Outcome and impact of mental disorders in primary care at 5 years

• Published in: Psychosomatic medicine Vol. 69; no. 3; p. 270
• Main Authors: Jackson, Jeffrey L, Passamonti, Mark, Kroenke, Kurt
• Format: Journal Article
• Language: English
• Published: United States 01.04.2007
• Subjects: Adult; Aged; Anxiety - epidemiology; Anxiety Disorders - diagnosis; Anxiety Disorders - epidemiology; Cohort Studies; Comorbidity; Depression - epidemiology; Depressive Disorder - diagnosis; Depressive Disorder - epidemiology; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Disease Progression; District of Columbia - epidemiology; Ethnic Groups - statistics & numerical data; Female; Follow-Up Studies; Hospitals, Military - statistics & numerical data; Humans; Male; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Middle Aged; Mood Disorders - diagnosis; Mood Disorders - epidemiology; Outcome Assessment (Health Care); Outpatient Clinics, Hospital - statistics & numerical data; Outpatients - statistics & numerical data; Panic Disorder - diagnosis; Panic Disorder - epidemiology; Patient Satisfaction; Prevalence; Primary Health Care - statistics & numerical data; Prospective Studies; Surveys and Questionnaires; District of Columbia
• ISSN: 1534-7796
• DOI: 10.1097/psy.0b013e3180314b59

To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%). Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.