Ingrid A. Arnold

Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care.

BackgroundBetter management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively.MethodsIn eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP).ResultsIn the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect.ConclusionHealth care planning should focus on the recognition and treatment of somatoform as well as affective disorders.

Medically Unexplained Physical Symptoms in Primary Care: A Controlled Study on the Effectiveness of Cognitive-Behavioral Treatment by the Family Physician

Background Disabling medically unexplained physical symptoms occur in 16% of all patients in primary care. Objective The aim of this study was to assess the effectiveness of a cognitivebehavioral intervention by the family physician. Method In a controlled design with detailed information on patient selection, 6,409 patients were screened on somatoform disorder, and 65 participants were allocated to care-as-usual or the experimental condition. Results After 6 and 12 months, the cognitive-behavioral intervention by trained family physicians was not more effective than care-as-usual. Conclusion Possibly, the intensity of treatment was insufficient for the severe and persistent symptoms that were encountered in primary care.

The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care

ObjectiveTo examine the contribution of a mental and physical symptom count to the detection of single or comorbid anxiety, depressive and somatoform disorders.MethodIn primary care 1,046 consulting patients completed the Hospital Anxiety and Depression Scale (HADS) and the Physical Symptom Checklist (PSC-51). In a stratified sample of 473 patients DSM-IV psychiatric disorders were assessed using the WHO-SCAN interview. The diagnostic value of the HADS total score and the PSC-51 symptom count was examined with ROC-analyses.ResultsThe discriminative power of PSC-51 and HADS was highest for patients with both a somatoform disorder and an anxiety or depressive disorder, with an AUC of 0.86 (95% CI: 0.81–0.91) and 0.91 (95% CI: 0.87–0.94) respectively. Using both symptom counts together did not increase the diagnostic value for the detection of the psychiatric disorders.ConclusionBoth symptom counts preferentially detected patients with comorbid disorders. When interpreting diagnostic values of screening questionnaires one should keep in mind that the validity of these values can be dependent of the presence of comorbid disorders.