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WHO study of psychological problems in general health care. Baseline findings and implications for primary care1

Published online by Cambridge University Press:  11 October 2011

Richard Gater*
Affiliation:
School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, UK
*
Indirizzo per la corrispondenza: Dr. R. Gater, Department of Psychiatry, Withington Hospital, Nell Lane, West Didsbury, Man-chester M20 8LR (UK). Fax +44 (0)-161 445.9263

Summary

Objective - To investigate the form, frequency, management and outcome of common psychological disorders in primary care patients. Design - Two-stage sampling of primary care attenders followed by 3 and 12 month longitudinal assessment of mental state disability and treatment carried out using the same methods in 15 centres around the world, and coordinated by the World Health Organization. Main measures - The General Health Questionnaire, the primary care version of the Composite International Diagnostic Interview used to derive ICD-10 diagnosis, the Groningen Social Disability Schedule, and the primary care physician's assessment of the patient's current physical and psychological status along with a summary of their management of the case. Results - 25,916 patients were screened and 5,438 patients were interviewed in detail. Mental disorders among general health care attenders were common (average 24% of consecutive attenders, range 7.3%-52.5%). Disability was increased in patients with psychological illness: the more severe the psychological illness, the more severe was the disability The main presenting problem of such patients was often somatic, and only a minority presented a clearly psychological symptom. Detection varied greatly between centres, and across all centres half of the ICD-10 cases were not detected by the attending physician. Doctors in Verona displayed a particular bias towards psychological disorder. Treatment was offered to almost all patients identified as having psychological disorder by the primary care physician, though treatments showed a similar distribution regardless of diagnosis. Conclusions - The frequency and disability associated with the psychiatric disorder in general health care emphasise their importance to primary care and public health. These are patients who present to primary care, and most continue to be managed in primary care without recourse to specialist mental health services. It is important that training about the detection, diagnosis and management of common mental disorders are strengthened at medical school and in the vocational training of general practitioners.

Riassunto

Scopo - 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.

Type
Articles
Copyright
Copyright © Cambridge University Press 1996

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Footnotes

1

Based on IRGASD (Italian Research Group for Affective and Schizophrenic Disorders) lecture, organised by the Institute of Psychiatry of the University of Verona, and delivered in Verona on March 23, 1996. IRGASD activities carried out under the auspices of Dr. Paul Janssen Medical Institute, are supported by Janssen-Cilag.

References

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