[Preliminary study aimed at the construction of a questionnaire for referral from primary care to mental health services]. / Estudio preliminar dirigido a la construcción de un cuestionario de derivación de la atención primaria a los servicios de salud mental.

The high prevalence of psychiatric morbidity in primary care, the growing perception of the need for specialized help by the least severe patients and the lack of accuracy in referrals, contribute to the increasing overload in mental health services. So it seems necessary to design diagnostic tools in order to improve the detection of more severe patients and to help in the referral decision. With this purpose in mind, we have designed the multidimensional heteroadministrated Scale Referral Criteria for Mental Health (CRMH). This paper presents the preliminary results of a pilot study on its application in a sample of 198 patients by a group of Primary Care Physicians (PCP). The data show the detection of a high percentage of potential psychiatric patients (46.9%) and 4% of patients who having the possibility of being referred. The results also illustrate the low ability of PCP to detect these disorders. CRMH has a moderate correlation with the General Health Questionnaire (GHQ) and with detection of psychopathology by PCP. Other factors, apart from clinical severity evaluated through CRMH, possibly belonging to doctor-patient relationship, which should be analyzed, seem to influence the mental health referral. In a future article, we will present the validation of this scale in our care setting.

Validation in Spanish population of the family objective and subjective burden interview (ECFOS-II) for relatives of patients with schizophrenia.

INTRODUCTION: The family burden experienced by caregivers of people with schizophrenia is one of the most relevant consequences of this disorder. This paper aims to show the validity and reliability of the Spanish version of the Family Burden Interview Schedule (FBIS) designed to assess objective and subjective family burden for people with schizophrenia. DESIGN: cross sectional study. PARTICIPANTS: 356 patients fulfilling DSM-IV criteria for schizophrenia from four Spanish geographic areas (Barcelona, Madrid, Pamplona and Granada) and 205 main caregivers of these patients were assessed. MATERIAL: caregivers were assessed with the Family Burden Interview Schedule (FBIS) Spanish version (ECFOS-II), which assesses family burden in eight different modules: activities of daily living, disrupted behaviors restraint, expenses, caregiver's routine, concern, help, repercussions on health, and assessment of general burden. Patients were also assessed with PANSS, DAS-sv and GAF. STATISTICAL ANALYSIS: in order to assess internal consistency, parametrical tests of Cronbach's alpha were undertaken. To compute test-retest reliability Cohen's kappa and Weighted kappa were used. A principal component analysis was undertaken for assessing construct validity. Convergent validity was assessed with Spearman and Pearson correlation coefficients respectively, relating the instrument with the psychopathological (PANSS) and disability scale (DAS-sv) and general functioning (GAF). Moreover, a description of the viability of the ECFOS-II was described by a questionnaire especially designed for this purpose. RESULTS: Cronbach's alpha coefficient was 0.85 for the global assessment. Test-retest coefficients were very high, both for Cohen's kappa and for Weighted kappa, most values being between 0.61 and 1. Principal component analysis detected four factors that coincide with the modules of the original schedule. In the convergent validity we found that these factors are related with the symptom, disability and global functioning characteristics of the patients. CONCLUSIONS: ECFOS-II results in a valid and reliable instrument for assessing family burden experienced by caregivers of people with schizophrenia.

[One year prevalence of mental disorders comorbidity and associated socio-demographic risk factors in the general population of Spain. Results of the ESEMeD-Spain study]. / Prevalencia-año de la comorbilidad de los trastornos mentales y factores de riesgo sociodemográficos asociados en la población general de España. Resultados del estudio ESEMeD-España.

INTRODUCTION: Comorbidity among mental disorders in the general population is common, affecting more than the 50 % of individuals with a lifetime mental disorder. In Spain, there are no data describing it or its associated risk factors. METHOD: The ESEMeD-Spain study is an epidemiological study assessing mental disorders in a sample of 5,473 individuals from the general population of Spain aged 18 years or older. The aims of the present study were to evaluate the frequency of mental disorders comorbidity in Spain (assessed with the Composite International Diagnostic Interview: CIDI 3.0) and associated sociodemographic risk factors. Response rate was 78.6%. RESULTS: Mood disorders showed the highest comorbidity frequency. Analysing specific disorders, generalized anxiety disorder, dysthymic and panic disorders showed the highest comorbidity percentages. Female gender, ages above 24 years old and being previously married were found to be risk factors associated to the presence of comorbid mood and anxiety disorders. CONCLUSIONS: As it has been suggested for other European countries and for the United States, in the general population of Spain mental disorders, specially mood disorders, are frequently comorbid. When treating mental disorders, comorbidity should be taken into account.

Assessment of service use patterns in out-patients with schizophrenia: a Spanish study.

OBJECTIVE: The objective is to describe and characterize patterns of service use by out-patients with schizophrenia in Spain. METHOD: A representative treated prevalence sample of cases with schizophrenia was selected from four Spanish health areas. The evaluation included health service use, clinical severity, functioning and disability. Statistical analysis was based on hierarchical clustering methods. RESULTS: A total of 356 patients were included in the analysis. Five patterns of health service use were defined: heavy out-patient mental health users; mental health and general health service users; heavy hospital service users; nursing service users; low users of mental health services. Patients in each group showed differences in clinical and disability status. Patterns of health service use showed consistency, but also variability, among the geographical areas. CONCLUSION: Development and organization of mental health services should take into account the combinations of services patients most frequently use.

Validation of the Spanish version of the geriatric depression scale (GDS) in primary care.

OBJECTIVE: To estimate the predictive value of the 30-question Geriatric Depression Scale (GDS) in Spanish and calculate the most adequate cut-point for its use in Primary Health Care consultations. METHOD: 218 patients over the age of 64 treated at three health centers of Area 10 in Madrid were selected. In the first phase, the subjects completed the GDS, the Mini-Mental State Examination (MMSE) and a questionnaire on health and socio-demographic variables. They were later interviewed using the Geriatric Mental Schedule (GMS), used as the gold standard by doctors who were unaware of the results of the GDS. Two categories were contemplated according to the results of the GMS: cases of depression (diagnosis of psychotic or neurotic depression) and non-psychiatric cases (no psychiatric diagnosis, although isolated symptoms could be present). RESULTS: 192 aged subjects were interviewed using the GDS and the GMS. Of these, 103 were considered "non-cases of depression" and 60 others made up the "cases of psychotic/neurotic depression" group. For the most effective cut-point (9/10), sensitivity was 86.7% and specificity 63.1%. Considering a prevalence of depression of 30%, the predictive value for positives was 50.2% and for negatives 91.7%. The Cronbach alpha coefficient was 0.82, and the area below the ROC curve obtained was 0.85. Those patients with cognitive deterioration had a mean GDS score similar to those that did not present deterioration (11.16 vs 10.52; p > 0.05). CONCLUSIONS: The Geriatric Depression Scale is valid as a screening test in Primary Care consultations due to its high sensitivity and negative predictive value. The most effective Spanish GDS cut-point (9/10) is lower than that obtained in the original English version (10/11).

The interaction between physical illness and neurotic morbidity in the community.

As part of an epidemiological survey of rural community in the North of Spain we analysed the interaction between physical illness and neurotic morbidity using a two-phase cross-sectional analysis of a representative sample of the population over 15 years old. There was a very high prevalence of neurosis in the somatically ill (males-15.6 per cent, females-33.1 per cent) and much physical pathology in the group of neurotics (males-42.4 per cent, females-39 per cent). The personal characteristics of the sample, as well as some sociological factors like rural-urban way of life, educational level and social class, appear to influence the relationship between both types of illness. The neurotic morbidity of the somatic group comprised depressive, anxiety and hypochondriac types.