Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 39, Issue 12, pp 962–966 | Cite as

Detection of somatization and depression in primary care in Saudi Arabia

  • Susan M. BeckerEmail author
ORIGINAL PAPER

Abstract

Background

Studies have shown a high worldwide prevalence of mental disorders in primary care. Many patients present with unexplained physical symptoms rather than psychological complaints, resulting in an excess number of costly clinical investigations. This study investigates the ability of primary care physicians to correctly detect and diagnose somatization and depression in Saudi Arabian patients.

Methods

In all 431 primary care patients in Riyadh Saudi Arabia were screened for somatization and depression using the Patient Health Questionnaire (PHQ). Primary care physicians independently assessed these same patients while blinded to the results of the PHQ. Agreement between physician observations and the screening instrument was examined.

Results

Using the PHQ as the standard of comparison for measuring the detection rates of Saudi physicians, the agreement between and the PHQ and physician assessments was κ=0.40 for depression (0.45 females, 0.31 males) and κ=0.27 for somatization (0.36 females, 0.12 males). Physicians assessed higher rates of somatization than indicated by the screening instrument and demonstrated poor diagnostic agreement on somatization and depression, particularly for male patients.

Conclusions

Saudi primary care physicians have awareness of psychiatric disorders, but their diagnostic skills are poor for somatization and depression. Psychiatric training should be supported in the continuing education of primary care physicians and patients should be encouraged to report psychological complaints to family physicians. A simple screening instrument for identifying mental disorders in developing countries is a valuable tool for assessment in primary care.

Key words

somatization depression mental disorders primary care Patient Health Questionnaire Saudi Arabia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Escobar JI, Burnam A (1987) Somatization in the community. Arch Gen Psychiatry 44:713–718PubMedGoogle Scholar
  2. 2.
    Goldberg D (1995) Epidemiology of Mental Disorders in Primary Care. Epidemiologic Rev 17:182–188Google Scholar
  3. 3.
    Escobar JI, Gara M, Silver RC (1998) Somatization Disorder in Primary Care. Br J Psychiatry 173:262–266PubMedGoogle Scholar
  4. 4.
    Katon W (1998) Medically unexplained symptoms in Primary Care. J Clin Psychiatry 59:15–21Google Scholar
  5. 5.
    Gureje O, Simon G (1997) Somatiztion in Cross Cultural Perspective. A World Health Organization Study in Primary Care. Am J Psychiatry 154:989–995PubMedGoogle Scholar
  6. 6.
    De Gucht V, Fischler B (2002) Somatization: A Critical Review of Conceptual and Methodological Issues. Psychosomatics 431:1–9Google Scholar
  7. 7.
    Al Faris E, Al Hamid A (1995) Hidden and Conspicuous Psychiatric Morbidity in Saudi Primary Health Care. Arab J Psychiatry 6(2):162–175Google Scholar
  8. 8.
    Becker S, Al Zaid K, Al Faris E (2002) Screening for Somatization and Depression in Saudi Arabia. Int J Psychiatry Med 323:271–283Google Scholar
  9. 9.
    Al Faris E, Towards A (1998) Campaign to Combat psychological Disorders in the Community. Ann Saudi Med 83:205–207Google Scholar
  10. 10.
    Racy J (1980) Somatization and Saudi Women. Br J Psychiatry 137:175–180Google Scholar
  11. 11.
    Spitzer R, Kroenke K, Williams J (1999) Validation and Utility of a Self Report Version of the PRIME MD. The PHQ Primary Care Study. J Am Med Assoc 282(18):1737–1744Google Scholar
  12. 12.
    Narrow W, Rae D (2002) Revised Prevalence Estimates of Mental Disorders in the United States. Arch Gen Psychiatry 52:115–123Google Scholar
  13. 13.
    American Psychiatric Association (2000) Diagnostic and Statistical Manual IV-TR. Washington D. C.Google Scholar
  14. 14.
    Rief W, Joerg H (1996) The classification of Multiple Somatoform Symptoms. J Nerv Ment Dis 184:680–687PubMedGoogle Scholar
  15. 15.
    Lipowski ZL (1988) Somatization: The Concept and Its Clinical Application. Am J Psychiatry 145:1358–1368PubMedGoogle Scholar
  16. 16.
    Lipowski Zl (1990) Somatization and Depression. Psychosomatics 31:13–21PubMedGoogle Scholar
  17. 17.
    Escobar J, Rubio-Saipec M (1989) Somatic Symptom Index. A New and Abridged Somatization Construct. J Nerv Ment Dis 177(3):140–146PubMedGoogle Scholar
  18. 18.
    Kronke K, Spritzer RL, deGruy F, Hahn S, Linzer M, Williams J (1997) Multisomatoform Disorder.An Alternative to Undifferentiated somatoform Disorder for the Patient in Primary Care. Arch Gen Psychiatry 544:352–356Google Scholar
  19. 19.
    Spitzer R, Williams J, Kroenke K (1994) Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care: The PRIME MD 1000 Study. J Am Med Assoc 272:1749–1756Google Scholar
  20. 20.
    Cohen J (1996) Coefficient of agreement for nominal scales. Educational and Psychological Measurements 20:37–46Google Scholar
  21. 21.
    Mezzich JE, Jorge M, Salloum I (1994) Psychiatric Epidemiology: Assessment Concepts and Methods. Johns Hopkins University Press, Baltimore MarylandGoogle Scholar
  22. 22.
    Spitzer R, Williams J (2000) Validity and Utility of PHQ in Assessment of 3000 OB-GYN Patients. Am J Obstetr Gynecol 183(3):759–769Google Scholar
  23. 23.
    Kroenke K, Spitzer R (1994) Physical Symptoms in Primary Care. Archives of Family Medicine (3):774–779Google Scholar
  24. 24.
    Bass C, Peveler R, House A (2001) Somatoform Disorders: Severe Psychiatric Illnesses Neglected by Psychiatrists. Br J Psychiatry 179:11–14PubMedGoogle Scholar
  25. 25.
    Ormel J, Von Korff,Ustun TB (1994) Common Mental Disorders and Disability Across Cultures. J Am Med Assoc 272:1741–1748Google Scholar
  26. 26.
    Gilbody S, House A, Sheldon S (2001) Routinely Administered Questionnaires for Depression and Anxiety: A Systematic Review. Br Med J 322:406–409Google Scholar
  27. 27.
    Fink P, Sorensen L, Engberg N (1999) Somatization in Primary Care. Prevalence, Health Care Utiliztion, and General Practitioner Recognition. Psychosomatics 40:330–338PubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  1. 1.Dept. of Community and Family Health, College of Public HealthUniversity of South FloridaTampa (FL)USA

Personalised recommendations