BACKGROUND: We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n = 201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability. METHODS: A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n = 292) with differing probabilities was selected for second-stage interview (Present State Examination and Groningen Disability Schedule). Patients with psychiatric symptoms (n = 201) were reassessed 1 (n = 182) and 3 1/2 (n = 154) years later. RESULTS: At 1- and 3 1/2-year follow-ups, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety and mixed anxiety-depression. CONCLUSIONS: We concluded that a multicategorical, rather than a binary, outcome measure better reflects patient outcomes, since it highlights partial remission, mild symptoms, and residual disability, and as such, stresses the need to supplement short-term treatment. A multicategorical caseness model may be advantageous for research and clinical practice. We suggest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the recognition, treatment, and 1-year course of common psychiatric illnesses in general practice.
BACKGROUND: We evaluated the long-term outcome of depression and anxiety and associated disability among primary-care attenders with common psychiatric disorders and symptoms (n = 201) using binary and multicategorical, interview-based outcome measures of psychiatric illness and disability. METHODS: A two-stage design was used. In the first stage, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Questionnaire and by their physicians. A stratified random sample (n = 292) with differing probabilities was selected for second-stage interview (Present State Examination and Groningen Disability Schedule). Patients with psychiatric symptoms (n = 201) were reassessed 1 (n = 182) and 3 1/2 (n = 154) years later. RESULTS: At 1- and 3 1/2-year follow-ups, many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped. However, partial remission, not full recovery, was the rule, and was associated with residual disability. Depression had better outcomes than anxiety and mixed anxiety-depression. CONCLUSIONS: We concluded that a multicategorical, rather than a binary, outcome measure better reflects patient outcomes, since it highlights partial remission, mild symptoms, and residual disability, and as such, stresses the need to supplement short-term treatment. A multicategorical caseness model may be advantageous for research and clinical practice. We suggest a dynamic-equilibrium model to account for residual symptoms and disability. This study is a follow-up to two earlier reports on the recognition, treatment, and 1-year course of common psychiatric illnesses in general practice.
Authors: Stephen D Anton; Adam J Woods; Tetso Ashizawa; Diana Barb; Thomas W Buford; Christy S Carter; David J Clark; Ronald A Cohen; Duane B Corbett; Yenisel Cruz-Almeida; Vonetta Dotson; Natalie Ebner; Philip A Efron; Roger B Fillingim; Thomas C Foster; David M Gundermann; Anna-Maria Joseph; Christy Karabetian; Christiaan Leeuwenburgh; Todd M Manini; Michael Marsiske; Robert T Mankowski; Heather L Mutchie; Michael G Perri; Sanjay Ranka; Parisa Rashidi; Bhanuprasad Sandesara; Philip J Scarpace; Kimberly T Sibille; Laurence M Solberg; Shinichi Someya; Connie Uphold; Stephanie Wohlgemuth; Samuel Shangwu Wu; Marco Pahor Journal: Ageing Res Rev Date: 2015-10-14 Impact factor: 10.895
Authors: Gretchen A Brenes; Jack M Guralnik; Jeff D Williamson; Linda P Fried; Crystal Simpson; Eleanor M Simonsick; Brenda W J H Penninx Journal: J Am Geriatr Soc Date: 2005-01 Impact factor: 5.562
Authors: Ilse Mj van Beljouw; Peter Fm Verhaak; Pim Cuijpers; Harm Wj van Marwijk; Brenda Wjh Penninx Journal: BMC Psychiatry Date: 2010-10-20 Impact factor: 3.630
Authors: Bertus F Jeronimus; Roman Kotov; Johan Ormel; Harriëtte Riese; Elisabeth H Bos; Benjamin Hankin; Judith G M Rosmalen; Albertine J Oldehinkel Journal: Clin Psychol Rev Date: 2013-04-29