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The Relationship Between Social Dysfunctioning and Psychopathology among Primary Care Attenders

Published online by Cambridge University Press:  02 January 2018

Tamar D. Wohlfarth ,
Wim Van Den Brink ,
Johan Ormel ,
Maarten W. J. Koeter  and
Albertine J. Oldehinkel
Tamar D. Wohlfarth
Affiliation:
Department of Social Psychiatry, University of Groningen, The Netherlands
Wim Van Den Brink*
Affiliation:
Amsterdam Institute for Addiction Research, Jacob Obrechtstraat 92, 1071 KR Amsterdam, The Netherlands
Johan Ormel
Affiliation:
Department of Social Psychiatry, University of Groningen, The Netherlands
Maarten W. J. Koeter
Affiliation:
Department of Social Psychiatry, University of Groningen, The Netherlands
Albertine J. Oldehinkel
Affiliation:
Department of Social Psychiatry, University of Groningen, The Netherlands
*
∗Correspondence
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Abstract

The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 163 , Issue 1 , July 1993 , pp. 37 - 44
Copyright
Copyright © The Royal College of Psychiatrists 

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References

American Psychiatric Association (1960) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Angst, J. & Dobler-Mikola, A. (1985) The Zurich study: VI. A continuum from depression to anxiety disorders? European Archives of Psychiatry and Neurological Science, 235, 179–186.CrossRefGoogle Scholar
Arrindell, W. A., Emmelkamp, P. M. G. & Sanderman, R. (1986) Marital quality and general life adjustment in relation to treatment outcome in agoraphobia. Advances in Behavior Research and Therapy, 8, 139–185.Google Scholar
Asselbergs, L. J. (1989) Sociaal beperkt: een empirisch ondenoek naar het sociale functioneren van sehizofrenie-patiënten in het Psychose Preventie Project Rotterdam. (Socially disabled: an empirical study on social dysfunctioning among schizophrenic patients in the Psychosis Prevention Project Rotterdam.) Dissertation. Utrecht: NcGV.Google Scholar
Barrett, J. E., Barrett, J. A., Oxman, T. E., et al (1988) The prevalence of psychiatric disorders in primary care practice. Archives of General Practice, 45, 1100–1119.Google Scholar
Blacker, C. V. R. & Clare, A. W. (1988) The prevalence and treatment of depression in general practice. Psychopharmacology, 95, 514–517.Google Scholar
Blumenthal, M. D. & Dielman, T. E. (1975) Depressive symptomatology and role function in a general population. Archives of General Psychiatry, 32, 985–991.Google Scholar
Bothwell, S. & Weissman, M. M. (1977) Social impairment four years after an acute depressive episode. American Journal of Orthopsychiatry, 47, 231–237.CrossRefGoogle ScholarPubMed
Brink, W. van den, Leenstra, A., Ormel, J., et al (1991) Mental health intervention programs in primary care: their scientific basis. Journal of Affective Disorders, 21, 273–284.Google Scholar
Bronisch, T., Wittchen, H-U., Krieg, C., et al (1985) Depressive neurosis: a long-term perspective and retrospective follow-up study of former inpatients. Acta Psychiatrica Scandinavica, 71, 237–248.CrossRefGoogle Scholar
Bronisch, T., & Hecht, H. (1989) Validity of adjustment disorders, comparison with major depression. Journal of Affective Disorders, 17, 229–236.Google Scholar
Bronisch, T., & Hecht, H. (1990) Major depression with and without a coexisting anxiety disorder: social dysfunctioning, social integration, and personality features. Journal of Affective Disorders, 20, 151–157.CrossRefGoogle ScholarPubMed
Brown, G. W. & Davidson, S. (1978) Social class, psychiatric disorder of mother, and accidents to children. Lancet, i, 378–380.CrossRefGoogle Scholar
Casey, P. R., Tyrer, P. J. & Platt, S. (1985) The relationship between social functioning and psychiatric symptomatology in primary care. Social Psychiatry, 20, 5–9.Google Scholar
Cooper, B., Eastwood, M. R. & Sylph, J. (1970) Psychiatric morbidity and social adjustment in a general practice population. In Psychiatric Epidemiology (eds Hare, E. H. & Wing, J. K.), pp. 299–309. Oxford: Oxford University Press.Google Scholar
Coryell, W., Endicott, J., Andreasen, N. C., et al (1988) Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. American Journal of Psychiatry, 145, 293–300.Google Scholar
Curson, D. A., Barnes, T. R. E., Bamber, R. W., et al (1985) Long-term depot maintenance of chronic schizophrenic outpatients: the seven year follow-up of the MRC fluphenazine/ placebo trial. I. Course of illness, stability of diagnosis and the role of a special maintenance clinic. British Journal of Psychiatry, 146, 464–480.Google Scholar
DeJong, A., Giel, R., Soloff, C. J., et al (1985) Sodal disability and outcome in schizophrenic patients. British Journal of Psychiatry, 147, 631–636.Google Scholar
DeJong, A., Giel, R., Soloff, C. J., et al (1986) Relationship between symtomatology and sodal disability. Social Psychiatry, 21, 200–205.Google Scholar
DeJong, A., & Molenaar, I. W. (1987) An application of Mokken's model for stochastic, cumulative scaling in psychiatric research. Journal of Psychiatric Research, 21, 137–149.CrossRefGoogle ScholarPubMed
Dohrenwend, B. S., Cook, D. & Dohrenwend, B. P. (1981) Measurement of sodal functioning in community populations. In What is a Case? Problems of Definitions in Psychiatric Community Surveys (eds Wing, J. K., Bebbington, P. & Robins, L. N.), pp. 183–201. London: Grant McIntyre.Google Scholar
Dohrenwend, B. S., Dohrenwend, B. P., Link, B., et al (1983) Sodal functioning of psychiatric patients in contrast with community cases in the general population. Archives of General Psychiatry, 40, 1174–1182.Google Scholar
Finley-Jones, R., Brown, G. W., Duncan-Jones, P., et al (1980) Depression and anxiety in the community: replicating the diagnosis of care. Psychological Medicine, 10, 445–454.Google Scholar
Goldberg, D. (1972) The Detection of Psychiatric Illness by Questionnaire. London: Oxford University Press.Google Scholar
Grayson, D., Bridges, K., Duncan-Jones, P., et al (1987) The relationship between symptoms and diagnosis of minor psychiatric disorder in general practice. Psychological Medicine, 17, 933–942.CrossRefGoogle ScholarPubMed
Hecht, H. & Wittchen, H-U. (1988) The frequency of social dysfunction in a general population sample and in patients with mental disorders. Social Psychiatry and Psychiatric Epidemiology, 23, 17–29.CrossRefGoogle Scholar
Hecht, H., Zerssen, D. von, Krieg, C., et al (1989) Anxiety and depression: comorbidity, psychopathology, and social functioning. Comprehensive Psychiatry, 30, 420–433.Google Scholar
Hecht, H., Zerssen, , & Wittchen, H-U. (1990) Anxiety and depression in a community sample: the influence of comorbidity on sodal functioning. Journal of Affective Disorders, 18, 137–144.CrossRefGoogle Scholar
Hurry, J. & Sturt, E. (1981) Social performance in a population sample: Relations to psychiatric symptoms. In What is a Case? Problems of Definitions in Psychiatric Community Surveys (eds Wing, J. K., Bebbington, P. & Robins, L. N.), pp. 202–213. London: Grant McIntyre.Google Scholar
Kane, R. A., Kane, R. L. & Arnold, S. (1984) Measuring Social Functioning in Mental Health Studies: Concepts and Instruments. Washington, DC: National Institute of Mental Health.Google Scholar
Kedward, H. B. & Sylph, J. (1974) The social correlates of chronic neurotic disorder. Social Psychiatry, 9, 91–98.Google Scholar
Kraaijkamp, H. J. M. (1991) De Groningse Sociale Beperkingen School. (The Groningen Social Disabilities Schedule). Dissertation, Rijksuniversiteit Groningen.Google Scholar
Link, B. (1982) Mental patient status, work and income: an examination of the effect of a psychiatric label. American Sociological Review, 47, 202–215.Google Scholar
Mokken, R. J. & Lewis, C. (1982) A nonparametric approach to the analysis of dichotomous item responses. Applied Psychological Measurement, 6, 417–430.CrossRefGoogle Scholar
Murphy, J. M., Oliner, D. C., Sobol, A. M., et al (1986) Diagnosis and outcome: depression and anxiety in a general population. Psychological Medicine, 16, 117–126.Google Scholar
Ormel, J., Brink van den, W., Koeter, M. W. J., et al (1990) Recognition, management, and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychological Medicine, 20, 909–923.Google Scholar
Pai, S. & Kapur, R. L. (1982) Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunctioning and burden on the family of psychiatric inpatients. Psychological Medicine, 12, 651–658.CrossRefGoogle Scholar
Paykel, E. S. & Weissman, M. M. (1973) Social adjustment and depression. Archives of General Psychiatry, 28, 659–663.Google Scholar
Platt, S. (1985) Measuring the burden of psychiatric illness on the family: an evaluation of some rating scales. Psychological Medicine, 15, 383–393.Google Scholar
Platt, S., Hirsch, S. R. & Knights, A. C. (1981) Effects of brief hospitalization on psychiatric patients' behavior and social functioning. Acta Psychiatrica Scandinavica, 63, 117–128.Google Scholar
Schreurs, M. (1990) Over chronische psychiatric in Miden-Twente. Een epidemiologisch onderzoek in Midden-Twente naar het functioneren en de zorghehoefte van mensen met chronische psychiatrische problematiek. (Chronic psychiatric care in the region of Midden-Twente. An epidemiological study on social dysfunctioning and the need for care in patients with chronic psychiatric problems.) Hengelo: NFGV.Google Scholar
Serban, G. (1979) Mental status, functioning, and stress in chronic schizophrenic patients in community care. American Journal of Psychiatry, 136, 948–952.Google Scholar
Serban, G. & Gidynski, C. B. (1979) Relationship between cognitive defect, affect response and community adjustment in chronic schizophrenics. British Journal of Psychiatry, 134, 602–608.Google Scholar
Staal, J. L., Ormel, J., Schoenmacher, J. M., et al (1989) Het beloop van psychopathologie en sociale beperkingen. Een exploratieve studie onder psychiatrische polikliniek patienten. Tijdschrift voor Sociale Gezondheidszorg, 67, 1–4.Google Scholar
Sturt, E. (1981) Hierarchical patterns in the distribution of psychiatric symptoms. Psychological Medicine, 11, 783–794.Google Scholar
Sturt, E. & Wykes, E. (1987) Assessment schedules for chronic psychiatric patients. Psychological Medicine, 17, 485–493.Google Scholar
Tanner, J., Weissman, M. & Prusoff, B. (1975) Social adjustment and clinical relapse in depressed out-patients. Comprehensive Psychiatry, 16, 547–556.CrossRefGoogle Scholar
Tholen, A. J. (1991) Patient of Bewoner? (Patient or resident?) Dissertation. Rijksuniversiteit Groningen.Google Scholar
van Valkenburg, C., Akiskal, H. S., Puzantian, V., et al (1984) Anxious depression: clinical, family history, and naturalistic outcome - comparisons with panic and major depressive disorders. Journal of Affective Disorders, 6, 67–82.Google Scholar
von Korff, M., Shapiro, S., Burke, T. D., et al (1987) Anxiety and depression in a primary care clinic. Comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessment. Archives of General Psychiatry, 44, 152–156.Google Scholar
von Korff, M., Katon, W., Ormel, J., et al (1992) Disability and depression among medical patients: a longitudinal analysis. Archives of General Psychiatry, 49, 91–100.Google Scholar
Waryszak, Z. (1982) Symptomatology and social functioning of psychiatric patients before and after hospitalization. Social Psychiatry, 17, 149–154.Google Scholar
Weissman, M. M. (1975) The assessment of social adjustment. Archives of General Psychiatry, 32, 357–365.CrossRefGoogle ScholarPubMed
Weissman, M. M., Prusoff, B. A., Thompson, W. D., et al (1978) Social adjustment by self report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease, 166, 317–326.Google Scholar
Wells, K. B., Stewart, A., Hays, R. D., et al (1989) The functioning and well-being of depressed patients. Results from the medical outcome study. Journal of the American Medical Association, 262, 914–919.Google Scholar
Wiersma, D., DeJong, A. & Ormel, J. (1988) The Groningen Social Disability Schedule: development, relationship with ICIDH, and psychometric properties. International Journal of Rehabilitation Research, 11, 213–224.Google Scholar
Wiersma, D., DeJong, A., Kraaijkamp, H. J. M., et al (1990) GSDS-II. The Groningen Social Disability Schedule. Second Version: An Interview Schedule to Assess Disabilities in Social Role Functioning: Manual. Groningen: Rijksuniversiteit Groningen, Department of Social Psychiatry.Google Scholar
Wilmink, F. W. (1989) Patient, Physician, Psychiatrist: Assessment of Mental Health Problems in Primary Care. PhD thesis, University of Groningen, The Netherlands.Google Scholar
Wing, J. K. (1989) The measurement of “social disablement”. The MRC social behavior and social role performance schedules. Social Psychiatry and Psychiatric Epidemiology, 24, 173–178.Google Scholar
Wing, J. K., Cooper, J. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Wing, J. K. & Sturt, E. (1978) The PSE-ID-CATEGO System - A Supplementary Manual. London: Institute of Psychiatry.Google Scholar
Winokur, G., Clayton, P. J. & Reich, J. (1969) Manic Depressive Illness. St. Louis: Mosby.Google Scholar
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