Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T12:50:57.296Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric disorders in primary care: why so many differences?

Published online by Cambridge University Press:  11 October 2011

Marco Piccinelli
Marco Piccinelli*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dr. M. Piccinelli, Servizio di Psicologia Medica, Istituto di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax: (+39)045-585.871
Get access Rights & Permissions [Opens in a new window]

Summary

Objectives - (I) To review the studies which investigated the frequency of psychiatric disorders among primary care attenders, using a standardized psychiatric interview as the case finding instrument; (II) to discuss the factors possibly explaining the different results found; (III) to highlight the central role of international multicenter collaborative studies, carried out in primary care settings. Method - the studies were reviewed, which were published in international journals between 1970 and 1993. The studies were located through a computerized search of the databases MEDLINE and Psychological Abstracts; in addition, the reference lists of the studies located in this way were examined and international journals were manually scanned in order to avoid possible omissions. Finally, the annotated bibliography, edited by Wilkinson (1985), was examined, since it included the studies having psychiatric focus, carried out in primary care and published between 1977 and 1985. Results - Thirty papers were traced, but 9 were excluded since they duplicated results or because of methodological limitations. So far, the overall frequency of psychiatric disorders among primary care attenders has been investigated using standardized procedures in 13 countries only. The frequency of psychiatric disorders ranged between approximately 10% and 50%. The possible reasons accounting for the differe- nces between the studies were discussed in the light of three factors: I) the research design and study characteristics; II) the reliability and comparability of different diagnostic categories and classificatory systems; and III) the different organization of health services across countries. Conclusions - In the light of the difficulties faced when the findings of independent studies, carried out in different countries or even in the same country, are compared, the central role of in- ternational multicenter collaborative studies conducted in this field is suggested.

Riassunto

Scopo - (I) Operare una revisione critica degli studi che hanno indagato la frequenza dei disturbi psichici tra i pazienti della medicina generale, utilizzando come criterio un'intervista psichiatrica standardizzata; (II) discutere i possibili fattori all'origine delle diverse frequenze riscontrate; (III) mettere in luce il ruolo di primaria importanza che possono assolvere in questo campo gli studi multicentrici condotti grazie a programmi di collaborazione internazionale. Metodo - sono stati selezionati i lavori pubblicati nella letteratura internazionale tra il 1970 ed il 1993. La selezione è stata effettuata grazie ad una ricerca computerizzata, nel corso della quale sono stati incrociati i databases MEDLINE e Psychological Abstracts; questa è stata a sua volta integrata da una ricerca manuale, consistente neU'esame delle bibliografie contenute nei lavori cosi individuati e nella consultazione degli indici analitici delle principal! riviste psichiatriche internazionali. Infine, è stata consultata la bibliografia commentata, curata da Wilkinson (1985), relativa a lavori di interesse e pertinenza psichiatrici condotti nella medicina generale e pubblicati tra il 1977 ed il 1985. Risultati - Sono stati individuati 30 lavori, ma 9 sono stati esclusi, dal momento che replicavano dati già riportati in letteratura o presentavano limiti metodologici. È emerso cosi che indagini sulla frequenza complessiva dei disturbi psichici tra i soggetti che si rivolgevano ai servizi di medicina generale sono state finora condotte secondo procedure standardizzate solo in 13 Paesi. La frequenza dei disturbi psichici variava tra il 10% ed il 50% circa. Le possibili ragioni all'origine dellem diverse frequenze riscontrate sono state discusse alia luce di tre fattori: I) le caratteristiche dell'indagine; II) l'affidabilità e la confrontabilità delle categorie diagnostiche e dei sistemi nosografici utilizzati; e III) la diversa organizzazione dei servizi sanitari nei vari Paesi. Conclusioni - alia luce delle difficoltà che si incontrano quando si tenta di confrontare i risultati forniti da studi indipendenti condotti in Paesi diversi o perfino nello stesso Paese viene suggerito il ruolo di primaria importanza che possono assolvere in questo campo gli studi multicentrici condotti grazie a programmi di collaborazione internazionale.

Keywords

medicina generaledisturbi psichiciclassificazionedisegno della ricercaaccessibilità dei servizi sanitariprimary carepsychiatric disordersclassificationresearch designhealth services accessibility
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 3 , Issue 3 , December 1994 , pp. 195 - 208
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografia

Abiodun, O.A. (1993). A study of mental morbidity among primary care patients in Nigeria. Comprehensive Psychiatry 34, 10–13.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed.American Psychiatric Association: Washington.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. revised American Psychiatric Association: Washington.Google Scholar
Balestrieri, M., Bon, M.G., Rodriguez-Sacristan, A. & Tansella, M. (1994). Pathways to psychiatric care in South-Verona, Italy. Psychological Medicine 24, 641–649.CrossRefGoogle ScholarPubMed
Barrett, J.E., Barrett, J.A., Oxman, T.E. & Gerber, P.D. (1988). The prevalence of psychiatric disorders in a primary care practice. Archives of General Psychiatry 45, 1100–1106.CrossRefGoogle Scholar
Bech, P., Kastrup, M. & Rafaelsen, O.J. (1986). Mini compendium of rating scales for states of anxiety, depression, mania, schizophrenia with corresponding DSM-III syndromes. Ada Psychiatrica Scandinavica, 73, suppl. 73, 1–37.Google Scholar
Bellantuono, C., Fiorio, R., Williams, P. & Cortina, P. (1987a). Psychiatric morbidity in an Italian general practice. Psychological Medicine 17, 243–247.CrossRefGoogle Scholar
Bellantuono, C., Fiorio, R., Zanotelli, R. & Tansella, M. (1987b). Psychiatric screening in general practice in Italy. A validity study of the GHQ. Social Psychiatry 22, 113–117.CrossRefGoogle ScholarPubMed
Bellantuono, C., Williams, P. & Tansella, M. (1991). Psychiatric morbidity in general practice. In Community-based Psychiatry: Long-term Patterns of Care in South-Verona (ed. Tansella, M.), Psychological Medicine Monograph Supplement 19, pp. 41–45. Cambridge University Press: Cambridge.Google Scholar
Benjamin, J., Moaz, B., Shiber, A., Antonovsky, H. & Mark, M. (1992). Prevalence of psychiatric disorders in three primarycare clinics in Beersheba, Israel. Concurrent assessment by the General Health Questionnaire, general practitioners, and Research Diagnostic Criteria. General Hospital Psychiatry 14, 307–314.CrossRefGoogle ScholarPubMed
Berti, Ceroni G., Berti, Ceroni F., Bivi, R., Corsino, M.A., De Marco, P., Gallo, E., Giovannini, G., Gherardi, S., Pezzoli, A., Rucci, P. & Neri, C. (1992). DSM-III mental disorders in general medical sector: a follow-up and incidence study over a twoyear period. Social Psychiatry and Psychiatric Epidemiology 27, 234–241.Google Scholar
Boardman (1987), The General Health Questionnaire and the detection of emotional disorder by general practitioners. A replicated study. British Journal of Psychiatry 151, 373–381.CrossRefGoogle Scholar
Dean, C., Surtees, P.G. & Sashidharan, S.P. (1983). Comparison of research diagnostic systems in an Edinburgh community sample. British Journal of Psychiatry 142, 247–256.CrossRefGoogle Scholar
Dilling, H., Weyerer, S. & Fichter, M. (1989). The Upper Bavarian studies. In Changes in Frequency of Mental Disorder over Time, Results of Repeated Surveys of Mental Disorders in the General Population (ed. Sartorius, N., Nielsen, J.A. and Stromgren, E.). Acta Psychiatrica Scandinavica, Supplementum No. 348, pp. 113–140. Munksgaard: Copenhagen.Google Scholar
Dunn, G. (1983). Longitudinal records of anxiety and depression in general practice: the Second National Morbidity Survey. Psychological Medicine 13, 897–906.CrossRefGoogle ScholarPubMed
Dunn, G. & Smeeton, N. (1989). The study of episodes of psychiatric morbidity. In The Scope of Epidemiological Psychiatry (ed. Williams, P., Wilkinson, G. and Rawnsley, K.), pp. 167–177. Routledge: London.Google Scholar
Eames, S.A. (1988). Pazienti psichiatrici del medico di base inglese: chi sono e chi li assiste? Psichiatria Generate e dell'Eta Evolutiva 26, 9–21.Google Scholar
El-Rufaie, O.E.R. & Absood, G.H. (1993). Minor psychiatric morbidity in primary health care: prevalence, nature and severity. The International Journal of Social Psychiatry 39, 159–166.CrossRefGoogle ScholarPubMed
Endicott, J. & Spitzer, R.L. (1978). A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry 35, 837–844.CrossRefGoogle ScholarPubMed
Fleiss, J.L. (1981). The measurement of interrater agreement. In Statistical Methods for Rates and Proportions (ed. Fleiss, J.L.), pp. 212–236. John Wiley and Sons: New York.Google Scholar
Fontanesi, F., Gobetti, C., Zimmermann-Tansella, Ch. & Tansella, M. (1985). Validation of the Italian version of the GHQ in a general practice setting. Psychological Medicine 15, 411–415.CrossRefGoogle Scholar
Gater, R., de Almeida e Sousa, B., Barrientos, G., Caraveo, J., Chandrashekar, C.R., Dhadphale, M., Goldberg, D., Al Kathiri, A.H., Mubbashar, M., Silhan, K., Thong, D., Torres-Gonzales, F. & Sartorius, N. (1991). The pathways to psychiatric care: a cross-cultural study. Psychological Medicine 21, 761–774.CrossRefGoogle Scholar
Giel, R., Koeter, M.W. & Ormel, J. (1990). Detection and treatment of primary care patients with mental health problems: the 2nd and 3rd filter. In The Public Health Impact of Mental Disorder (ed. Goldberg, D.P. and Tantam, D.). Hagrefe and Huber: Bern.Google Scholar
Goldberg, D.P. & Blackwell, B.B. (1970). Psychiatric illness in general practice. A detailed study using a new method of case identification. British Medical Journal ii, 439–443.CrossRefGoogle Scholar
Goldberg, D. & Bridges, K. (1987). Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire. Journal of the Royal College of General Practitioners 37, 15–18.Google ScholarPubMed
Goldberg, D. & Huxley, P. (1980). Mental Illness in the Community. The Pathway to Psychiatric Care. Tavistock Publications: London.Google Scholar
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders. A Bio-social Model. Tavistock/Routledge: London.Google Scholar
Goldberg, D.P. & Williams, P. (1988). The User's Guide to the General Health Questionnaire. NFER/NELSON: Windsor, Slough.Google Scholar
Goldberg, D.P., Cooper, B., Eastwood, M.R., Kedward, H.B. & Shepherd, M. (1970). A standardised psychiatric interview suitable for use in community surveys. British Journal of Preventive and Social Medicine 24, 18–26.Google Scholar
Gureje, O. & Obikoya, B. (1990). The GHQ-12 as a screening tool in a primary care setting. Social Psychiatry and Psychiatric Epidemiology 25, 276–280.CrossRefGoogle Scholar
Harding, T.W., De Arango, M.V., Baltazar, J., Climent, C.E., Ibrahim, H.H.A., Ladrido-Ignacio, L., Srinivasa, Murthy R. & Wig, N.N. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231–241.CrossRefGoogle ScholarPubMed
Hoeper, E., Nycz, G., Cleary, P., Regier, D. & Goldberg, I. (1979). Estimated prevalence of RDC mental disorder in primary medical care. International Journal of Mental Health 8, 6–15.CrossRefGoogle Scholar
Hoppe, S.K., Leon, R.L. & Realini, J.P. (1989). Depression and anxiety among Mexican Americans in a family health center. Social Psychiatry and Psychiatric Epidemiology 24, 63–68.CrossRefGoogle Scholar
Horgan, C.M. (1985). Specialty and general ambulatory mental health services. Archives of General Psychiatry 42, 565–572.CrossRefGoogle ScholarPubMed
Jong de, J.T.V.M., Klein de, G.A.J. & Ten, Torn S.G.H.H.M. (1986). A baseline study on mental disorders in Guine-Bissau. British Journal of Psychiatry 148, 27–32.CrossRefGoogle Scholar
Kapur, R.L, Kapur, M. & Carstairs, G.M. (1974). Indian Psychiatric Survey Schedule. Social Psychiatry 9, 71–76.CrossRefGoogle Scholar
Kellner, R. (1987). A symptom questionnaire. Journal of Clinical Psychiatry 48, 268–274.Google ScholarPubMed
Kessler, L.G., Cleary, P.D. & Burke, J.D. (1985). Psychiatric disorder in primary care. Archives of General Psychiatry 42, 583–587.CrossRefGoogle ScholarPubMed
Kessler, L.G., Burns, B., Shapiro, S. & Tischler, G. (1987). Psychiatric diagnoses of medical service users: evidence from the Epidemiologic Catchment Area Program. American Journal of Public Health 77, 18–24.CrossRefGoogle ScholarPubMed
Lindholm, H. (1983). Sectorized Psychiatry. A Methodological Study of the Effects of Reorganization on Patients Treated at a Mental Hospital. Acta Psychiatrica Scandinavica, Supplementum No. 304, pp. 11–24. Munksgaard: Copenhagen.Google Scholar
Lipman, R.S., Covi, L. & Shapiro, A.K. (1979). The Hopkins Symptom Check List (HSCL): factors derived from the HSCL-90. Journal of Affective Disorders 1, 9–24.CrossRefGoogle Scholar
Mann, A.H., Jenkins, R. & Belsey, E. (1981). The twelve-month outcome of patients with neurotic illness in general practice. Psychological Medicine 11, 535–550.CrossRefGoogle ScholarPubMed
Mari, J.J. (1987). Psychiatric morbidity in three primary medical care clinics in the city of Sao Paulo. Social Psychiatry and Psychiatric Epidemiology 22, 129–138.Google ScholarPubMed
Mari, J.J. & Williams, P. (1984). Minor psychiatric disorder in primary care in Brazil: a pilot study. Psychological Medicine 14, 223–227.CrossRefGoogle ScholarPubMed
Mari, J.J. & Williams, P. (1986). A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. British Journal of Psychiatry 148, 23–26.CrossRefGoogle ScholarPubMed
Marino, S., Bellantuono, C. & Tansella, M. (1990). Psychiatric morbidity in general practice in Italy. A point-prevalence survey in a defined geographical area. Social Psychiatry and Psychiatric Epidemiology 25, 67–72.CrossRefGoogle Scholar
Marks, J., Goldberg, D.P. & Hillier, V.F. (1979). Determinants of the ability of general practitioners to detect psychiatric illness. Psychological Medicine 9, 337–353.CrossRefGoogle ScholarPubMed
Okasha, A., Sadek, A., Al-Haddad, M.K. & Abdel-Mawgoud, M. (1993). Diagnostic agreement in psychiatry. A comparative study between ICD-9, ICD-10 and DSM-III-R. British Journal of Psychiatry 162, 621–626.CrossRefGoogle ScholarPubMed
Ormel, J., Van Den Brink, W., Koeter, M.W.J., Giel, R., Van Der Meer, K., Van De Villige, G. & Wilmink, F.W. (1990). Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychological Medicine 20, 909–923.CrossRefGoogle ScholarPubMed
Ormel, J., Oldehinkel, T., Brilman, E. & Van Den Brink, W. (1993). Outcome of depression and anxiety in primary care. A threewave 3i-year study of psychopathology and disability. Archives of General Psychiatry 50, 759–766.CrossRefGoogle ScholarPubMed
Penayo, U., Kullgren, G. & Caldera, T. (1990). Mental disorders among primary health care patients in Nicaragua. Ada Psychiatrica Scandinavica 82, 82–85.CrossRefGoogle ScholarPubMed
Piccinelli, M. & Ferraris, A. (1992). La morbilita psichiatrica nella medicina di base: aspetti concettuali e diagnostici. Epidemiologia e Psichiatria Sociale 3, 185–190.CrossRefGoogle Scholar
Piccinelli, M., Pini, S., Bellantuono, C., Bonizzato, P., Paltrinieri, E., Ustiin, T.B., Sartorius, N. & Tansella, M. (in stampa). Lo studio internazionale multicentrico dell'Organizzazione Mondiale della Sanita sui disturbi psichici nella medicina generate: risultati relativi all'area di Verona. Epidemiologia e Psichiatria Sociale.Google Scholar
Radloff, L.S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measures 3, 385–401.CrossRefGoogle Scholar
Robins, L.N., Helzer, J.E., Croughan, J. & Ratcliff, K.S. (1981). National Institute of Mental Health Diagnostic Interview Schedule. Archives of General Psychiatry 38, 381–389.CrossRefGoogle ScholarPubMed
Robins, L.N., Wing, J.K., Wittchen, H.U., Helzer, J.E., Babor, T.F., Burke, J. & Farmer, A. (1988). The Composite International Diagnostic Interview. An epidemiologic instrument. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Sartorius, N. & Ustiin, T.B. (ed.) (in press). Mental Illness in Primary Care. An International Study. John Wiley & Sons: New York.Google Scholar
Sartorius, N., Ustiin, T.B., Costa e Silva, J.-A., Goldberg, D., Lecrubier, Y., Ormel, J., Von Korff, M. & Wittchen, H.-U. (1993). An international study of psychological problems in primary care. Archives of General Psychiatry 50, 819–824.CrossRefGoogle Scholar
Seivewright, H., Tyrer, P., Casey, P. & Seivewright, N. (1991). A three-year follow-up of psychiatric morbidity in urban and rural primary care. Psychological Medicine 21, 495–503.CrossRefGoogle Scholar
Sen, B., Wilkinson, G. & Mari, J.J. (1987). Psychiatric morbidity in primary health care. A two-stage screening procedure in developing countries: choice of instruments and cost-effectiveness. British Journal of Psychiatry 151, 33–38.CrossRefGoogle ScholarPubMed
Shamasundar, C., Krishna, Murthy S., Prakash, O., Prabhakar, N. & Subba, Krishna D.K. (1986). Psychiatric morbidity in a general practice in an Indian city. British Medical Journal 292, 1713–1716.CrossRefGoogle Scholar
Sharp, D. & Morrell, D. (1989). The psychiatry of general practice. In The Scope of Epidemiological Psychiatry (ed. Williams, P., Wilkinson, G. and Rawnsley, K.), pp. 404–419. Routledge: London.Google Scholar
Shepherd, M. & Wilkinson, G. (1988). Primaiy care as the middle ground for psychiatric epidemiology. Editorial. Psychological Medicine 18, 263–267.CrossRefGoogle Scholar
Skuse, D. & Williams, P. (1984). Screening for psychiatric disorder in general practice. Psychological Medicine 14, 365–377.CrossRefGoogle ScholarPubMed
Smeeton, N.C. (1986). Distribution of episodes of mental illness in general practice: results from the Second National Morbidity Survey. Journal of Epidemiology and Community Health 40, 130–133.CrossRefGoogle ScholarPubMed
Spitzer, R.L., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Tansella, M. & Williams, P. (1989). The spectrum of psychiatric morbidity in a defined geographical area. Psychological Medicine 19, 765–770.CrossRefGoogle Scholar
Vazquez-Barquero, J.L., Diez-Manrique, J.F., Pena, C., Aldama, J.M., Samaniego, C. & Quintanal, R.G. (1986). Two-stage design in a community survey. British Journal of Psychiatry 149, 88–97.CrossRefGoogle Scholar
Vazquez-Barquero, J.L., Wilkinson, G., Williams, P., Diez-Manriwque, J.F. & Pena, C. (1990). Mental health and medical consultation in primary care settings. Psychological Medicine 20, 681–694.CrossRefGoogle ScholarPubMed
Von Korff, M. (1992). Case definition in primary care. The need for clinical epidemiology. Editorial. General Hospital Psychiatry 14, 293–295.CrossRefGoogle Scholar
Von Korff, M., Shapiro, S., Burke, J.D., Teitlebaum, M., Skinner, E.A., German, P., Turner, R.W., Klein, L. & Burns, B. (1987). Anxiety and depression in a primary care clinic. Archives of General Psychiatry 44, 152–156.CrossRefGoogle Scholar
Wiersma, D., DeJong, A. & Ormel, J. (1988). The Groningen Social Disability Schedule: development, relationship with ICIDH and psychometric properties. International Journal of Rehabilitation Research 3, 213–224.CrossRefGoogle Scholar
Wilkinson, G. (1985). Mental Health Practices in Primary Care Settings. An Annotated Bibliography 1977–85. Tavistock: London.Google Scholar
Williams, P., Tarnopolsky, A. & Hand, D. (1980). Case definition and case identification in psychiatric epidemiology: review and assessment. Psychological Medicine 10, 101–114.CrossRefGoogle Scholar
Wing, J.K. & Sturt, E. (1978). The PSE ID CATEGO System Supplementary Manual. MRC Social Psychiatry Unit, Institute of Psychiatry: London.Google Scholar
Wittchen, H. & Essau, C.A. (1990). Assessment of symptoms and psychosocial disabilities in primary care. In Psychological Disorders in General Medical Settings(ed. Sartorius, N., Goldberg, D., Girolamo, G. de, Silva, J. Costa e, Lecrubier, Y. and Wittchen, U.), pp. 21–33. Hogrefe & Huber Publishers: Toronto.Google Scholar
World Health Organization (1974). Glossary of Mental Disorders and Guide to their Classification for Use in Conjunction with the International Classification of Diseases, 8th revision. World Health Organization: Geneva.Google Scholar
World Health Organization (1977). International Classification of Diseases, 9th revision. World Health Organization: Geneva.Google Scholar
World Health Organization (1990). CIDI-Core. Composite International Diagnostic Interview, Core Version. World Health Organization: Geneva.Google Scholar
World Health Organization (1992). International Classification of Diseases, 10th revision. World Health Organization: Geneva.Google Scholar
Zintl-Wiegand, A., Krumm, B., Weyerer, S. & Dilling, H. (1988). Psychiatric morbidity and referral rates in general practices: comparison of an industrial town and a rural area in West Germany. Social Psychiatry and Psychiatric Epidemiology 23, 49–56.CrossRefGoogle Scholar