Giulia Bisoffi

Validity and test-retest reliability of the italian version of the 12-item General Health Questionnaire in general practice: A comparison between three scoring methods

Validity coefficients of the 12-item General Health Questionnaire (GHQ-12) were established against the Clinical Interview Schedule (CIS) in a sample of primary care patients. Comparison between the conventional scoring method, Likert scoring, and the revised scoring procedure proposed by Goodchild and Duncan-Jones (C-GHQ) showed very similar screening properties: sensitivity ranged between 71% and 75%, and specificity ranged between 73% and 76%. The test-retest reliability of the GHQ-12, as expressed by Pearsons r and intraclass correlation coefficient, was satisfactory irrespective of the scoring method used, even though mean scores on the second test tended to be significantly lower than the corresponding mean scores on the first test. The C-GHQ by itself did not result in an improvement of the screening capacity of the GHQ; however, the best results were obtained by combining the conventional scoring and C-GHQ case criteria.

Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics

BACKGROUND The authors analyse the prevalence of subthreshold psychiatric disorders in primary care and their association with the patients health perception, disability in daily activities and psychological distress. METHODS Five-hundred and fifty-four primary care patients who completed a two-phase study were administered the Composite International Interview for Primary Health Care (CIDI-PHC) and other self-report measures. Unweighted and weighted prevalence estimates were obtained for ICD-10 formal disorders and subthreshold disorders defined by specific operational criteria. The impact of subthreshold disorders on health perception, disability in daily activities and psychological distress was analysed by using multiple regression models. RESULTS The overall prevalence of subthreshold disorders exceeded that of ICD-10 disorders. Subjects with subthreshold disorders reported levels of psychological distress, disability in daily activities and perceived health comparable to those of patients with full-fledged ICD-10 disorders. When we analysed the associated health characteristics of individual subthreshold disorders, we found that each subthreshold disorder was characterized by poorer health perception, after adjusting for comorbidity with defined disorders and physical illness, age and gender. Disability in daily activities was increased in individuals with subthreshold depression and agoraphobia. LIMITATIONS The number of cases with subthreshold panic and somatization is very small and does not allow one to draw any definite conclusions on their associated characteristics. To reduce non-response bias related to sampling design and refusals, adjusted sampling weights were computed. Since the study design in Bologna and Verona was different and Bologna patients scoring <4 on the General Health Questionnaire were not interviewed, individuals with minimal distress come from the Verona sample alone. CONCLUSIONS Because of the prevalence and associated characteristics of subthreshold disorders, primary care physicians should attach adequate importance to the patients perceived poor health, distress and inability to fulfil daily tasks. The clinical relevance of subthreshold disorders has also potential implications for ongoing revisions of classification systems.

Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5

Objective: Investigate the relationship of various domains of quality of life (QoL) with socio‐demographics, clinical and social characteristics, service use and satisfaction in a representative sample of patients in contact with the South‐Verona community mental health service.

Collecting psychiatric resources utilisation data to calculate costs of care: a comparison between a service receipt interview and a case register.

Background: Economic assessment of interventions and policies is becoming increasingly common, in large measure because of the growing emphasis on cost containment within health care. Comprehensive and reliable outcome and cost data are required to advise policy makers and clinicians as to the best use of their limited resources. The process of costing can be broken down into three connected tasks: the collection of service receipt or utilisation data relative to individual clients or patients over a defined period; the costing of each of the services used; and the combination of these two sets of information in order to calculate individual costs. The aim of this study was to compare two methodologies of collecting data on individual service use – a customised interview schedule, ICAP, and the psychiatric case register (PCR) – and to calculate costs, testing the extent of agreement between them. Method: The agreement between the ICAP and the PCR costs measurement was evaluated using the concordance correlation coefficient ρc. From all patients (n = 543) who had atleast one contact with a psychiatrist or a psychologist during the period October–December 1996, 339 patients were interviewed using the ICAP. The overall number of patients in contact with the South-Verona CPS in the same period was 630. Results: The agreement between the two sources was very different for each diagnostic group and each professional category. However, the overall agreement on total costs was satisfactory (ρc < 0.95). This result is probably due to the effect of the good agreement observed on more costly services: inpatient care and sheltered accommodation. Conclusion: The results suggested practical implications for the use of the service receipt interview: interviewers should be trained in order to avoid misinterpretation of the definitions given in the form; the sources of information should be clearly defined to tease out all the items of services provided for the users; the professionals (i.e. psychiatrists) could influence the reliability of data collection by underestimating services provided by different professionals (nurses, social workers, etc.). The findings confirm that it is possible to use this approach when the aim is to estimate the whole cost of the services; however, the importance of adopting adequate procedures for analysing the complexity of cost components should be pointed out. Only a trained interviewer who thoroughly knows each component of the health and social services provided could guarantee an accurate data collection.

Identification of depression by medical and surgical general hospital physicians

Little information is available about identification of mental distress by general hospital physicians (GHPs). We compared, among patients admitted in a General Hospital, depressed patients with patients identified as depressed by the GHPs. A random sample of 1,039 patients were screened with the 12-item General Health Questionnaire. Afterwards, all high scorers and a probability sample of low scorers were interviewed with a variety of measures, including the Composite International Diagnostic Interview-Primary Care version (CIDI-PHC). GHPs recorded the presence of depression on a Physician Encounter Form. Patients were more likely to have depression detected on medical than surgical wards. Of the 195 patients who had a depression, the GHPs assessed 32.5% as depressed. A number of factors associated with CIDI diagnoses were not significantly associated with being identified by the GHPs - female gender, two or more life events in the previous year, and a previous history of depression. The identification by the GHPs was associated with a higher probability of contacts with medical professionals and of antidepressant drug prescriptions during the year which followed the first interview.

Frequency of contact with community-based psychiatric services and the lunar cycle: a 10-year case-register study.

The relationship between the lunar cycle and the frequency of contact with community-based psychiatric services was assessed using the South Verona Psychiatric Case Register data. For each day of the study period (January 1982–December 1991) we recorded the number of contacts made by South Verona residents with psychiatric services and the corresponding day of the lunar cycle. First, the synodic month was divided into four interval phases (usually called new moon, first quarter, full moon and third quarter), and interphase differences in the mean number of contacts were tested using one-way analysis of variance. Second, the null hypothesis of no relationship between the lunar cycle and the frequency of contact with psychiatric services was tested against the alternative hypothesis of a sinusoidal distribution according to the lunar phase. The average number of contacts with psychiatric services on each day of the lunar cycle over the 10-year period was obtained and a sine-wave curve was fitted to the data. Both for total and drop-in contacts, no significant differences in mean number of contacts were found between the four interval phases of the synodic month (new moon, first quarter, full moon and third quarter). Similarly, no significant results were found by setting the expected surge in consultations at 1–3 days after the full moon and the period of the sine-wave curve equal to 30 days. When the period of the sine-wave curve was allowed to vary in order to fit the data best, none of the statistical tests reached the level of significance required to dismiss the possibility of false-positive results. These findings did not support the theory that a relationship exists between the lunar cycle and the frequency of contact with community-based psychiatric services.

Are social deprivation and psychiatric service utilisation associated in neurotic disorders

SummaryMeasures of service utilisation from the South Verona psychiatric case register in North-East Italy for the years 1983, 1986 and 1989 were used to identify possible associations with sociodemographic variables from the 1981 census for neurotic disorders. There were no consistent patterns of associations between local social and demographic predictors and rates of psychiatric service utilisation. This contrasts markedly with the associations found previously in England (for all psychiatric admissions) and in Italy (for various measures of service utilisation concerning contacts both in and outside hospital for schizophrenic as well as for all psychiatric patients) where social deprivation factors proved to be strong predictors of service use.