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An International Study of the Effect of Physical Ill Health on Psychiatric Recovery in Primary Care

From the Department of Psychiatry, Dalhousie University, Halifax, Canada.

Address correspondence and reprint requests to Stephen Randolph Kisely, MD, Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Room 425, Centre for Clinical Research, 5790 University Ave., Halifax, NS B3H 1V7, Canada. E-mail: Stephen.Kisely{at}cdha.nshealth.ca.

Objective: The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care.

Methods: A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients’ family practitioners.

Results: Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability.

Conclusion: Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention.

Key Words: medically explained symptoms • psychiatric recovery • primary care

Abbreviations: PPGHC = Psychological Problems in General Health Care; MES = medically explained symptoms; MUS = medically unexplained symptoms; GHQ-12 = 12-item General Health Questionnaire; CIDI-PHC = Composite International Diagnostic Interview–Primary Health Care; GSDS = Groningen Social Disability Schedule; FP = family physician; SPHERE = Somatic and Psychological Health Report.

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