Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-26T22:31:23.925Z Has data issue: false hasContentIssue false

Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study*

Published online by Cambridge University Press:  09 July 2009

J. Ormel*
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
W. Van Den Brink
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
M. W. J. Koeter
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
R. Giel
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
K. Van Der Meer
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
G. Van De Willige
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
F. W. Wilmink
Affiliation:
Departments of Social Psychiatry, Family Medicine and Health Science, University of Groningen, The Netherlands
*
1Address for correspondence: Dr J. Ormel, Department of Psychiatry, Academisch Ziekenhuis Groningen, Postbus 30.001.9700RB Groningen, The Netherlands.

Synopsis

This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and he association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS).

Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 ‘new’ patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrolment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders.

Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

Type
Orginal Articles
Copyright
Copyright © Cambridge University Press 1990

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.)

Footnotes

*

This article is a modified and extended version of a paper presented at the 5th European Symposium on Social Psychiatry, Manchester. March 1989.

References

REFERENCES

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, 11001119.CrossRefGoogle Scholar
Blacker, C. V. R. & Clare, W. (1987). Depressive disorder in primary care. British Journal of Psychiatry 150, 737751.Google Scholar
Blacker, C. V. R. & Thomas, J. M. (1988). Treatment of psychiatric disorder in primary care settings.Research conference: ‘The treatment of mental disorders in general practice.’Pittsburgh,15–17 June.Google Scholar
Brink, W., Vanden, , Koeter, M. W. J., Ormel, J., Dijkstra, W., Giel, R., Slooff, C. & Wohlfarth, T. D. (1989). Psychiatric diagnosis in an outpatient population: a comparative study of PSE-Catego and DSM-III. Archives of General Psychiatry 46, 369372.CrossRefGoogle Scholar
Campbell, T. L. (1987). An opposing view. The Journal of Family Practice 5, 184187.Google Scholar
Casey, P. R., Dillon, S. & Tyrer, P. J. (1984). The diagnostic status of patients with conspicuous psychiatric morbidity in primary care. Psychological Medicine 14, 673683.CrossRefGoogle ScholarPubMed
Clare, A. W. (1982). Problems of psychiatric classification in general practice. In Psychiatry and General Practice (ed. Clare, A. W. and Lader, M.), pp. 1525. Academic Press: London.Google Scholar
Finlay-Jones, R., Brown, G. W., Duncan-Jones, P., Harris, E., Murphy, E. & Prudo, R. (1980). Depression and anxiety in the community: replicating the diagnosis of a case. Psychological Medicine 10, 445454.CrossRefGoogle ScholarPubMed
Fleiss, J. L. (1980). Statistical Methods for Rates and Proportions. John Wiley: New York.Google Scholar
Giel, R., Ormel, J., Koeter, & Willige, G. vanden (1989). Social factors determining permeability of filters in the Goldberg-Huxley model. In Social Psychiatry and Public Health (ed. Goldberg, D. and Tantam, D.). Hogrefe and Huber: Göttingen.Google Scholar
Goldberg, D. P. (1978). The concept of a psychiatric case in general practice. Social Psychiatry 17, 6165.CrossRefGoogle Scholar
Goldberg, D. P. (1979). Detection of and assessment of emotional disorders in primary care. International Journal of Mental Health 8, 3048.CrossRefGoogle Scholar
Goldberg, D. P. & 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, 1518.Google ScholarPubMed
Goldberg, D. P. & Huxley, P. (1980). Mental Illness in the Community, the Pathway to Psychiatric Care. Tavistock: London.Google Scholar
Hankin, J. R. & Oktay, J. S. (1979). Mental Disorder and Primary Medical Care: An Analytic Review of the Literature. Department of Health and Human Services, publication number (ADM) 78661, National Institute of Mental Health Series D5: Washington, DC.Google Scholar
Hodiamont, P., Peer, N. & Syben, N. (1987). Epidemiological aspects of psychiatric disorders in a Dutch health area. Psychological Medicine 17, 495505.CrossRefGoogle Scholar
Hoeper, E. W., Nycz, G. R., Cleary, P. D., Regier, D. A. & Goldberg, I. D. (1979). Estimated prevalence of RDC mental disorder in primary medical care. International Journal of Mental Health 8, 615.CrossRefGoogle Scholar
Hoeper, E. W., Nycz, L. G., Kessler, J. D., Burke, J. D. & Pierce, W. E. (1984). The usefulness of screening for mental illness. Lancet i, 3335.CrossRefGoogle Scholar
Jencks, S. F. (1985). Recognition of menial distress and diagnosis of mental disorder in primary care. Journal of the American Medical Association 253, 19031907.CrossRefGoogle Scholar
Johnstone, A. & Goldberg, D. P. (1976). Psychiatric screening in general practice: a controlled trial. Lancet i, 605609.CrossRefGoogle Scholar
Lamberts, H. & Wood, M. (1987). International Classification of Primary Care. Oxford University Press: Oxford.Google Scholar
Linn, L. S. & Yager, J. (1980). The effect of screening sensitization and feedback on notation of depression. Journal of Medical Education 55, 938942.Google ScholarPubMed
Marks, J. N., Goldberg, D. & Hillier, V. F. (1979). Determinants of the ability of general practitioners to detect psychiatric illness. Psychological Medicine 9, 337353.CrossRefGoogle ScholarPubMed
Moore, J. T., Silimperi, D. R. & Bobula, J. A. (1978). Recognition of depression by family residents: the impact of screening. Journal of Family Practice 7, 509513.Google ScholarPubMed
Nielsen, A. C. & Williams, T. A. (1980). Depression in ambulatory medical patients. Archives of General Psychiatry 37, 991004.CrossRefGoogle Scholar
Ormel, J. & Giel, R. (1983). Omvang, beloop, and behandeling van psychische stoornissen in de eerste lijn (Prevalence, course, and management of psychological disorders in primary care). Tijdschrift voor Psychiatry 25, 688710.Google Scholar
Ormel, J. & Giel, R. (1989). Medical effects of non-recognition of affective disorders in general medical settings. In Psychological Disorders in General Medical Settings (ed. Sartorious, N. and Goldberg, D.), pp. 146158. Hogrefe and Huber: Bern.Google Scholar
Ormel, J., Koeter, M. W. J., Brink, W., vanden, & Giel, R. (1989). Concurrent validity of GHQ and PSE as measures of change. Psychological Medicine 19, 10071013.CrossRefGoogle ScholarPubMed
Rand, E. H., Badger, L. W. & Coggings, D. R. (1988). Toward a resolution of contradictions utility of feedback from the GHQ. General Hospital Psychiatry 10, 189196.CrossRefGoogle Scholar
Regier, D. A., Goldberg, I. D. & Taube, C. A. (1978). The de facto US mental health services system: a public health perspective. Archives of General Psychiatry 38, 685693.CrossRefGoogle Scholar
Schulberg, H. C., Saul, M., McClelland, M., Ganguli, M., Christy, W. & Frank, R. (1985). Assessing depression in primary medical and psychiatric practices. Archives of General Psychiatry 42, 11641170.CrossRefGoogle ScholarPubMed
Schulberg, H. C., McClelland, M., Coulehan, J. L., Bolck, M. & Werner, G. (1986). Psychiatric decision making in family practice. Future research directions. General Hospital Psychiatry 8, 16.CrossRefGoogle ScholarPubMed
Shapiro, S., Skinner, E. A., Kramer, M., Steinwachs, S. & Regier, D. A. (1985). Measuring need for mental health services in a general population. Medical Care 23, 10331043.CrossRefGoogle ScholarPubMed
Shapiro, S., German, P. S., Skinner, E. A., Von Korf, M., Turner, R. W., Klein, L. E., Teitelbourn, M. L., Kramer, M., Burke, J. D. & Burns, B. J. (1987). An experiment to change detection and management of mental morbidity in primary care. Medical Care 25, 327339.CrossRefGoogle ScholarPubMed
Shepherd, M., Cooper, B., Brown, A. C. & Kalton, G. W. (1966). Psychiatric Illness in General Practice. Oxford University Press: London.Google Scholar
Skuse, D. & Williams, P. (1984). Screening for psychiatric disorder in general practice. Psychological Medicine 14, 365377.Google Scholar
Vaillant, G. E & Schnurr, P. (1988). What is a case? A 45-year study of psychiatric impairment within a college sample selected for mental health. Archives of General Psychiatry 45, 313319.Google Scholar
Verhaak, P. F. M. (1984). Interdoktervarianlie bij Psychosociale Problematiek. NIVEL: Utrecht (Netherlands).Google Scholar
Verhaak, P. F. M. (1986). Interpretatie en Behandeling van Psychosociale Klachten in de Huisartsenpraktijk: Een Onderzoek naar Verschillen Tussen Huisartsen. NIVEL: Utrecht, (Netherland).Google Scholar
Verhaak, P. F. M. (1988). Detection of psychological complaints by general practitioners. Medical Care 26, 10091020.Google 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: comparison of DIS, GHQ and practitioner assessments. Archives of General Psychiatry 44, 152156.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, 213224.CrossRefGoogle Scholar
Williams, P., Tarnopolsky, A., Hand, D. & Shepherd, M. (1986). Minor psychiatric morbidity and general practice consultations: the West London Survey. Psychological Medicine, Monograph Suppl. Number 9, 137.CrossRefGoogle ScholarPubMed
Wilmink, F. W. (1989). Patient, physician, psychiatrist assessment of mental health problems in primary care. PhD thesis, University of Groningen. The Netherlands.Google Scholar
Wilmink, F. W. & Snijders, T. A. B. (1989). Polytomous logistic regression of the General Health Questionnaire and the Present State Examination. Psychological Medicine 19, 755764.CrossRefGoogle ScholarPubMed
Wing, J. K. & Sturt, E. (1978). The PSE-ID-CATEGO System A Supplementary Manual. Institute of Psychiatry (mimeo): London.Google Scholar
Wing, J. K., Cooper, J. & Sartorious, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Zung, L. S., Magill, M., Moore, J. T. & George, T. (1983). Recognition and treatment of depression in a family medicine practice. Journal of Clinical Psychiatry 44, 13.Google Scholar