Stephen Kisely1, Gregory Simon. 1. Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Halifax, Canada. Stephen.Kisely@cdha.nshealth.ca
Abstract
OBJECTIVE: The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care. METHODS: A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients' family practitioners. RESULTS: Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability. CONCLUSION: Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention.
OBJECTIVE: The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care. METHODS: A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients' family practitioners. RESULTS: Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability. CONCLUSION: Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention.
Authors: Andrea L Murphy; Ruth Martin-Misener; Stan P Kutcher; Claire L O'Reilly; Timothy F Chen; David M Gardner Journal: BMC Health Serv Res Date: 2016-10-12 Impact factor: 2.655