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Outcome and Impact of Mental Disorders in Primary Care at 5 years

From the Department of Medicine (J.L.J.), Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed Army Medical Center, Washington DC; Department of Medicine (M.P.), General Medicine Division, Fort Stewart, Georgia; Department of Medicine (K.K.), Regenstrief Institute for Health Care, Indianapolis University School of Medicine, Indianapolis, IN.

Address correspondence and reprint requests to Jeffrey L. Jackson, Department of Medicine (EDP), Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.

Objective: To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care.

Methods: 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.

Results: 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%).

Conclusions: 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.

Key Words: depression • anxiety • mental disorders • outcomes

Abbreviations: NOS = not otherwise specified.

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