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Am J Psychiatry 1996; 153:636-644
Copyright © 1996 by American Psychiatric Association
Occurrence, recognition, and outcome of psychological disorders in primary care
BG Tiemens, J Ormel and GE Simon
Department of Social Psychiatry, University of Groningen, The Netherlands.
OBJECTIVE: The authors' goal was to cross-validate the earlier finding of
the Groningen Primary Care Study that recognition of psychological
disorders was associated with better patient outcomes. METHOD: The 12- item
General Health Questionnaire was used to screen 1,271 consecutive primary
care patients. A stratified sample of 340 of these patients participated in
the second-stage baseline series of interviews, which included the
Composite International Diagnostic Interview, the occupational role section
of the Social Disability Schedule, the 28- item General Health
Questionnaire, and the SCL-90. Three months later 209 of the patients
completed the 28-item General Health Questionnaire and the SCL-90, and 12
months later 213 of the patients completed the second-stage baseline series
of interviews. The study was carried out in six primary care practices (11
general practitioners) in the northern part of The Netherlands. RESULTS:
Recognition of psychological disorders was associated with higher initial
severity of psychopathology and occupational disability and with a
psychological reason for the medical encounter. Recognition rates were
higher for anxiety than for depression. Patients whose psychological
disorders were recognized did not have better outcomes than those whose
psychological disorders were not recognized. CONCLUSIONS: Recognition of
psychological disorders was not associated with better outcome. Recognition
is a necessary but not a sufficient condition for delivery of treatment
according to clinical guidelines. Increasing recognition is likely to
improve outcomes only if general practitioners have the skills and
resources to deliver adequate interventions.
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