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Physical and Psychiatric Comorbidity in General Practice

Published online by Cambridge University Press:  02 January 2018

S. R. Kisely  and
D. P. Goldberg
S. R. Kisely*
Affiliation:
Department of Psychiatry, Withington Hospital, Manchester
D. P. Goldberg
Affiliation:
Department of Psychiatry, Withington Hospital, Manchester
*
Dr S. Kisely, School of Epidemiology & Health Sciences, Medical School, University of Manchester, Oxford Road, Manchester M13 9PT
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Abstract

Background

The aim of this study was to determine the association between physical and psychiatric morbidity among general practice patients and to explore the influence of possible intervening variables.

Method

Physical and psychiatric morbidity in 1620 consecutive patients attending their general practitioner (GP) was assessed using a two-stage design. Ninety-four per cent of the patients (n=1523) were successfully screened using the General Health Questionnaire (GHQ–12); 428 of the 602 patients (71%) eligible for the second stage were interviewed using the Composite International Diagnostic Instrument adapted for use in primary health care (CIDI–PHC), the Brief Disability Questionnaire (BDQ) and the Groningen Social Disability Schedule (GSDS) to assess psychiatric, physical and social status. Assessments of physical and psychiatric morbidity were also obtained from the patients' GPs.

Results

There was a significant association between physical and psychiatric morbidity, although patients with four symptoms or less of physical illness were no more likely to be psychiatric cases than those with none. The association was accounted for by patients at the severe end of the physical continuum with five or more medically explained somatic symptoms: these were twice as likely to be psychiatric cases as those with no such symptoms. Female gender, social disability and physical disability were all significantly more likely to be associated with psychiatric disorder, whether measured by GP or research interview; and these relationships remained after the data were corrected for age differences.

Conclusions

Patients in general practice with moderate to severe physical morbidity are at increased risk of developing psychiatric illness, and when medical illness is present, psychiatric symptoms are more severe. As physical and psychiatric comorbidity is relatively common in general practice, the specific needs of these patients should receive greater attention.

Type
Papers
Information
The British Journal of Psychiatry , Volume 169 , Issue 2 , August 1996 , pp. 236 - 242
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Aneshensel, C., Frerichs, R. & Huba, G. (1984) Depression and physical illness: a multi-wave, non-recursive causal model. Journal of Health and Social Behaviour, 25, 350–371.CrossRefGoogle Scholar
Bridges, K. & Goldberg, D. (1985) Somatic presentation of DSM–III psychiatric disorders in primary care. Journal of Psychosomatic Research, 29, 563–569.CrossRefGoogle ScholarPubMed
Casey, P., Dillon, S. & Tyrer, P. (1984) The diagnostic status of patients with conspicuous morbidity in primary care. Psychological Medicine, 14, 673–681.CrossRefGoogle ScholarPubMed
Craig, T. J. K., Boardman, A. P., Mills, K., et al (1993) The South London Somatisation Study. 1: Longitudinal course and the influence of early life experiences. British Journal of Psychiatry, 163, 579–588.CrossRefGoogle Scholar
Dworkin, S. F., von Korff, M. & Leresche, L. (1990) Multiple pains and psychiatric disturbance, an epidemiologic investigation. Archives of General Psychiatry, 47, 239–245.CrossRefGoogle ScholarPubMed
Goldberg, D. & Bridges, K. (1991) Minor psychiatric disorders and neurasthenia in general practice. In Problems of Psychiatry in General Practice (eds Gastpar, M. & Kielholz, P.). Bern: Hogrefe/Huber.Google Scholar
Koenig, H., Goli, V. & Shelp, F. (1989) Antidepressant use in elderly medical inpatients. Lessons from an attempted clinical trial. Journal of General Internal Medicine, 4, 498–505.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., Williams, J. B., et al (1994) Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment Archives of Family Medicine, 3, 774–779 CrossRefGoogle ScholarPubMed
Mayou, R. & Hawton, K. (1986) Psychiatric disorder in general hospital. British Journal of Psychiatry, 149, 172–190.CrossRefGoogle ScholarPubMed
Mayou, R. & Smith, E. (1986) Hospital doctors' management of psychological problems. British Journal of Psychiatry, 148, 194–197.CrossRefGoogle ScholarPubMed
Popkin, M., Callies, A. & Mackenzie, T. (1985) The outcome of antidepressant use in the medically ill Archives of General Psychiatry, 42, 1160–1164.CrossRefGoogle ScholarPubMed
Robins, L., Wing, J. & Wittchen, H.-U. (1988) The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic symptoms and in different cultures. Archives of General Psychiatry, 45, 1069–1077.CrossRefGoogle ScholarPubMed
Shepherd, M., Cooper, A., Brown, A., et al (1966) Psychiatric Illness in General Practice. Oxford: Oxford University Press.Google Scholar
Simon, G. & Vonkorff, M. (1991) Somatization and psychiatric disorders in the NIMH Epidemiologic Catchment Area Study. American Journal of Psychiatry, 148, 1494–1500.Google ScholarPubMed
Sullivan, M. (1995) Depression and disability from chronic medical illness. European Journal of Public Health, 5, 40–45.CrossRefGoogle Scholar
Ustun, B. & Sartorius, N. (1995) Mental Illness in General Health Care. Chichester Wiley.Google Scholar
Vázquez-Barquero, J. L., Diez-Manrique, J. F., Pena Martin, C., et al (1987) A community mental health survey in Cantabria, a general description of morbidity. Psychological Medicine, 17, 227–241.CrossRefGoogle ScholarPubMed
Vázquez-Barquero, , Munoz, J., et al (1992) Sex differences in mental illness, a community study of the influence of physical health and socio-demographic factors. Social Psychiatry & Psychiatric Epidemiology, 27, 62–68.CrossRefGoogle Scholar
Welch, S., Lewis, G. & Donmall, R., et al (1995). Somatic presentation of psychiatric morbidity in general practice. British Journal of General Practice, 45, 143–147.Google Scholar
Wells, K., Golding, J. M. & Burman, M. A. (1988) Psychiatric disorder in a sample of the general population with and without chronic conditions. American Journal of Psychiatry, 145, 976–981.Google Scholar
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