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The course of psychiatric illness in primary care patients

A 1-year follow-up

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Abstract

The aim of the study was to investigate the course of psychiatric illness in primary care patients. A 12-month follow-up study was conducted using a subsample of 93 patients, assessed by interviewing with the aid of the Present State Examination (PSE), from an original cohort of 388 primary care patients in a Swedish health district. The relationships of the course of illness to psychosocial stress, perceived health, utilization of care and health insurance, and patient satisfaction with primary health care services were investigated. The results showed that at index contact. 32.1 % of the follow-up sample were psychiatric cases in need of treatment according to the screening procedure with the Hopkins Symptom Check List (HSCL-25). The continuing cases constituted 19 % of the total follow-up sample, remitting cases, 13.1 %, new cases, 4.8 % and non-cases, 63.1 %. Continuing cases had a significantly higher utilization of ambulant care during follow-up. They also had 3 times more days of sick-leave. Poor perceived health at index contact, measured using the Nottingham Health Profile (NHP), predicted that the patient became a continuing case during follow-up. Continuing cases, to a greater extent, showed psychosocial stress concerning unemployment, private economy and loneliness/social isolation. Continuing cases also showed a lower satisfaction with primary health care services in all areas measured.

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References

  1. Goldberg D, Huxley P (1980) Mental illness in the community. Pathways to psychiatric care. Tavistock publications, London

    Google Scholar 

  2. Regier DA, Goldberg ID, Taube CA (1978) The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry 38:685–693

    Google Scholar 

  3. Shapiro S, Skinner EA, Kramer M, Steinwachs S, Regier DA (1985) Measuring need for mental health services in a general population. Med Care 23:1033–1043

    Google Scholar 

  4. Johnston A, Goldberg DP (1976) Psychiatric screening in general practice. A controlled trial. Lancet I:605–608

    Google Scholar 

  5. Barrett JE, Barrett JA, Oxman TE et al (1988) The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry 45:1100–1106

    Google Scholar 

  6. Goldberg D, Bridges K (1987) Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire. J R Coll Gen Pract 37:15–18

    Google Scholar 

  7. Skuse D, Williams P (1984) Screening for psychiatric disorder in general practice. Psychol Med 14:365–377

    Google Scholar 

  8. Cooper B, Fry J, Kalt GW (1969) A longitudinal study of psychiatric morbidity in a general practice population. Br J Prev Soc Med 23:210–217

    Google Scholar 

  9. Shepherd M, Cooper B, Brown AC, Kalton GW (1966) Psychiatric illness in general practice. Oxford University Press, London

    Google Scholar 

  10. Mann AH, Jenkins R, Belsey E (1981) The twelve-month outcome of patients with neurotic illness in general practice. Psychol Med 11:535–550

    Google Scholar 

  11. Kessler LG, Cleary PD, Burke JD (1985) Psychiatric disorders in primary care. Results of a follow-up study. Arch Gen Psychiatry 42:583–587

    Google Scholar 

  12. Goldberg DP, Blackwell P (1970) Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J 2:439–443

    Google Scholar 

  13. Marks JN, Goldberg DP, Hillier VF (1979) Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med 9:337–353

    Google Scholar 

  14. Boardman AP (1987) The General Health Questionnaire and the detection of emotional disorder by general practitioners. A replicated study. Br J Psychiatry 151:373–381

    Google Scholar 

  15. Novack DA (1981) Physical aspects of illness. South Med J 74:1376–1381

    Google Scholar 

  16. Nettelbladt P, Hansson L, Borgquist L (1993) Mental health problems in occupational health care. A pilot study. J Occup Med 35:53–56

    Google Scholar 

  17. Marino S, Bellantuono C, Tansella M (1990) Psychiatric morbidity in general practice in Italy — a point prevalence survey in a defined geographical area. Soc Psychiatry Psychiatr Epidemiol 25:67–72

    Google Scholar 

  18. Verhaak P, Tijhuis M (1992) Psychosocial problems in primary care: some results from the Dutch national study of morbidity and interventions in general practice. Soc Sci Med 35:105–110

    Google Scholar 

  19. Larsen DL, Attkisson CC, Hargreaves WA, Nquyen TD (1979) Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann 2:197–207

    Google Scholar 

  20. Hansson L (1989) The quality of outpatient psychiatric care. A survey of patient satisfaction in a sectorised care organisation. Scand J Caring Sci 3:71–81

    Google Scholar 

  21. Krakau I (1991) Satisfaction with health care in a Swedish primary care district. A ten year's perspective. Scand J Prim Health Care 9:59–64

    Google Scholar 

  22. Hansson L, Nettelbladt P, Borgquist L, Nordström G (1994) Screening for psychiatric illness in primary care. A cross sectional study in a Swedish health district. Soc Psychiatry Psychiatr Epidemiol (in press)

  23. Borgquist L, Hansson L, Nettelbladt P, Nordström G, Lindelöw G (1993) Perceived health and high-consumers of care. A study of mental health problems in a Swedish primary health care district. Psychol Med 23:763–770

    Google Scholar 

  24. Nettelbladt P, Hansson L, Stefansson C-G, Borgquist L, Nordström G (1993) Test characteristics of the Hopkins Symptom Check List (HSCL-25) in Sweden, using Present State Examination (PSE) as a caseness criterion. Soc Psychiatry Psychiatr Epidemiol 28:130–133

    Google Scholar 

  25. Derogatis LR, Lipman RS, Rickels K et al (1974) The Hopkins Symptom Check List. A self report symptom inventory. Behav Sci 19:1–15

    Google Scholar 

  26. Dencker SJ, Fasth BG (1986) Combination of psychotherapy and drugs in the treatment of neurosis. A controlled comparison of bromazepam and thioridazine. Acta Psychiatr Scand 74:569–575

    Google Scholar 

  27. Hansson L, Berglund M, Öhman R (1987) Individualized measures versus standardized rating scales in evaluation of inhospital psychiatric treatment. Acta Psychiatr Scand 75:275–282

    Google Scholar 

  28. Hansson L, Sjöstedt M, Nylander B, Bliding G (1992) Education of relatives of schizophrenics. A study of the effects on the living conditions of relatives. Nord J Psychiatry 46:269–275

    Google Scholar 

  29. Goldberg DP, Rickels K, Downing R et al (1978) A comparison of two psychiatric screening tests. Br J Psychiatry 129:61–67

    Google Scholar 

  30. Glass RM, Allan AT, Uhlenhuth EH et al (1978) Psychiatric screening in a medical clinic. An evaluation of a self-report inventory. Arch Gen Psychiatry 35:1189–1195

    Google Scholar 

  31. Goldberg DP (1972) The detection of psychiatric illness by questionnaire. Oxford University Press, London

    Google Scholar 

  32. Sörensen T (1987) Mental helse i Nordkyst (Mental health in Nordkyst). Bodö, Norway

  33. Stefansson CG, Svensson C (1993) Identified and unidentified mental illness in primary health care — social characteristics medical measures and total care utilization during one year. Scand J Prim Health Care (in press)

  34. Hunt SM, Wiklund I (1987) Cross cultural variation in the weighting of health statements: a comparison of English and Swedish valuations. Health Policy 8:227–235

    Google Scholar 

  35. Sjöberg L, Svensson E, Persson LO (1979) The measurement of mood. Scand J Psychol 20:1–18

    Google Scholar 

  36. International classification of diseases, 9th revision (ICD-9) (1986) Stockholm

  37. Wing JK, Cooper JE, Sartorius N (1974) The description and classification of psychiatric symptoms: an instruction manual for the PSE and Catego system. Cambridge University Press, London

    Google Scholar 

  38. Siegel S (1956) Non-parametric statistics for the behavioural sciences. McGraw-Hill, New York

    Google Scholar 

  39. Statistical packages for the social sciences, SPSSPC+V3.1 (1988) Spss Inc, Chicago

  40. Ormel J, van den Brink W, Koeter MWJ, Giel R, van der Meer K, van de Willige G, Wilmink FW (1990) Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med 20:909–923

    Google Scholar 

  41. Hankin JR, Oktay JS (1979) Mental disorder and primary medical care. An analytical review of the literature. US Dept of Health, Education and Welfare publication (ADM) 78-661, series D, no 5. National Institute of Mental Health, Washington DC

    Google Scholar 

  42. Hansson L, Nettelbladt P, Borgquist L (1990) Patterns of care in patients utilizing both primary health care and psychiatric care in a Swedish health district. Scand J Prim Health Care 8:173–178

    Google Scholar 

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Author notes

  1. L. Hansson

    Present address: Department of Psychiatry, University of Lund, S-22185, Lund, Sweden

Authors and Affiliations

  1. Department of Psychiatry, University of Lund, S-22185, Lund, Sweden

    P. Nettelbladt & G. Nordström

  2. Department of Community Health Sciences, University of Lund, Lund, Sweden

    L. Borgquist

Authors
  1. L. Hansson
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  2. L. Borgquist
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  3. P. Nettelbladt
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  4. G. Nordström
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Hansson, L., Borgquist, L., Nettelbladt, P. et al. The course of psychiatric illness in primary care patients. Soc Psychiatry Psychiatr Epidemiol 29, 1–7 (1994). https://doi.org/10.1007/BF00796442

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