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Lo studio internazionale multicentrico dell'Organizzazione Mondiale della Sanità sui disturbi psichici nella medicina generale: risultati relativi all'area di Verona1

Published online by Cambridge University Press:  07 August 2014

Marco Piccinelli ,
Stefano Pini ,
Cesario Bellantuono ,
Paola Bonizzato ,
Elisabetta Paltrinieri ,
T. Bedirhan Üstün ,
Norman Sartorius  and
Michele Tansella
Marco Piccinelli*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Stefano Pini
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Cesario Bellantuono
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Paola Bonizzato
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Elisabetta Paltrinieri
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
T. Bedirhan Üstün
Affiliation:
Division of Mental Health, World Health Organization, Geneva
Norman Sartorius
Affiliation:
Division of Mental Health, World Health Organization, Geneva
Michele Tansella
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dr. M. Piccinelli, Servizio di Psicologia Medica, Istituto di Psichiatria, Ospedale Policlinico, 37134 Verona. Fax (+39) 45-585.871.
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Summary

Objectives - To present the results obtained from a cross-sectional evaluation of a sample of primary care attenders selected in Verona in the framework of the World Health Organization International Multicentre Study on Psychological Problems in Primary Care Settings. Methods - Among consecutive attenders at 16 primary care clinics in Verona during the period April 1991/February 1992, a random sample, stratified on the basis of GHQ-12 scores, was selected for a thorough evaluation of psychological status, physical status and disability in occupational and other daily activities. All patients with psychopathological symptoms at baseline assessment and a 20% random sample of those without psychopathological symptoms were interviewed again after 3 and 12 months (data not presented here). Results - Overall, 1,656 subjects were approached at the primary care clinics and 1,625 met inclusion criteria. The screening procedure was completed by 1,558 subjects and the second-stage evaluation by 250. Psychiatric disorders according to ICD-10 criteria were diagnosed in 12.4% of consecutive primary care attenders; of these, about one-third (4.5% of consecutive primary care attenders) satisfied ICD-10 diagnostic criteria for two or more disorders. Current Depressive Episode (4.7%) and Generalized Anxiety Disorder (3.7%) were the most common diagnoses. In addition, 11.2% of consecutive primary care attenders had ‘sub-threshold’ psychiatric disorders (i.e., they suffered from symptoms in at least two different areas among those listed in ICD-10, but they did not satisfy diagnostic criteria for well-defined disorders). Psychiatric disorders were more common among females and those aged 24-44 years. Only 20.6% of the subjects with psychiatric disorders contacted the general practitioner for their psychological symptoms, 5.7% complained of symptoms which might have had a psychological origin, whereas in about 70% of the cases the psychiatric disorder was concealed behind the presentation of somatic symptoms, pains in various parts of the body or chronic physical illness. Sixty-two percent of the subjects with psychiatric disorders rated their health status as fair or poor, as compared to 52.0% of those with chronic physical illness and 31.3% of those without such disorders. According to the general practitioner, 40.1% of the subjects with psychiatric disorders and 45.3% of those with chronic physical illness had a fair or poor health status, compared to 14.4% of those without such disorders. Disability in occupational and other daily activities was reported by 52.5% of the subjects with psychiatric disorders (in 40.1% of the cases disability was moderate or severe), 44.4% of those with chronic physical illness (in 26.8% of the cases disability was moderate or severe), and 15.0% of the subjects without such disorders (in 9.1% of the cases disability was moderate or severe). According to the interviewer, disability was identified in 48.4% of the subjects with psychiatric disorders, 39.0% of those with chronic physical illness, and 27.6% of the subjects without such disorders. Sixty per cent of the subjects with psychiatric disorders suffered from concurrent chronic physical illness; these subjects had a poorer health status and higher disability levels than those with psychiatric disorders only. Conclusions - Psychiatric disorders among primary care attenders are frequent and represents a major public health problem, since they entail severe functional limitations for the patients and high costs for the society. Thus, appropriate programs for their recognition and treatment are needed.

Keywords

primary health carepsychiatric disorderschronic diseasehealth statusdisability evaluationmedicina generaledisturbi psichicistato di salutedisabilità.
Type
Articoli
Information
Epidemiology and Psychiatric Sciences , Volume 4 , Issue 1 , Gennaio-Aprile 1995 , pp. 27 - 50
Copyright
Copyright © Cambridge University Press 1995

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Footnotes

(1)

Questo lavoro si basa sui dati raccolti nel corso del Progetto Psychological Problems in General Health Care Settings, che è stato coordinato dall'Organizzazione Mondiale della Sanità e finanziato dalla stessa e dai Centri partecipanti. I ricercatori responsabili del Progetto sono stati: Dr. N. Sartorius e Dr. T.B. Üstün, Division of Mental Health, WHO, Ginevra (Svizzera), Dr. O. Özturk e Dr. M. Rezaki, Ankara (Turchia), Dr. C. Stefanis e Dr. V. Mavreas, Atene (Grecia), Dr. S.M. Channabasavanna e Dr. T.G. Sriram, Bangalore (India), Dr. H. Helmchen e Dr. M. Linden, Berlino (Germania), Dr. W. van den Brink e Dr. B. Tiemens, Groningen (Olanda), Dr. M. Olatawura e Dr. O. Gureje, Ibadan (Nigeria), Dr. O. Benkert e Dr. W. Maier, Mainz (Germania), Dr. D. Goldberg e Dr. R. Gater, Manchester (Gran Bretagana), Dr. Y. Nakane e Dr. S. Michitsuji, Nagasaki (Giappone), Dr. Y. Lecrubier e Dr. P. Boyer, Parigi (Francia), Dr. J.A. Costa e Silva e Dr. L. Villano, Rio de Janeiro (Brasile), Dr. R. Florenzano e Dr. J. Acuna, Santiago del Cile (Cile), Dr. M. von Korff e Dr. G. Simon, Seattle (USA), Dr. Yan He-Qin e Dr. Xaio Shi Fu, Shangai (Cina), Dr. M. Tansella e Dr. C. Bellantuono, Verona (Italia). Un elenco completo dei ricercatori e del personale che ha fornito il proprio contributo durante lo svolgimento del Progetto è riportato nella monografia Mental Illness in Primary Care. An International Study (ed. N. Sartorius and T.B. Üstün), attualmente in stampa.

References

BIBLIOGRAFIA

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed. revised). American Psychiatric Association: Washington DC.Google Scholar
Babor, T.F., de la Fuente, J.R., Saunders, J. & Grant, M. (1989). Audit: the Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Health Care. World Health Organization: Geneva.Google Scholar
Balestrieri, M., Meneghelli, G. & Tansella, M. (1992). Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Verona-Sud 1987-1990. Epidemiologia e Psichiatria Sociale 1, 117–132.CrossRefGoogle Scholar
Barsky, A.J., Geringer, E. & Wool, C.A. (1988). A cognitive-educational treatment for hypochondriasis. General Hospital Psychiatry 10, 322–327.CrossRefGoogle ScholarPubMed
Berti Ceroni, G., Berti Ceroni, F., Bivi, R., Corsino, M.A., De Marco, P., Gallo, E., Giovannini, G., Gherardi, S., Pezzoli, A., Rucci, P. & Neri, C. (1992). DSM-III mental disorders in general medical sector: a follow-up and incidence study over a two-year period. Social Psychiatry and Psychiatric Epidemiology 27, 234–241.CrossRefGoogle Scholar
Bridges, K. & Goldberg, D. (1985). Somatic presentation of DSM-III psychiatric disorders in primary care. Journal of Psychosomatic Research 29, 563–569.CrossRefGoogle ScholarPubMed
Bridges, K., Goldberg, D., Evans, B. & Sharpe, T. (1991). Determinants of somatization in primary care. Psychological Medicine 21, 473–483.CrossRefGoogle ScholarPubMed
Cormier, L.E., Katon, W., Russo, J., Hollifield, M., Hall, M.L. & Vitaliano, P.P. (1988). Chest pain with negative cardiac diagnostic studies: relationship to psychiatric illness. Journal of Nervous and Mental Disease 176, 351–358.CrossRefGoogle ScholarPubMed
Croft-Jeffreys, C. & Wilkinson, G. (1989). Estimated costs of neurotic disorder in UK general practice 1985. Editorial. Psychological Medicine 19, 549–558.CrossRefGoogle Scholar
Escobar, J.I., Burnam, M.A., Karno, M., Forsythe, A. & Golding, J.M. (1987). Somatization in the community. Archives of General Psychiatry 44, 713–718.CrossRefGoogle ScholarPubMed
Finlay-Jones, R. & Burvill, P.W. (1978). Contrasting demographic patterns of minor psychiatric morbidity in general practice and the community. Psychological Medicine 8, 455–466.CrossRefGoogle ScholarPubMed
Finlay-Jones, R., Brown, G.W., Duncan-Jones, P., Haris, J., Murphy, E. & Prudo, R. (1980). Depression and anxiety in the community: replicating the diagnosis of a case. Psychological Medicine 10, 445–454.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, F.E. & McHugh, P.R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Fylkesnes, K. & Førde, O.H. (1991). The Tromsø-study: predictors of self-evaluated health - Has society adopted the expanded health concept? Social Science and Medicine 32, 141–146.CrossRefGoogle ScholarPubMed
Fylkesnes, K. & Førde, O.H. (1992). Determinants and dimensions involved in self-evaluation of health. Social Science and Medicine 35, 271–279.CrossRefGoogle ScholarPubMed
Gask, L. (1992). Training general practitioners to detect and manage emotional disorders. International Review of Psychiatry 4, 293–300.CrossRefGoogle Scholar
Gater, R., de Almeida, e Sousa, B., Barrientos, G.,.Caraveo, J., Chandrashekar, C.R., Dhadphale, M., Goldberg, D., Al Kathiri, A.H., Mubbashar, M., Silhan, K., Thong, D., Torres-Gonzales, F. & Sartorius, N. (1991). The pathways to psychiatric care: a cross-cultural study. Psychological Medicine 21, 761–774.CrossRefGoogle Scholar
Goldberg, D.P. (1972). The Detection of Psychiatric Illness by Questionnaire. Maudsley Monograph N° 21. Oxford University Press: London.Google Scholar
Goldberg, D.P. & Bridges, K. (1988). Somatic presentation of psychiatric illness in primary care setting. Journal of Psychosomatic Research 32, 137–144.CrossRefGoogle ScholarPubMed
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders. A Bio-social Model. Tavistock/Routledge: London.Google Scholar
Goldberg, D.P. & Williams, P. (1988). The User's Guide to the General Health Questionnaire. NFER/NELSON: Windsor, Slough.Google Scholar
Huxley, P. & Goldberg, D. (1975). Social versus clinical prediction in minor psychiatric disorder. Psychological Medicine 5, 96–100.CrossRefGoogle Scholar
Johnson, J., Weissman, M.M. & Klerman, G.L. (1992). Service utilization and social morbidity associated with depressive symptoms in the community. Journal of the American Medical Association 267, 1478–1483.CrossRefGoogle ScholarPubMed
Katon, W., Ries, R.K. & Kleinman, A. (1984). Part II: a prospective DSM-III study of 100 consecutive somatization patients. Comprehensive Psychiatry 25, 305–314.CrossRefGoogle Scholar
Katon, W., Lin, E., Von Korff, M., Russo, J., Lipscomb, P. & Bush, T. (1991). Somatization: a spectrum of severity. American Journal of Psychiatry 148, 34–40.Google ScholarPubMed
Klerman, G.L. (1989). Depressive disorders: further evidence for increased medical morbidity and impairment of social functioning. Archives of General Psychiatry 46, 856–858.Google ScholarPubMed
Kruesi, M.J.P., Dale, J. & Straus, S.E. (1989). Psychiatric diagnoses in patients who have chronic fatigue syndrome. Journal of Clinical Psychiatry 50, 53–56.Google ScholarPubMed
Marino, S., Bellantuono, C. & Tansella, M. (1990). Psychiatric morbidity in general practice in Italy. A point-prevalence survey in a defined geographical area. Social Psychiatry and Psychiatric Epidemiology 25, 67–72.CrossRefGoogle Scholar
Narrow, W.E., Regier, D.A., Rae, D.S., Manderscheid, R.W. & Locke, B.Z. (1993). Use of services by persons with mental and addictive disorders. Findings from the National Institute of Mental Health Epidemiologic Catchment Area Program. Archives of General Psychiatry 50, 95–107.CrossRefGoogle ScholarPubMed
Ormel, J., Oldehinkel, T., Brilman, E. & Van Den Brink, W. (1993). Outcome of depression and anxiety in primary care. A three -wave 3½-year study of psychopathology and disability. Archives of General Psychiatry 50, 759–766.CrossRefGoogle Scholar
Piccinelli, M. (1994). Disturbi psichici nella medicina generale: perché tante differenze? Epidemiologia e Psichiatria Sociale 3, 195–208.CrossRefGoogle Scholar
Piccinelli, M., Bisoffi, G., Bon, M.G., Cunico, L. & Tansella, M. (1993). Validity and test-retest reliability of the Italian version of the 12-item General Health Questionnaire in general practice: a comparison between three scoring methods. Comprehensive Psychiatry 34, 198–205.CrossRefGoogle ScholarPubMed
Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z. & Goodwin, F.K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50, 85–94.CrossRefGoogle Scholar
Robins, L.N. & Regier, D.A. (ed.) (1991). Psychiatric Disorders in America. The Epidemiologic Catchment Area Study. The Free Press: New York.Google Scholar
Robins, L.N., Wing, J.K., Wittchen, H.U., Helzer, J.E., Babor, T.F., Burke, J. & Farmer, A. (1988). The Composite International Diagnostic Interview. An epidemiologic instrument. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Rosenblatt, R.A., Cherkin, D.C., Schneeweiss, R. & Hurt, L.G. (1983). The content of ambulatory medical care in the United States. An interspecialty comparison. New England Journal of Medicine 309, 892–897.CrossRefGoogle ScholarPubMed
Roy, R., Thomas, M. & Matas, M. (1984). Chronic pain and depression: a review. Comprehensive Psychiatry 25, 96–105.CrossRefGoogle ScholarPubMed
Sartorius, N. & Üstün, T.B. (in press). Mental Illness in Primary Care. An International Study. John Wiley & Sons: New York.Google Scholar
Sartorius, N., Davidian, H., Ernberg, G., Fenton, F.R., Fujii, I., Gastpar, M., Gulbinat, W., Jablensky, A., Kielholz, P., Lehman, H.E., Naraghi, M., Shimizu, M., Shinfuku, N. & Takahashi, R. (ed.) (1983). Depressive Disorders in Different Cultures. World Health Organization: Geneva.Google Scholar
Sartorius, N., Jablensky, A., Korten, A., Ernberg, G., Anker, M., Cooper, J.E. & Day, R. (1986). Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO collaborative study on determinants of outcome of severe mental disorders. Psychological Medicine 16, 909–928.CrossRefGoogle Scholar
Sartorius, N., Üstün, T.B., Costa, e Silva, J.-A., Goldberg, D., Lecrubier, Y., Ormel, J., Von Korff, M. & Wittchen, H.-U. (1993). An international study of psychological problems in primary care. Archives of General Psychiatry 50, 819–824.CrossRefGoogle Scholar
Sharp, D. & Morrel, D. (1989). The psichiatry of general practice. In The Scope of Epidemiological Psychiatry (ed. Williams, P., Wilkinson, G. and Rawnsley, K.), pp. 404–419. Routledge: London.Google Scholar
Shepherd, M. & Clare, A. (1981). Psychiatric Illness in General Practice, 2nd ed. Oxford University Press: Oxford.Google Scholar
Shepherd, M., Cooper, B., Brown, A.C. & Graham, K. (1966). Psychiatric Illness in General Practice. Oxford University Press: Oxford.Google Scholar
Simon, G.E. & Von Korff, M. (1991). Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area Study. American Journal of Psychiatry 148, 1494–1500.Google ScholarPubMed
Smith, G.R., Monson, R.A. & Ray, D.C. (1986). Psychiatric consultation in somatization disorder. A randomized controlled study. New England Journal of Medicine 314, 1407–1413.CrossRefGoogle ScholarPubMed
Stewart, A.L., Hays, R.D. & Ware, J.E. (1988). The MOS short form general health survey: reliability and validity in a patient population. Medical Care 26, 724–735.CrossRefGoogle Scholar
Sullivan, M.D., Katon, W., Dobie, R., Sakai, C., Russo, J. & Harrop-Griffiths, J. (1988). Disabling tinnitus: association with affective disorder. General Hospital Psychiatry 10, 285–291.CrossRefGoogle ScholarPubMed
Tacchini, G., Coppola, M.T., Musazzi, A., Altamura, A.C. & Invernizzi, G. (1994). Validazione multinazionale della Composite International Diagnostic Interview (CIDI). Minerva Psichiatrica 35, 63–80.Google ScholarPubMed
Tansella, M. & Williams, P. (1989). The spectrum of psychiatric morbidity in a defined geographical area. Psychological Medicine 19, 765–770.CrossRefGoogle Scholar
Van Hemert, A.M., Hengeveld, M.W., Bolk, J.H., Rooijmans, H.G.M. & Vandenbroucke, J.P. (1993). Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic. Psychological Medicine 23, 167–173.CrossRefGoogle ScholarPubMed
Vazquez-Barquero, J.L., Wilkinson, G., Williams, P., Diez-Manrique, J.F. & Pena, C. (1990). Mental health and medical consultation in primary care settings. Psychological Medicine 20, 681–694.CrossRefGoogle ScholarPubMed
Walker, E., Katon, W., Arrop-Griffiths, J., Holm, L., Russo, J. & Hickock, L.R. (1988). Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. American Journal of Psychiatry 145, 75–80.Google ScholarPubMed
Ware, J.E.J. & Sherbourne, C.D. (1992). The MOS 36-item short form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473–483.CrossRefGoogle ScholarPubMed
Warwick, H.M.C. (1989). A cognitive-behavioral approach to hypochondriasis and health anxiety. Journal of Psychosomatic Research 33, 705–711.CrossRefGoogle ScholarPubMed
Wells, K.B., Golding, J. & Burnam, M.A. (1988). Psychiatric disorder and limitations in physical functioning in a sample of the Los Angeles general population. American Journal of Psychiatry 145, 712–717.Google Scholar
Wells, K.B., Stewart, A., Hays, R.D., Burnam, M.A., Rogers, W., Daniels, M., Berry, S., Greenfield, S.& Ware, J. (1989). The functioning and well-being of depressed patients. Results from the Medical Outcome Study. Journal of the American Medical Association 262, 914–919.CrossRefGoogle Scholar
Wells, K.B., Rogers, W., Burnam, M.A., Greenfield, S. & Ware, J.E. Jr. (1991). How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcome Study. American Journal of Psychiatry 148, 1688–1696.Google Scholar
Wiersma, D., DeJong, A. & Ormel, J. (1988). The Groningen Social Disability Schedule: development, relationship with ICIDH and psychometric properties. International Journal of Rehabilitation Research 3, 213–224.CrossRefGoogle Scholar
Wilkinson, G., Smeeton, N., Skuse, D. & Fry, J. (1988). Consultation for physical illness by patients diagnosed and treated for psychiatric disorders by a general practitioner: a 20 year follow up study. British Medical Journal 297, 776–778.CrossRefGoogle ScholarPubMed
Williams, P., Tarnopolsky, A., Hand, D. & Shepherd, M. (1986). Minor Psychiatric Morbidity and General Practice Consultation: The West London Survey. Psychological Medicine Monograph Supplement No. 9. Cambridge University Press: Cambridge.Google ScholarPubMed
Wing, J.K. & Sturt, E. (1978). The PSE - ID - CATEGO System Supplementary Manual. MRC Social Psychiatry Unit, Institute of Psychiatry: London.Google Scholar
Wohlfarth, T.D., Van den Brink, W., Ormel, J., Koeter, M.W. & Oldehinkel, A.L. (1993). The relationship between social dysfunctioning and psychopathology among primary care attenders. British Journal of Psychiatry 163, 37–44.CrossRefGoogle ScholarPubMed
World Health Organization (1978). Primary Health Care, Report of the International Conference on Primary Health Care in Alma Ata, 1978. Health for All Series, N° 1. World Health Organization: Geneva.Google Scholar
World Health Organization (1980). WHO Psychiatric Disability Assessment Schedule (WHO/DAS). World Health Organization: Geneva.Google Scholar
World Health Organization (1990a). The Introduction of a Mental Health Component into Primary Health Care. World Health Organization: Geneva.Google Scholar
World Health Organization (1990b). CIDI-Core. Composite International Diagnostic Interview, Core Version. World Health Organization: Geneva.Google Scholar
World Health Organization (1992). International Classification of Diseases, 10th Revision. World Health Organization: Geneva.Google Scholar