The natural history of somatization in primary care

1999 ◽  
Vol 29 (3) ◽  
pp. 669-676 ◽  
Author(s):  
OYE GUREJE ◽  
GREGORY E. SIMON
Keyword(s):  
Primary Care ◽  
Natural History ◽  
Health Beliefs ◽  
Empirical Studies ◽  
General Health Questionnaire ◽  
Composite International Diagnostic Interview ◽  
National Sample ◽  
Diagnostic Interview ◽  
Considerable Change ◽  
Stratified Sample

Background. Somatization is often regarded as a chronic disorder. However, empirical studies to support this view and to determine its natural history in primary care are lacking. This paper provides data on the incidence and persistence of current somatization syndrome in a large cross-national sample drawn from 15 sites in 14 countries.Methods. After screening with the General Health Questionnaire, a stratified sample of 5438 primary care patients was interviewed with the Composite International Diagnostic Interview and evaluated for physical health status, self-rated overall health and for occupational disability. Twelve months later, 3204 of the patients completed follow-up interviews.Results. Over a 12-month period, an abridged form of somatization defined as four current symptoms in males and six in females was persistent in 45·9% of the patients. Persistence of syndrome was related to age and to subjective indices of psychological distress at baseline. Persistence was unrelated to depression. The 12-month incidence of the abridged somatization syndrome was 7·1% (95% CI, 6·1–8·3%). Individuals with depression at baseline and those with poor view of their health were more likely to develop new episodes of somatization 12-months later.Conclusion. Somatization syndrome showed considerable change over time. Persistence and onset of somatization were related to both level of psychopathology and health beliefs.

WHO study of psychological problems in general health care. Baseline findings and implications for primary care

1996 ◽  
Vol 5 (3) ◽  
pp. 172-177
Author(s):  
Richard Gater
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Health ◽  
General Health Questionnaire ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Psychological Problems ◽  
Health Questionnaire ◽  
Sono Stati ◽  
Icd 10

RIASSUNTOScopo - Indagare la forma, la frequenza, la gestione e l'esito dei disturbi psichici comuni in pazienti della medicina generale. Disegno - Campionamento a due-stadi di coloro che si rivolgono ai servizi di medicina generale seguito da una valutazione longitudinale a 3 e 12 mesi dello stato mentale, della disabilità e del trattamento, eseguiti utilizzando gli stessi metodi in 15 Centri nel mondo, sotto il coordinamento dell'Organizzazione Mondiale della Sanita. Principali misure utilizzate - General Health Questionnaire, la versione per la medicina generale della Composite International Diagnostic Interview utilizzata per ricavare diagnosi secondo i criteri dell'ICD-10, la Groningen Social Disability Schedule, ed una valutazione da parte del medico di medicina generale dell'attuale stato fisico e mentale insieme ad un riassunto della loro gestione del caso. Risultati - Sono stati sottoposti a screening 25.916 pazienti e sono stati sottoposti a dettagliate interviste 5.438 pazienti. I disturbi psichici tra i pazienti degli ambulatori di medicina generale sono risultati frequenti (in media il 24% di pazienti visti consecutivamente, range 7.3%-52.5%). La disabilità è risultata più elevata nei pazienti con disturbi psichici: quanto più gravi erano i disturbi psichici, tanto pià grave era la disabilità. Il problema principale lamentato dai pazienti era spesso un sintomo somatico, mentre solo una minoranza di essi lamentava un chiaro sintomo psichico. Il riconoscimento dei disturbi da parte dei medici è risultato essere molto diverso tra i diversi Centri e in tutti i Centri metà dei casi ICD-10 non è stata identificata dai medici. I medici operand nell'area di Verona hanno messo in evidenza una particolare distorsione nei riguardi dei disturbi psichici. Un trattamento e stato prescritto a quasi tutti i pazienti che secondo i medici presentavano disturbi psichici, per cui i trattamenti sono risultati simili, indipendentemente dalla diagnosi. Conclusioni - La frequenza dei disturbi psichici nel setting della medicina generale e la disabilità ad essi associata sottolineano la loro importanza per la salute pubblica. Questi sono pazienti che si rivolgono agli ambulatori di medicina generale; la maggior parte di essi continua ad essere trattata in tale setting senza ricorrere ai servizi psichiatrici specialistici. È pertanto importante potenziare il training per il riconoscimento, la diagnosi ed il trattamento dei disturbi psichici comuni sia nelle Facolta di medicina che nei corsi di formazione dei medici di medicina generale.

Characteristics, recognition and treatment of dysthymics in primary care

1998 ◽  
Vol 13 (4) ◽  
pp. 198-202 ◽  
Author(s):  
Y Lecrubier ◽  
E Weiller
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Health ◽  
General Health Questionnaire ◽  
Composite International Diagnostic Interview ◽  
Psychological Problem ◽  
Diagnostic Interview ◽  
Current Prevalence ◽  
Icd 10 ◽  
Disability Questionnaire

SummaryAs part of the WHO-PPGHC study aimed to better understand the form, frequency and burden of psychiatric conditions in primary care throughout the world, the clinical characteristics of dysthymic patients consulting in primary care were examined. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionaire (GHQ-12). Of those screened, 5,438 were assessed in detail using a Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC) in conjunction with among others the Brief Disability Questionnaire (BDQ) and the 28-item General Health Questionnaire (GHQ-28). General practitioners (GPs) gave their opinion on the existence of a psychological problem and indicated what therapeutic intervention was proposed to patients they recognised as psychological cases. The estimated current prevalence of dysthymia as defined by the ICD-10 was 2.1%. The social disability was found to be substantial in patients with dysthymia (52.2% of patients moderately or severely disabled) similar to that observed in patients with Depressive Episode (DE) (57.4%). When both conditions were present, the level of disability was even higher (63.6%). The symptoms presented by dysthymic patients without DE were mostly those specific for the diagnosis of dysthymia (ie, tearful, hopeless, inability to cope, pessimism) while these symptoms were less frequent when dysthymia was complicated by a DE. On the contrary, fatigue and loss of interest were more rarely observed in “pure” dysthymics. In spite of a lower symptomatic severity about half of the patients with dysthymia were recognised as cases by their GPs, a proportion similar to those with DE. However, dysthymics without DE were not, in contrast to patients with DE or with dysthymia and DE, more treated with drugs than non-depressed patients.

scholarly journals Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires

2007 ◽  
Vol 38 (2) ◽  
pp. 221-228 ◽  
Author(s):  
V. Patel ◽  
R. Araya ◽  
N. Chowdhary ◽  
M. King ◽  
B. Kirkwood ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
General Health Questionnaire ◽  
Diagnostic Interview ◽  
Systematic Sampling ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Self Reporting Questionnaire ◽  
Distress Scale

BackgroundScreening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.MethodAdult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).ResultsComplete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.ConclusionsThere is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.

scholarly journals Cross-cultural differences in the epidemiology of unexplained fatigue syndromes in primary care

2003 ◽  
Vol 182 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Petros Skapinakis ◽  
Glyn Lewis ◽  
Venetsanos Mavreas
Keyword(s):  
Primary Care ◽  
Secondary Analysis ◽  
Composite International Diagnostic Interview ◽  
Developed Countries ◽  
Diagnostic Interview ◽  
World Health ◽  
Less Developed Countries ◽  
Cross Cultural Differences ◽  
International Data ◽  
Health Organization

BackgroundUnexplained fatigue has been extensively studied but most of the samples used were from Western countries.AimsTo present international data on the prevalence of unexplained fatigue and fatigue as a presenting complaint in primary care.MethodSecondary analysis of the World Health Organization study of psychological problems in general health care. A total of 5438 primary care attenders from 14 countries were assessed with the Composite International Diagnostic Interview.ResultsThe prevalence of unexplained fatigue of 1-month duration differed across centres, with a range between 2.26 (95% CI 1.17–4.33) and 15.05 (95% CI 10.85–20.49). Subjects from more-developed countries were more likely to report unexplained fatigue but less likely to present with fatigue to physicians compared with subjects from less developed countries.ConclusionsIn less-developed countries fatigue might be an indicator of unmet psychiatric need, but in more-developed countries it is probably a symbol of psychosocial distress.

Prevalence and recognition of anxiety syndromes in five European primary care settings

1998 ◽  
Vol 173 (S34) ◽  
pp. 18-23 ◽  
Author(s):  
E. Weiller ◽  
J.-C. Bisserbe ◽  
W. Maier ◽  
Y. Lecrubier
Keyword(s):  
Primary Care ◽  
Help Seeking ◽  
Composite International Diagnostic Interview ◽  
Well Being ◽  
Significant Degree ◽  
Diagnostic Interview ◽  
Primary Care Settings ◽  
Psychosocial Disability ◽  
Icd 10 ◽  
Degree Of Disability

Background This study explored the prevalence, socio-demographic characteristics and severity of different anxiety syndromes in five European primary care settings, as well as medical help-seeking, recognition by general practitioners (GPs) and treatment prescribed.Method The data were collected as part of the WHO study on Psychological Problems in General Health Care. Among 9714 consecutive primary care patients, 1973 were interviewed using the Composite International Diagnostic Interview. Reason for contact, ICD–10 diagnoses, severity and disability were assessed. Recognition rates and treatment prescribed were obtained from the GPs.Results Anxiety syndromes, whether corresponding to well-defined disorders or to subthreshold conditions, are frequent in primary care and are associated with a clinically significant degree of severity and substantial psychosocial disability. Their recognition by GPs as well as the proportion treated are low.Conclusions Since people with subthreshold anxiety show a substantial degree of disability and suffering, GPs may consider diagnostic criteria to be insufficient. However, their awareness of specific definitions and treatment patterns for anxiety disorders still needs a lot of improvement both for patients' well-being and for the cost resulting from non-treatment.

scholarly journals Childhood Adversities and Traumata in Lebanon: A National Study

2014 ◽  
Vol 10 (1) ◽  
pp. 116-125 ◽  
Author(s):  
Lynn Itani ◽  
Youmna C Haddad ◽  
John Fayyad ◽  
Aimee Karam ◽  
Elie Karam
Keyword(s):  
Traumatic Event ◽  
Traumatic Events ◽  
Composite International Diagnostic Interview ◽  
Female Gender ◽  
National Sample ◽  
Diagnostic Interview ◽  
National Study ◽  
Childhood Adversities ◽  
Nationally Representative ◽  
Personal Trauma

Background: The goal of this paper is to map the total occurrence and evaluate the risk of co-occurrence of childhood adversities (CA) and a wide variety of childhood traumatic events (including war) in a national sample. Method: The nationally representative sample included 2,857 respondents and the instrument used was the Composite International Diagnostic Interview which screened for all CAs and traumatic events. Results: 27.9% experienced CAs; the most common were parental death and parental mental/substance use disorder. 70.6% experienced a war-related traumatic event during their lifetime, and around half of them (38.1%) experienced it below the age of 18 years. 51.3% of the subjects experienced a traumatic event not related to war during their lifetime, and 19.2% experienced it before the age of 18 years. Sexual abuse, being a refugee during war, and experiencing a natural disaster were associated with female gender. Having any CA was associated with active war exposure (OR: 4.2, CI: 2.0-8.6); war-related direct personal trauma (OR: 3.9, CI: 1.5-10.0); war-related trauma to others (OR: 2.4, CI: 1.3-4.4); non-war direct personal trauma (OR: 3.8, CI: 2.0-7.4); and any non-war childhood traumatic event (OR: 1.9, CI: 1.1-3.1). Conclusion:Childhood is awash with adversities and traumatic events that co-occur and should be measured simultaneously; otherwise, the effects of a subset of traumata or adversities could be wrongly thought to be the contributor to negative outcomes under study.

Validation of two survey diagnostic interviews among primary care attendees: a comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories

2004 ◽  
Vol 34 (6) ◽  
pp. 1013-1024 ◽  
Author(s):  
V. JORDANOVA ◽  
C. WICKRAMESINGHE ◽  
C. GERADA ◽  
M. PRINCE
Keyword(s):  
Primary Care ◽  
Common Mental Disorders ◽  
Psychiatric Morbidity ◽  
High Specificity ◽  
Composite International Diagnostic Interview ◽  
Random Order ◽  
Diagnostic Interview ◽  
Cut Point ◽  
Icd 10 ◽  
Valid Assessment

Background. The most widely used survey measures in psychiatry, the Composite International Diagnostic Interview (CIDI) and the Clinical Interview Schedule – Revised (CIS-R) have generated estimates of psychiatric morbidity that show considerable variation. Doubts have been raised regarding the validity of these structured lay interviewer assessments. There have been no direct comparisons of the performances of these instruments against a common, established criterion.Method. A total of 105 unselected primary care attendees were each interviewed with CIDI, CIS-R and SCAN in a single sitting with random order of administration. SCAN was administered by a SCAN trained psychiatrist, and CIDI and CIS-R by a public health doctor. Concordance was estimated for all ICD-10 neurotic disorders. We assessed the overall discriminability of the CIS-R morbidity scale using a receiver operating characteristic (ROC) analysis.Results. The concordance for CIDI for ICD-10 diagnoses was moderate to excellent (kappa=0·58–0·97). Concordance for CIS-R ranged between poor and moderate (kappa=0·10–0·65). The area under the ROC curve for the CIS-R morbidity scale with respect to any ICD-10 disorder [0·87 (95% CI 0·79–0·95)] indicated good overall discriminability, but poor sensitivity (44%) and high specificity (97%) at the usual CIS-R cut-point of 11/12.Conclusion. Among primary care attendees the CIDI is a highly valid assessment of common mental disorders, and the CIS-R is moderately valid. Previous studies may have underestimated validity. Against the criteria of all ICD-10 diagnoses (including less severe depressive and anxiety disorders) a much lower CIS-R cut-point is required than that which is usually advocated.

Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians

2006 ◽  
Vol 19 (4) ◽  
pp. 623-634 ◽  
Author(s):  
Seyed Kazem Malakouti ◽  
Paridokht Fatollahi ◽  
Arash Mirabzadeh ◽  
Taher Zandi
Keyword(s):  
Urban Areas ◽  
Roc Analysis ◽  
Short Form ◽  
General Health Questionnaire ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Face Validity ◽  
Receiver Operating Curve ◽  
Elderly Subjects ◽  
Cutoff Score

Background: The object of this study was to develop an Iranian version of the General Health Questionnaire-28 (GHQ-28) for use with elderly subjects.Methods: The GHQ-28 Farsi version was evaluated for face validity among 204 elderly subjects aged 59 years or older, chosen randomly from residents of Tehran. The Composite International Diagnostic Interview (CIDI) was used to establish a gold standard diagnosis of mental disorders.Results: The GHQ-28 was an internally consistent measure. Cronbach's α, split-half coefficients and test-retest reliability were 0.9, 0.89 and 0.58 respectively. Four factors were extracted using factor analysis: “depression,” “psychosocial activity,” “anxiety,” and “somatic.” Using receiver operating curve (ROC) analysis, the optimum cutoff score for the GHQ-28 in this group was 19/20 (sensitivity 0.83, specificity 0.76). Using a loading of 0.6 or greater, a short form of the instrument (GHQ-15) (α = 0.9) was derived and correlated well with the longer form of the scale (r = 0.97). Using ROC analysis, the optimum cutoff score was 10/11 (sensitivity 0.83, specificity 0.69).Conclusions: The short and long forms of the GHQ-28 are suitable screening instruments for elderly Iranian residents, particularly those living in urban areas.

Childhood trauma and distress experiences associate with psychotic symptoms in patients attending primary and psychiatric outpatient care. Results of the RADEP study

2012 ◽  
Vol 28 (3) ◽  
pp. 154-160 ◽  
Author(s):  
S. Luutonen ◽  
M. Tikka ◽  
H. Karlsson ◽  
R.K.R. Salokangas
Keyword(s):  
Primary Care ◽  
Childhood Trauma ◽  
Psychiatric Care ◽  
Composite International Diagnostic Interview ◽  
Clinical Work ◽  
Diagnostic Interview ◽  
Psychotic Symptoms ◽  
Sum Score ◽  
Primary Care Patients ◽  
Distress Scale

AbstractGoalWe studied the prevalence of and association between psychotic symptoms and childhood trauma experiences in primary care patients compared with psychiatric care patients.Patients and methodsWe note 911 primary care and psychiatric care patients over 16 years of age filled in a questionnaire including a list of lifetime psychotic symptoms of the Composite International Diagnostic Interview (CIDI) and the childhood Trauma and Distress Scale (TADS). Prevalence of and correlations between psychotic symptoms and childhood trauma and stressful experiences were calculated. Association between the sum of CIDI symptoms and the TADS sum score was analysed by Anova.ResultsIn primary care, more than half of the patients had had at least one psychotic symptom during their lifetime, and nearly 70% of patients had experienced a childhood trauma at some time or more often. In psychiatric care patients, CIDI symptoms were more prevalent and TADS scores were higher than in primary care patients. In the whole sample, CIDI symptoms correlated with TADS scores. The association remained even when the effects of age, service, and patient's functioning were taken into account. There was a dose-response between TADS scores and CIDI symptoms.ConclusionChildhood trauma experiences associate with psychotic symptoms. In clinical work, it is important to acknowledge that psychotic symptoms and childhood trauma experiences are common not only in psychiatric care but also in primary care patients, and thus require adequate attention.

Sign in / Sign up

Export Citation Format

Share Document