The mental component of the short-form 12 health survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods.

OBJECTIVES: To evaluate the performance of the Mental Component of the Short-Form 12 Health Survey, Version 1(SF-12v1), as a screening measure of depressive disorders. METHODS: Data come from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional survey carried out on representative samples of 21,425 individuals from the noninstitutionalized adult general population of six European countries (response rate = 61.2%). The SF-12 was administered and scored according to three algorithms: the "original" method (mental component summary of SF-12 [MCS-12]), the RAND-12 (RAND-12 Mental Health Composite [RAND-12 MHC]), and the Bidemensional Response Process Model 12 mental health score (BRP-12 MHS), based on a two-factor Item Response Theory graded response model. Thirty-day and 12-month depressive disorders (major depressive episode or dysthymia) were assessed with the Composite International Diagnostic Interview, Version 3.0, by using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Receiver operating characteristic curves analysis was carried out, and optimal cutoff points maximizing balance between sensitivity (SN) and specificity (SP) were chosen for the three methods. RESULTS: Prevalence of 30-day and 12-month depressive disorders in the overall sample was 1.5% and 4.4%, respectively. The area under the curve for 30-day depressive disorders was 0.92, and it decreased to 0.85 for 12-month disorders, regardless of the scoring method. Optimal cutoff for 30-day depressive disorders was 45.6 (SN = 0.86; SP = 0.88) for the MCS-12, 44.5 for the RAND-12 MHC (SN = 0.87, SP = 0.86), and 40.2 for the BRP-12 MHS (SN = 0.87, SP = 0.87). The selected 12-month cutoffs for MCS-12 and RAND-12 MHC were between 4.2 and 5.8 points below the general population means of each country, with SN range 0.67 to 0.78 and SP range 0.77 to 0.87. CONCLUSIONS: The SF-12 yielded acceptable results for detecting both active and recent depressive disorders in general population samples, suggesting that the questionnaire could be used as a useful screening tool for monitoring the prevalence of affective disorders and for targeting treatment and prevention.

Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative.

PURPOSE: The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders. METHODS: Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated. RESULTS: In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders. CONCLUSIONS: Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens' mental health.

Comorbidity of major depressive episode and chronic physical conditions in Spain, a country with low prevalence of depression.

OBJECTIVES: The objectives were to describe the comorbidity between 12-month major depressive episode (MDE) and chronic physical condition (CPC) in Spain, a Latin country with relatively low prevalence of depression. METHODS: The European Study of Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional, general-population, household survey representative of the Spanish noninstitutionalized adult population (N=5473). The Composite International Diagnostic Interview was used for assessing mental disorders. CPCs were assessed among a subsample (N=2121) with a standardized checklist. Logistic regression analysis was performed. ESEMeD-Spain is part of the World Health Organization World Mental Health Surveys. RESULTS: Among those with CPC, the prevalence of MDE was 5.9%, and the odds ratio (OR) of comorbid MDE was 2.2 compared with those without CPC. The strongest association with MDE was for respiratory disorders (OR up to 7.8). Having an MDE increased notably the odds of disability among those with a CPC (ORs ranged from 3.6 to 23.0). The likelihood of receiving treatment for the MDE was similar irrespective of having or not comorbid CPC. CONCLUSIONS: Results show intense associations among MDE and CPC. Compared to other developed countries, higher likehoods of comorbidity and more severe impacts on disability are found in specific comorbid conditions. These findings highlight the need to improve the treatment of MDE in those with a CPC in Spain.

Adjustment disorders in primary care: prevalence, recognition and use of services.

BACKGROUND: Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care. AIMS: To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs). METHOD: Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories. RESULTS: The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription. CONCLUSIONS: Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).

Recognition of anxiety disorders by the general practitioner: results from the DASMAP study.

OBJECTIVES: The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors. METHODS: An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed. RESULTS: GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased. CONCLUSION: GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.

Psychotropic prescribing in Catalonia: results from an epidemiological study.

BACKGROUND: Mental disorders (MDs) are mainly treated in primary care (PC), where psychotropic drug (PSD) prescribing is highly prevalent. Prescription of PSD is associated with clinical and non-clinical factors. PURPOSE: To describe the patterns of PSD prescribing over a 12-month period and to determine the factors associated with this in a PC population. METHODS: Cross-sectional study. Data were collected on 3815 patients, via patient interview, on sociodemographics and MDs [Diagnostic and Statistical Manual of Mental Disorders (DSM-IV criteria)]. Computerized records provided data on PSD prescribing. Multilevel logistic regressions assessed the factors that influence prescribing. RESULTS: Thirty-four per cent of PC patients were prescribed PSDs >12 months, with anxiolytics being the most commonly prescribed (22%). Fifty-three per cent of patients with any MD in this 12-month period were prescribed PSDs; however, 25% of patients without any of these disorders were also prescribed these medications. Higher rates of prescribing were associated with female gender, older age, presence of MD, being a househusband/housewife, consulting about psychological problems, increasing number of consultations and higher self-perceived disability. PSDs were less likely to be prescribed to patients born outside Spain and those consulting about physical conditions. PSD prescribing was higher in patients previously married and antipsychotic prescribing was higher in patients never married. No statistically significant associations were found between PSD prescription and education. CONCLUSIONS: PSD prescribing rates are high in Catalonia and are associated with a number of clinical and non-clinical factors. A significant proportion of patients are receiving these drugs in the absence of MD. These findings need to be considered when prescribing in PC.

Use of primary and specialized mental health care for a major depressive episode in Spain by ESEMeD respondents.

OBJECTIVE: This study described use of services for a major depressive episode and determined factors associated with use in Spain, a country with universal access to care and a relatively low prevalence of depression. METHODS: Data were from the European Study of the Epidemiology of Mental Disorders (ESEMeD). ESEMeD-Spain was a cross-sectional, general population survey conducted with a representative sample of noninstitutionalized adults (N=5,473). The Composite International Diagnostic Interview was used, and 12-month use of services for a major depressive episode, types of services used, and receipt of minimally adequate treatment were assessed. RESULTS: Among the 247 respondents with a major depressive episode in the past 12 months, 59% reported any use of past-year services for their disorder; of this group, 76% reported receipt of any active treatment (from a health care or mental health professional). Among respondents with severe depression, 31% used no services. A higher likelihood of service use was found among those who were unemployed or too disabled to work (OR=4.9, CI=1.3-19), who had moderate depression symptoms (OR=3.2, CI=1.1-9.0), and who had one mental disorder comorbid with depression (OR=2.9, CI=1.2-7.0) or two or more such comorbid disorders (OR=4.1, CI=1.9-8.9). In the active treatment group, only 31.2% received treatment that was minimally adequate. CONCLUSIONS: There is a need in Spain to increase use of services for a major depressive episode, especially among certain population groups, such as women, and to improve adequacy of treatments. The role of specific factors, such as availability of services and of professionals, deserves further research.

Dropping out of mental health treatment among patients with depression and anxiety by type of provider: results of the European Study of the Epidemiology of Mental Disorders.

PURPOSE: Dropping out from mental health treatment is a major problem because mental health treatments delivered for inadequate durations are ineffective. The aim of this study was to compare treatment dropout rates by type of provider, dropout risk by number of visit, and to ascertain factors associated with treatment dropout. METHODS: A cross-sectional household survey of a representative sample of 626 out of 21,425 non-institutionalized adults from the general population of six European countries was carried out. Dropout was defined as terminating treatment before recommendation. RESULTS: Dropout from all treating providers during a 12-month period was 14%. Among psychiatrists, psychologists, and general practitioners figures were: 19.6, 20.3, and 20.3%, respectively. While the hazard risk for dropping out was higher during the first three visits to GPs and psychologists, it was stable for psychiatrists. Older age, female gender, and living in large or midsize urban areas were associated with a decreased risk of dropping out. CONCLUSIONS: Efforts for increasing patients' proportion completing adequate courses of care for mental disorders in Europe should focus on the first visits, especially those made to the general medical care.

Opiniones de médicos de atención primaria, psiquiatras y psicólogos acerca de las guías de práctica clínica para la depresión. Un estudio cualitativo exploratorio / Opinions of general practitioners, psychiatrists and psychologists on the clinical practice guidelines for depression

ObjetivoConocer las opiniones sobre las guías de práctica clínica (GPC) para la depresión de médicos de atención primaria (AP), psiquiatras y psicólogos.DiseñoEstudio cualitativo, descriptivo-exploratorio basado en entrevistas semiestructuradas individuales y grupales.EmplazamientoCentros de AP y centros de salud mental de la red pública de Barcelona, Sabadell, Cornellà y Gavà.Participantes y contextoTreinta y un profesionales (10 médicos de AP, 11 psiquiatras y 10 psicólogos). Las entrevistas se realizaron en su lugar de trabajo o en la unidad de investigación de la institución donde se realizó el estudio entre octubre de 2007 y junio de 2008.MétodosMuestreo teórico y de conveniencia. Para garantizar la heterogeneidad se tuvo en cuenta el sexo, la edad, la experiencia y la pertenencia a diferentes instituciones. Grabación y transcripción de las entrevistas. Análisis de contenido. Triangulación de técnicas y contraste de resultado con los participantes.ResultadosLa principal utilidad de las GPC es que agilizan la toma de decisiones y dan seguridad. Como inconvenientes, se duda sobre la objetividad de las GPC y no se considera que las recomendaciones puedan aplicarse a sus pacientes. Los médicos de AP no conocían, en el momento del estudio, ninguna GPC para la depresión. Los especialistas sí conocen, pero no las utilizan al priorizar su experiencia.ConclusionesSe han detectado ideas erróneas sobre lo que es una GPC. Si se desea implementar una GPC, es necesario informar previamente sobre qué es una GPC, qué no es y para qué puede resultar útil(AU)

AimTo explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists.DesignDescriptive-exploratory qualitative study based on semi-structured individual and group interviews.SettingPublic primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà.Participants and contextA total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008.MethodConvenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control.ResultsThe main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience.ConclusionsThere are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful(AU)

Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample.

RATIONALE, AIMS AND OBJECTIVES: The Sheehan Disability Scale (SDS) is a three-item instrument that measures disability in three inter-related domains: work, family life/home responsibilities and social/leisure activities. The main objective of the present study was to examine the factor structure, reliability and construct validity of the SDS in a wide Spanish sample of primary care (PC) patients. METHODS: One phase cross-sectional survey. A total of 3815 patients, aged 18 years or older attending PC for a medical visit, were interviewed between October 2005 and March 2006. The interviews included the Structured Clinical Interview for DSM-IV Axis I Disorders for depressive and anxiety disorders, the Mini-International Neuropsychiatric Interview for the rest of mental disorders, a medical conditions checklist, the 2.0 version of the 12-item Short-Form Health Survey (SF-12) for measuring quality of life and the SDS. RESULTS: The principal component analysis and the subsequent confirmatory factor analysis indicated that the SDS is one-dimensional (normed fit index = 0.990, non-normed fit index = 0.987, comparative fit index = 0.991, goodness-of-fit index = 0.993, standardized root mean-square residual = 0.037, root mean-square error of approximation = 0.053). The internal consistency of the scale was good (α = 0.83) and it was significantly associated with the physical and mental component of the SF-12. Concerning discriminative validity, patients with major depression or panic disorder scored higher on the SDS than patients with chronic medical conditions or with no chronic pathology. We also found that a cut-off point of 8 in the SDS adequately discriminated between patients with and without depression (area under the curve = 0.814, sensitivity = 81.60%, specificity = 70.60%). CONCLUSIONS: The SDS seems a reliable, valid and useful clinical tool for measuring disability in Spanish PC patients.

[Opinions of general practitioners, psychiatrists and psychologists on the clinical practice guidelines for depression]. / Opiniones de médicos de atención primaria, psiquiatras y psicólogos acerca de las guías de práctica clínica para la depresión. Un estudio cualitativo exploratorio.

AIM: To explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists. DESIGN: Descriptive-exploratory qualitative study based on semi-structured individual and group interviews. SETTING: Public primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà. PARTICIPANTS AND CONTEXT: A total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008. METHOD: Convenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control. RESULTS: The main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience. CONCLUSIONS: There are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful.

Burden of chronic physical conditions and mental disorders in primary care.

BACKGROUND: The World Health Organization (WHO) has stated that the three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depression and ischaemic heart disease. AIMS: To estimate health-related quality of life (HRQoL) and quality-adjusted life-year (QALY) losses associated with mental disorders and chronic physical conditions in primary healthcare using data from the diagnosis and treatment of mental disorders in primary care (DASMAP) study, an epidemiological survey carried out with primary care patients in Catalonia (Spain). METHOD: A cross-sectional survey of a representative sample of 3815 primary care patients. A preference-based measure of health was derived from the 12-item Short Form Health Survey (SF-12): the Short Form-6D (SF-6D) multi-attribute health-status classification. Each profile generated by this questionnaire has a utility (or weight) assigned. We used non-parametric quantile regressions to model the association between both mental disorders and chronic physical condition and SF-6D scores. RESULTS: Conditions associated with SF-6D were: mood disorders, beta = -0.20 (95% CI -0.18 to -0.21); pain, beta = -0.08 (95%CI -0.06 to -0.09) and anxiety, beta = -0.04 (95% CI -0.03 to -0.06). The top three causes of QALY losses annually per 100 000 participants were pain (5064), mood disorders (2634) and anxiety (805). CONCLUSIONS: Estimation of QALY losses showed that mood disorders ranked second behind pain-related chronic medical conditions.

Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study.

OBJECTIVES: The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria. METHODS: Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed. RESULTS: GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP. CONCLUSION: GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.

Frequent attendance in primary care: comparison and implications of different definitions.

BACKGROUND: The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. AIM: To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. DESIGN OF STUDY: One-phase cross-sectional study. SETTING: Seventy-seven primary care centres in Catalonia, Spain. METHOD: A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. RESULTS: The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. CONCLUSION: The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).

Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP).

OBJECTIVE: Previous epidemiological studies have revealed a high prevalence of mental disorders among primary care (PC) patients. However, most studies have methodological limitations (e.g. absence of structured clinical interviews, two-phase designs) that affect the generalizability of their results. The main objective of the present study was to estimate the lifetime and 12-month prevalence of mental disorders in the PC of Catalonia (Spain), using structured clinical interviews and a one-phase design. METHODS: One-phase cross-sectional survey. A representative probability sample without replacement of individuals aged 18 years or older attending PC for a medical visit were interviewed between October 2005 and March 2006. The interviews included SCID-I for depressive and anxiety disorders and the MINI interview for other mental disorders. A total of 3,815 patients from 77 PC centres were included in the statistical analyses. RESULTS: 45.1% of respondents reported at least one lifetime mental disorder and 30.2% reported at least one mental disorder in the previous 12 months. The most common mental disorders were major depression (9.6%), panic disorder (7.0%), specific phobia (6.6%), and generalized anxiety disorder (3.8%). There was a high comorbidity between mood and anxiety disorders, as well as between mental disorders and some chronic physical conditions. CONCLUSIONS: There is a high prevalence and comorbidity of mental disorders in the PC of Catalonia. Public health policies should reinforce the role of family physicians in the detection and treatment of persons with mental disorders.

Epidemiology of major depressive episode in a southern European country: results from the ESEMeD-Spain project.

BACKGROUND: Information of the epidemiology of Major Depressive Episode (MDE) in Spain, one of the biggest southern European countries, is scarce and heterogeneous. The objective of this study was to assess the epidemiology of the disorder in the Spanish sample of the ESEMeD project. METHODS: The ESEMED-Spain project is a cross-sectional, general population, household survey conducted with a representative sample of Spanish non-institutionalized adult population. The survey instrument was the CIDI 3.0, a structured diagnostic interview to assess disorders and treatment. RESULTS: Lifetime prevalence was 10.6% while 12-month prevalence was 4.0%. A monotonic increase in lifetime overall prevalence was found from the youngest to the 50-64 cohort, declining then in the oldest group. Median age of onset was 30.0. Being a woman (OR=2.7), previously married (OR=1.8), unemployed or disabled to work (OR=2.9) was associated to higher risk of 12-month-MDE. The highest comorbid associations were with dysthymia (OR=73.1) and panic disorder (OR=41.8). LIMITATIONS: 1. Psychiatric diagnoses were made by trained lay interviewers and this could have an imperfect sensitivity/specificity; 2. Individuals with mental illness could have more frequently rejected to participate in the survey; 3. Age-related recall bias could have affected the accuracy of age of onset estimates. CONCLUSIONS: The study shows that prevalence MDE in Spain is lower than in other Western countries. Important findings are the early age of onset, the high proportion of chronicity, and the high female/male ratio. Taken together, results offer a complex picture of the epidemiology of MDE in Spain, when compared to other countries in Europe. The role of cultural factors is discussed.

Impact of mental disorders and chronic physical conditions in health-related quality of life among primary care patients: results from an epidemiological study.

PURPOSE: To estimate the comorbidity of mental disorders with chronic physical conditions and to assess their independent and combined effects on health-related quality of life (HRQOL). METHODS: Face-to-face cross-sectional survey of adult attendants to public primary care (PC) centres from Catalonia (Spain). A total of 3,815 out of 5,402 selected patients provided data for this study. We report frequency of chronic physical conditions among participants with mental disorders and the contribution of each mental disorder and chronic physical condition to HRQOL. RESULTS: Chronic pain is the most frequent condition among those with mental disorders (74.54%). The effect of chronic physical conditions on HRQOL is rather minor when compared to the effect of mental disorders (especially mood disorders). However, chronic pain plays an important role in HRQOL loss. CONCLUSIONS: Mood disorders and chronic pain negatively affect HRQOL of PC patients. Especial efforts should be made to detect and treat mental disorders and chronic pain at this level.

The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project.

Few data are available to estimate the prevalence of eating disorders (EDs) and their correlates in the community. This paper reports data on EDs obtained in the framework of the ESEMeD project, aimed at investigating the prevalence of non-psychotic mental disorders in six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain), using a new version of the Composite International Diagnostic Interview. The ESEMeD study was a general population cross-sectional household survey. In total, 21,425 respondents aged 18 or older provided data for the project between January 2001 and August 2003. A subsample (N=4139) underwent a detailed investigation on EDs. Lifetime estimated prevalence of anorexia nervosa, bulimia nervosa, binge eating disorder, sub-threshold binge eating disorder, and any binge eating were 0.48%, 0.51%, 1.12%, 0.72%, and 2.15%, respectively, and they were 3-8 times higher among women for all EDs. However, since people under 18 were excluded from this study, our prevalence should be taken as lower-bound estimate of real frequencies. Indeed, cumulative lifetime prevalence analysis showed that the majority of eating disorders had their initial onset between 10 and 20 years of age. Role impairment and comorbidity with other mental disorders were highly common, yet only small proportions of patients with a lifetime diagnosis of EDs requested medical treatment. It still has to be proven whether early diagnostic identification and access to specialized care can reduce the burden caused by these disorders.

[Cooperation between primary care and mental health services]. / Cooperación entre atención primaria y servicios de salud mental.

PURPOSE: To find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated. DESIGN: Cross-sectional descriptive study. SETTING: Eighty PC centres representing the seven health regions of Catalonia. PARTICIPANTS: Selection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services. RESULTS: The PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas. CONCLUSIONS: The cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased.

Cooperación entre atención primaria y servicios de salud mental / Cooperation between primary care and mental health services

ObjetivoConocer el grado de coordinación/cooperación entre la atención primaria (AP) de Cataluña y los centros de salud mental de adultos (CSMA), los centros de atención y seguimiento a las drogodependencias (CASD) y los centros de salud mental infanto-juvenil (CSMIJ). Evaluar si hay diferencias en coordinación en función del carácter urbano o rural de los municipios.DiseñoEstudio descriptivo transversal.Emplazamiento80 centros de AP representativos de las 7 regiones sanitarias de Cataluña.ParticipantesSelección mediante muestreo aleatorio estratificado; 356 de los 618 médicos de familia a los que se ofreció participar completaron una encuesta que evaluaba diferentes aspectos de coordinación con los servicios especializados.ResultadosLos participantes indicaron un peor acceso a los CSMA que a los CASD y a los CSMIJ. Sin embargo, la formación proporcionada por los CSMA era mejor que la de los otros dos dispositivos en todos los indicadores empleados. No se hallaron diferencias significativas en las variables de acceso y formación entre zonas urbanas y rurales.ConclusionesLa cooperación entre la AP y los servicios especializados en salud mental de Cataluña es óptima en algunos aspectos. No obstante, sería conveniente que se redujera el tiempo de espera para las primeras visitas en los CSMA y que los CASD y los CSMIJ incrementaran las actividades de formación(AU)

PurposeTo find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated.DesignCross-sectional descriptive study.SettingEighty PC centres representing the seven health regions of Catalonia.ParticipantsSelection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services.ResultsThe PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas.ConclusionsThe cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased(AU)