Depression Comorbid with Anxiety: Results from the WHO Study on Psychological Disorders in Primary Health Care

1996 ◽  
Vol 168 (S30) ◽  
pp. 38-43 ◽  
Author(s):  
Nornam Sartorius ◽  
T. Bedirhan Üstün ◽  
Yves Lecrubier ◽  
Hans-Ulrich Wittchen
Keyword(s):  
Health Care ◽  
General Health ◽  
Health Care Services ◽  
Somatoform Disorders ◽  
Collaborative Study ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Psychological Problems ◽  
World Health ◽  
Health Organization

The World Health Organization collaborative study on “Psychological Problems in General Health Care” investigated the form, frequency, course and outcome of common psychological problems in primary care settings at 15 international sites. The research employed a two-stage case-finding procedure. GHQ–12 was administered to 25 916 adults who consulted health-care services. The second-stage assessment (n=5438) consisted of the Composite International Diagnostic Interview (GDI), the Social Disability Schedule, and questionnaires. Possible cases or borderline cases of mental disorder, and a sample of known cases, were followed up at three months and one year. Using standard diagnostic algorithms (ICD–10), prevalence rates were calculated for current disorder (one-month) and lifetime experience disorder. Well-defined psychological problems are frequent in all the general health-care settings examined (median 24.0%). Among the most common were depression, anxiety, alcohol misuse, somatoform disorders, and neurasthenia. Nine per cent of patients suffered from a “subthreshold condition” that did not meet diagnostic criteria but had clinically significant symptoms and functional impairment. The most common co-occurrence was depression and anxiety. Comorbidity increases the likelihood of recognition of mental disorders in general health care, and the likelihood of receiving treatment.

Form, frequency and burden of sleep problems in general health care: a report from the WHO Collaborative Study on Psychological Problems in General Health Care

1996 ◽  
Vol 11 (S1) ◽  
pp. 5s-10s ◽  
Author(s):  
TB Üstün ◽  
M Privett ◽  
Y Lecrubier ◽  
E Weiller ◽  
G Simon ◽  
...  
Keyword(s):  
Health Care ◽  
General Health ◽  
Sleep Problems ◽  
Somatoform Disorders ◽  
General Health Questionnaire ◽  
Collaborative Study ◽  
Alcohol Problems ◽  
Psychological Problems ◽  
Health Questionnaire ◽  
Icd 10

SummaryThe WHO Collaborative Study on Psychological Problems in General Health Care examined the frequency, form, course and outcome of psychological problems in general health care settings. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (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 the Brief Disability Questionnaire, the Social Disability Schedules, a self rated overall health status form and the 28-item General Health Questionnaire. The analysis has shown that sleep problems were common at all sites with: 26.8% of all patients having some form of sleep problem and 15% of the patients examined had trouble falling or staying asleep. Of those with sleep problems, 51.5% had a well-defined International Classification of Diseases 10th Revision (ICD-10) mental disorder (such as depression, anxiety, somatoform disorders or alcohol problems) and 48.5% of those with sleep problems for at least two weeks or more did not fulfil the criteria for any well defined ICD-10 diagnosis. Persons with sleep problems reported a degree of disability in the performance of their daily activities and social roles even when they had no symptoms of psychological disorders. When such symptoms were present the disability was significantly increased.

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.

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.

scholarly journals Seminars in social psychiatry in Romania

1992 ◽  
Vol 16 (6) ◽  
pp. 340-342 ◽  
Author(s):  
Greg Wilkinson ◽  
Linda Gask ◽  
John Henderson
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Graduate Training ◽  
Training Programme ◽  
World Health ◽  
Psychiatric Training ◽  
Regional Office ◽  
Care Services ◽  
Post Graduate Training ◽  
Health Organization

For more than a decade there has been no opportunity for formal post-graduate training in psychiatry in Romania. In February 1992, as part of a World Health Organization (Regional Office for Europe) initiative, we travelled to Romania as WHO temporary advisers to give seminars on: (i) the role of primary health care services in providing mental health care; and (ii) the development of community-based services for the mentally ill and disabled. Our seminars were designed to complement the biological and clinical elements of a developing psychiatric training programme.

Daily smoking and the subsequent onset of psychiatric disorders

2004 ◽  
Vol 34 (2) ◽  
pp. 323-333 ◽  
Author(s):  
N. BRESLAU ◽  
S. P. NOVAK ◽  
R. C. KESSLER
Keyword(s):  
Smoking Cessation ◽  
Panic Disorder ◽  
Psychiatric Disorders ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
World Health ◽  
Daily Smoking ◽  
Smoking Intensity ◽  
Health Organization ◽  
Subsequent Onset

Background. Recent research has demonstrated that smokers are at an elevated risk for psychiatric disorders. This study extends the enquiry by examining: (1) the specificity of the psychiatric sequelae of smoking; and (2) the variability in the likelihood of these sequelae by proximity and intensity of smoking.Method. Data come from the National Comorbidity Survey (NCS), a representative sample of the US population 15–54 years of age. The Smoking Supplement was administered to a representative subset of 4414 respondents. A modified World Health Organization – Composite International Diagnostic Interview was used to measure DSM-III-R disorders. Survival analysis with smoking variables as time-dependent covariates was used to predict the subsequent onset of specific psychiatric disorders.Results. The estimated effects of daily smoking varied across disorders. In the case of mood disorders, daily smoking predicted subsequent onset, with no variation between current versus past smokers or by smoking intensity. In the case of panic disorder and agoraphobia, current but not past smoking predicted subsequent onset; furthermore, the risk of these disorders in past smokers decreased with increasing time since quitting. In the case of substance use disorders, current but not past smoking predicted subsequent onset, with no variation by time since quitting or smoking intensity.Conclusions. The data suggest that smoking cessation programmes would not prevent the onset of mood disorder, as ex-smokers do not differ from current smokers in their risk for these disorders. In comparison, daily smoking might be a causal factor in panic disorder and agoraphobia, conditions that might be preventable by smoking cessation. Additionally, current smoking might serve as a marker for targeting interventions to prevent alcohol and drug disorders.

scholarly journals A Combined Digital and Biomarker Diagnostic Aid for Mood Disorders (the Delta Trial): Protocol for an Observational Study

10.2196/18453 ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. e18453 ◽  
Author(s):  
Tony Olmert ◽  
Jason D Cooper ◽  
Sung Yeon Sarah Han ◽  
Giles Barton-Owen ◽  
Lynn Farrag ◽  
...  
Keyword(s):  
Mood Disorders ◽  
Statistical Power ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Accurate Diagnosis ◽  
Diagnostic Methods ◽  
World Health ◽  
Diagnostic Aid ◽  
Health Organization

Background Mood disorders affect hundreds of millions of people worldwide, imposing a substantial medical and economic burden. Existing diagnostic methods for mood disorders often result in a delay until accurate diagnosis, exacerbating the challenges of these disorders. Advances in digital tools for psychiatry and understanding the biological basis of mood disorders offer the potential for novel diagnostic methods that facilitate early and accurate diagnosis of patients. Objective The Delta Trial was launched to develop an algorithm-based diagnostic aid combining symptom data and proteomic biomarkers to reduce the misdiagnosis of bipolar disorder (BD) as a major depressive disorder (MDD) and achieve more accurate and earlier MDD diagnosis. Methods Participants for this ethically approved trial were recruited through the internet, mainly through Facebook advertising. Participants were then screened for eligibility, consented to participate, and completed an adaptive digital questionnaire that was designed and created for the trial on a purpose-built digital platform. A subset of these participants was selected to provide dried blood spot (DBS) samples and undertake a World Health Organization World Mental Health Composite International Diagnostic Interview (CIDI). Inclusion and exclusion criteria were chosen to maximize the safety of a trial population that was both relevant to the trial objectives and generalizable. To provide statistical power and validation sets for the primary and secondary objectives, 840 participants were required to complete the digital questionnaire, submit DBS samples, and undertake a CIDI. Results The Delta Trial is now complete. More than 3200 participants completed the digital questionnaire, 924 of whom also submitted DBS samples and a CIDI, whereas a total of 1780 participants completed a 6-month follow-up questionnaire and 1542 completed a 12-month follow-up questionnaire. The analysis of the trial data is now underway. Conclusions If a diagnostic aid is able to improve the diagnosis of BD and MDD, it may enable earlier treatment for patients with mood disorders. International Registered Report Identifier (IRRID) DERR1-10.2196/18453

scholarly journals Governance in Public Purchasing of Tertiary-Level Health Care: Lessons From Madhya Pradesh, India

SAGE Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 215824402094248
Author(s):  
Raj Panda ◽  
Pradeep Guin ◽  
Kumar Gaurav
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Health Financing ◽  
Madhya Pradesh ◽  
World Health ◽  
Organizational Assessment ◽  
The Status ◽  
Critical Components ◽  
Health Organization

The performance of a health system hinges upon effective and efficient allocation of resources. The nature of governance within the health system, including critical components such as purchasing mechanism of health care services, also determines the health status of program beneficiaries. This article investigates an existing purchasing mechanism of a state-funded health care scheme through the lens of governance. We applied framework method on an adapted version of a tool developed by the World Health Organization (WHO), Organizational Assessment for Improving and Strengthening Health Financing (OASIS), to draw four themes to study the status of purchasing mechanism in Madhya Pradesh (MP), India. We used purposive sampling to select subjects from the state, district, and block levels and conducted 32 in-depth interviews. Subjects from the district and block levels were drawn from a sample of three out of 51 districts in MP. We found that although the scheme is functional, it has immense scope for improvement, thereby bettering the health outcomes of its beneficiaries.

scholarly journals Maternal near miss morbidity in Colombia: variables related to opportune access to health care related to the number of inclusion criteria

2015 ◽  
Vol 62 (4) ◽  
pp. 553-558 ◽  
Author(s):  
José Luis Pérez-Olivo ◽  
Esther Liliana Cuevas ◽  
Sara García-Forero ◽  
Adalberto Campo-Arias
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Services ◽  
Near Miss ◽  
World Health ◽  
Maternal Near Miss ◽  
Inclusion Criteria ◽  
Care Services ◽  
Timely Access ◽  
Health Organization

<p>Background. In Colombia, maternal near miss morbidity is<br />monitored in the health surveillance system. The National<br />Health Institute included a special report on cases that met<br />three or more World Health Organization criteria according to<br />the World Health Organization criteria.</p><p><br />Objective. To estimate the relationship between variables<br />related to opportune access to health care services in Colombia during 2013 depending on inclusion criteria –three or more– for maternal near miss morbidity.</p><p><br />Materials and methods. A cross-sectional analysis of the<br />national registry of obligatory notification on maternal near<br />miss morbidity was performed. Cases with three or more criteria were compared with those with one or two according to some variables related to the timely access of health care services.</p><p><br />Results. A total of 8 434 maternal near miss morbidity cases<br />were reported, women were aged between 12 and 51 years old<br />(M=26.4, SD=7.5). 961 (11.4%) lived in remote rural areas; 4<br />537 (53.8%) were uninsured under the health system, or they<br />were affiliated to either the subsidized or special health care<br />regime; 845 (10.0%) belonged to an ethnic minority; 3 696<br />(44.4%) were referred to a more complex service; 4 097 (49.2%) were admitted to the intensive care unit; and 3 975 (47.1%) met three or more of the inclusion criteria for maternal near miss morbidity. They were combined to meet three or more of the case inclusion criteria: intensive care unit admission (OR=5.58;IC95% 5.06-6.15); being uninsured or affiliated to the subsidized or special regime (OR=1.57; IC95% 1.42-1.74); and referral to a more complex service (OR=1.18; IC95% 1.07-1.31).</p><p><br />Conclusions. In Colombia, the timely access of health care<br />services is related to maternal near miss morbidity with three<br />or more inclusion criteria.</p>

Self-rated general health and psychiatric disorders in a general population sample

2005 ◽  
Vol 20 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Ulrich John ◽  
Christian Meyer ◽  
Hans-Jürgen Rumpf ◽  
Anja Schumann ◽  
Horst Dilling ◽  
...  
Keyword(s):  
General Population ◽  
Psychiatric Disorders ◽  
General Health ◽  
Somatoform Disorders ◽  
Population Sample ◽  
Participation Rate ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Diagnostic And Statistical Manual

AbstractThe purpose of this study was to explore the relationships between nicotine and alcohol dependence, depressive, anxiety and somatoform disorders with self-rated general health (GH). A cohort study of a random sample of the non-institutionalised general population aged 18–64 with a participation rate of 70.2% was carried out in a German area (n = 4075 at baseline). A follow-up of tobacco smokers or heavy drinkers (n = 1083, 79.4% of those who had given consent to be followed-up) was conducted 30 months after baseline measurement. The assessments included self-ratings of GH and Diagnostic and Statistical Manual (DSM-IV) diagnoses based on the Composite International Diagnostic Interview. The results show that nicotine dependence, anxiety disorders and somatoform disorders moderately predicted self-rated GH at follow-up (general linear model, R2 = 0.12). We conclude that psychiatric disorders may contribute to the prediction of a low self-rated GH.

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