful tool as a clinical diagnostic method. We suggest that further study is needed to reveal organ specific sensitivity, specificity, positivE and negative predictive value by using ccnfirmation method of organ specific disease.

The factors related with office worker's health perception

BACKGROUND: Recently, the concept of health is being extended to physical, mental and social aspects, which leads people to pursue health positively behavior. But the evaluation of health condition shows a tendency to be biased to functional side. It means the absence of well being sensation that anyone feels like he has poor health. In this case, even if he is in physically good health, he is not rated as healthy. We analyzed the relationship between one's health state and the factors related with health perception including health behavior, mind and social environment. METHODS: For a month of May 1996, we surveyed those who visited for Periodic medical check-up at one general hospital in Seoul. The questionnaire consisted of the total of 25 items ; diet behavior, weight control, coffee, coke, tea, drug use of, smoking, drinking, exercise, leisure, safety belts use, jay walking, sleep, stress, personality, anxiety, depression, occupational satisfaction, relationships with family and friends. Five point scale is used as the answer of each question item with high point as good living behavior. Among 406 who had sincerely answered the questionnaire, we divided them into healthy and unhealthy group and compared with the point of each question item and with the laboratory data(obesity, blood pressure, hemoglobin, fasting blood sugar, cholesterol and ALT). RESULTS: Among 406, the number of those who perceived themselves to be healthy was 175(43.1%, healthy group) and the one of those who did not was 231(56.9%, unhealthy group), The difference between both groups was not significant in distribution of sex, age, academic career, income and religion. In laboratory data and living behavior they showed same results, also. But the points of unhealthy group were significantly lower than those of healthy group in coffee, coke, tee, drugs usage, exercise, leisure, stress, personality, anxiety, depression, occupational satisfaction and relationship with family and friends. So was the total point of all items of unhealthy group in comparison with that of health group. In the case of male, the points of unhealthy group were significantly lower in smoking, safety belt use, fay walking, sleeping as well as the above items. On the contrary, in the case of female, both groups were not significantly different all item except exercise and leisure. CONCLUSIONS: Health perception is influenced by psychosocial factors and living behavior more than by physical health. Therefore family physician must be concerned about patient's living behavior, mental and social problems and must make an effort to change their perception of health as well as physical improvement.

Influence of weight gain to cardiovascular risk factors

BACKGROUND: The obese patients increased recently in Korea due to excessive energy intake and decreased physical activity. We are well known that obesity is associted with an increased risk of cardiovascular disease, angina pectoris, hypertension, but not known to influence of weight gain to change in cardio-vascular risk factors. Once, the study of obesity are many but the study of influence of weight gain are small in Korea. This study investigated to influence of weight gain in cardio-vascular risk factors. METHODS: We gatherd case and control group among persons who has taken twice medical examination except disease person from October 1990 to October 1995 at SungAe General hospital. In our study, total 167 case, compare weight gain group(>3kg) with control group to change in cardiovascular risk factor. RESULTS: Sex, age, smoking history, obesity index were not statistically significant difference between two group in the first medical examination. systolic blood pressure, diastolic blood pressure, fasting blood sugar, HDL, total cholesterol/HDL were not statistically significant difference between two group for weight gain. Total cholesterol and triglyceride, LDL were stastistically significant increased. CONCLUSIONS: Weight gain was increased of total cholestrol and triglyceride, LDL, so weight control was important.

A study of behavioral aspect for the health promotion among physician and general population

No abstract available.