ABSTRACT
OBJECTIVE: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. METHODS: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. RESULTS: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from sub-threshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. CONCLUSIONS: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.
Subject(s)
Mental Disorders/epidemiology , Primary Health Care/statistics & numerical data , Somatoform Disorders/epidemiology , Adult , Aged , Anxiety Disorders/epidemiology , Comorbidity , Cross-Sectional Studies , Depressive Disorder/epidemiology , Female , Humans , Italy/epidemiology , Male , Mass Screening , Middle Aged , Neurasthenia/epidemiology , Psychiatric Status Rating Scales , Sick RoleABSTRACT
In three general medical settings (general practice, hospital medical wards and emergency rooms) about 20% of the adult attenders had a DSM-III mental disorder, mainly in the area of affective and anxious disorders. Some of these disorders were quite severe. Of those cases reassessed 1 year and 2 years after the first interview, less than a quarter reached a "no-diagnosis status". The chronicity of most cases dependent on the interplay not only of either relapse or duration of the main disorder but also of comorbidity and incidence of new disorders. A high incidence of more transient disorders in subjects who were well at first assessment was also found.
Subject(s)
Mental Disorders/epidemiology , Patient Care Team , Psychiatric Status Rating Scales , Adult , Cross-Sectional Studies , Emergency Service, Hospital , Family Practice , Female , Humans , Incidence , Italy/epidemiology , Longitudinal Studies , Male , Mental Disorders/diagnosis , Middle Aged , Prospective StudiesABSTRACT
In a prospective naturalistic study many of the 120 patients treated for a current major depressive episode continued to meet the criteria for a major depressive episode as defined by DSM-III during the whole follow-up period (from 1 to 4 years). The problem of compatibility between the chronicity of a full depressive syndrome and the definition of the major depression as episodic with possible relapses or recurrences is discussed. A relationship between chronicity and lack of adequate treatment at onset was found.
