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Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study.
J Psychosom Res. 2009 Sep; 67(3):189-97.JP

Abstract

OBJECTIVE

Depression, anxiety, and somatization are the most frequently observed mental disorders in primary health care. Our main objective was to draw on the often neglected general practitioners' (GPs) perspective to investigate what characterizes these three common mental diagnoses with regard to creating more suitable categories in the DSM-V and ICD-11.

METHODS

We collected independent data from 1751 primary care patients (participation rate=77%) and their 32 treating GPs in Germany. Patients filled out validated patient self-report measures for depression (PHQ-9), somatic symptom severity (PHQ-15), and illness anxiety (Whiteley-7), and questions regarding coping and attribution of illness. GPs' clinical diagnoses and associated features were assessed.

RESULTS

Patients diagnosed by their GPs with depression, anxiety, and/or somatoform disorders were significantly older, less educated, and more often female than the reference group not diagnosed with a mental disorder. They had visited the GP more often, had a longer duration of symptoms, and were more often under social or financial stress. Among the mental disorders diagnosed by the GPs, depression (OR=4.4; 95% CI=2.6 to 7.5) and comorbidity of somatoform, depressive, and anxiety disorders (OR=9.5; 95% CI=4.6 to 19.4) were associated with the largest degrees of impairment compared to the reference group. Patients diagnosed as having a somatoform/functional disorder only had mildly elevated impairment on all dimensions (OR=2.0; 95% CI=1.4 to 2.7). Similar results were found for the physicians' attribution of psychosocial factors for cause and maintenance of the disease, difficult patient-doctor relationship, and self-assessed mental disorder.

CONCLUSION

In order to make the DSM-V and ICD-11 more suitable for primary care, we propose providing appropriate diagnostic categories for (1) the many mild forms of mental syndromes typically seen in primary care; and (2) the severe forms of comorbidity between somatoform, depressive, and/or anxiety disorder, e.g., with a dimensional approach.

Authors+Show Affiliations

Department of Psychosomatic and General Clinical Medicine, Medical Hospital, University of Heidelberg, Heidelberg, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19686874

Citation

Hanel, Gertraud, et al. "Depression, Anxiety, and Somatoform Disorders: Vague or Distinct Categories in Primary Care? Results From a Large Cross-sectional Study." Journal of Psychosomatic Research, vol. 67, no. 3, 2009, pp. 189-97.
Hanel G, Henningsen P, Herzog W, et al. Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res. 2009;67(3):189-97.
Hanel, G., Henningsen, P., Herzog, W., Sauer, N., Schaefert, R., Szecsenyi, J., & Löwe, B. (2009). Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. Journal of Psychosomatic Research, 67(3), 189-97. https://doi.org/10.1016/j.jpsychores.2009.04.013
Hanel G, et al. Depression, Anxiety, and Somatoform Disorders: Vague or Distinct Categories in Primary Care? Results From a Large Cross-sectional Study. J Psychosom Res. 2009;67(3):189-97. PubMed PMID: 19686874.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. AU - Hanel,Gertraud, AU - Henningsen,Peter, AU - Herzog,Wolfgang, AU - Sauer,Nina, AU - Schaefert,Rainer, AU - Szecsenyi,Joachim, AU - Löwe,Bernd, Y1 - 2009/06/27/ PY - 2008/06/10/received PY - 2009/04/26/revised PY - 2009/04/28/accepted PY - 2009/8/19/entrez PY - 2009/8/19/pubmed PY - 2009/11/3/medline SP - 189 EP - 97 JF - Journal of psychosomatic research JO - J Psychosom Res VL - 67 IS - 3 N2 - OBJECTIVE: Depression, anxiety, and somatization are the most frequently observed mental disorders in primary health care. Our main objective was to draw on the often neglected general practitioners' (GPs) perspective to investigate what characterizes these three common mental diagnoses with regard to creating more suitable categories in the DSM-V and ICD-11. METHODS: We collected independent data from 1751 primary care patients (participation rate=77%) and their 32 treating GPs in Germany. Patients filled out validated patient self-report measures for depression (PHQ-9), somatic symptom severity (PHQ-15), and illness anxiety (Whiteley-7), and questions regarding coping and attribution of illness. GPs' clinical diagnoses and associated features were assessed. RESULTS: Patients diagnosed by their GPs with depression, anxiety, and/or somatoform disorders were significantly older, less educated, and more often female than the reference group not diagnosed with a mental disorder. They had visited the GP more often, had a longer duration of symptoms, and were more often under social or financial stress. Among the mental disorders diagnosed by the GPs, depression (OR=4.4; 95% CI=2.6 to 7.5) and comorbidity of somatoform, depressive, and anxiety disorders (OR=9.5; 95% CI=4.6 to 19.4) were associated with the largest degrees of impairment compared to the reference group. Patients diagnosed as having a somatoform/functional disorder only had mildly elevated impairment on all dimensions (OR=2.0; 95% CI=1.4 to 2.7). Similar results were found for the physicians' attribution of psychosocial factors for cause and maintenance of the disease, difficult patient-doctor relationship, and self-assessed mental disorder. CONCLUSION: In order to make the DSM-V and ICD-11 more suitable for primary care, we propose providing appropriate diagnostic categories for (1) the many mild forms of mental syndromes typically seen in primary care; and (2) the severe forms of comorbidity between somatoform, depressive, and/or anxiety disorder, e.g., with a dimensional approach. SN - 1879-1360 UR - https://www.unboundmedicine.com/medline/citation/19686874/Depression_anxiety_and_somatoform_disorders:_vague_or_distinct_categories_in_primary_care_Results_from_a_large_cross_sectional_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3999(09)00179-2 DB - PRIME DP - Unbound Medicine ER -