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The burden of mental disorders in primary care

Published online by Cambridge University Press:  16 April 2020

G. Grandes ,
I. Montoya ,
M.S. Arietaleanizbeaskoa ,
V. Arce ,
A. Sanchez  and
on behalf of the MAS group
G. Grandes*
Affiliation:
Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, Luis Power, 18-4a Planta, 48014Bilbao, Spain
I. Montoya
Affiliation:
Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, Luis Power, 18-4a Planta, 48014Bilbao, Spain
M.S. Arietaleanizbeaskoa
Affiliation:
Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, Luis Power, 18-4a Planta, 48014Bilbao, Spain
V. Arce
Affiliation:
Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, Luis Power, 18-4a Planta, 48014Bilbao, Spain
A. Sanchez
Affiliation:
Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, Luis Power, 18-4a Planta, 48014Bilbao, Spain
on behalf of the MAS group
Affiliation:
Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, Luis Power, 18-4a Planta, 48014Bilbao, Spain
*
⁎Corresponding author. Tel.: +34 94 600 66 38; fax: +34 94 600 66 39. E-mail address: [email protected] (G. Grandes).
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Abstract

Objectives

To describe and compare the prevalence of mental disorders across primary care populations, and estimate their impact on quality of life.

Methods

Cross-sectional multilevel analysis of a systematic sample of 2539 attendees to eight primary care centres in different regions of Spain, assessed with the WHO Composite International Diagnostic Interview (CIDI 1.1), the Short Form Health Survey (SF-36) quality of life questionnaire and the SF-6D utility index.

Results

The 12-month prevalence of any mental disorder was 23% (95% confidence interval: 21–24%), 10% had mood, 9% anxiety, 5% organic, 4% somatoform, and 1% alcohol use disorders, with a significant between-centre variability (P < 0.001). People with mental disorders had one standard deviation lower mental quality of life than the general population. We estimated that 1831 quality-adjusted life-years (QALYs) are lost annually per 100,000 patients due to mental disorders, without considering mortality. Mood disorders have the worst impact with an annual loss of 1124 QALYs per 100,000 patients, excluding mortality (95% confidence interval: 912–1351).

Conclusions

Prevalence rates were similar to those obtained in international studies using the same diagnostic instrument and, given the significant between-centre variability found, it is recommended that mental health statistics be considered at small area level. Mental disorders, and especially mood disorders, are associated with very poor quality of life and higher scores on disability indexes than other common chronic conditions.

Keywords

Mood disordersAnxiety disordersHealth-related quality of lifePrevalenceComorbidityPrimary health care
Type
Original article
Information
European Psychiatry , Volume 26 , Issue 7 , October 2011 , pp. 428 - 435
Copyright
Copyright © European Psychiatric Association 2010

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Footnotes

1

Director team: Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza (principal investigator: Gonzalo Grandes; co-investigators: Alvaro Sanchez, Imanol Montoya, Ricardo Ortega Sanchez-Pinilla). Research team: Basque Healthcare Service-Osakidetza: Basauri-Aríz Health Center (Jesús Torcal,Verónica Arce), Galdakao Health Center (Pilar Echevarria, Marisol Arietaleanizbeaskoa), Algorta Health Center (Irene Toquero, Janire Payo). Catalonian Healthcare Service: Serraparera Health Center, Barcelona (Agusti Guiu, Ana Cascos). Castilla y León Healthcare Service: Casa Barco Health Center, Valladolid (Carmen Fernández, Jose Ignacio Recio), La Alamedilla Health Center, Salamanca (Luis García, Manuel Gómez, Yolanda Castaño). Castilla – la Mancha Healthcare Service: San Fernando Cuenca III Health Center, Cuenca (Vicente Martinez, Patricia López). Galicia Health Service: Sardoma Health Center, Vigo (Francisco J Soidán, Marisa Enríquez).

References

World Health Organization World Organization of Family Doctors Integrating mental health into primary care: a global perspective. Geneva: WHO press: 2008Google Scholar
Mathers, C.D.Loncar, D.Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006 3 e442CrossRefGoogle ScholarPubMed
World Health Organization The global burden of disease: 2004 update. Geneva:World Health Organization; 2008 http://www.who.int/evidence/bodGoogle Scholar
Goldberg, D.Huxley, P.Common mental disorders: a bio-social model. London: Tavistock/Routledge: 1992Google Scholar
Ormel, J.VonKorff, M.Ustun, T.B.Pini, S.Korten, A.Oldehinkel, T.Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994; 272: 1741–1748CrossRefGoogle Scholar
Barsky, A.J.Borus, J.F.Somatization and medicalization in the era of managed care. JAMA 1995; 274: 1931–1934CrossRefGoogle ScholarPubMed
Aiarzaguena, J.M.Grandes, G.Salazar, A.Gaminde, I.Sánchez, A.The diagnostic challenges presented by patients with medically unexplained symptoms in general practice. Scand J Prim Health Care 2008; 26: 99–105CrossRefGoogle ScholarPubMed
Prince, M.Patel, V.Saxena, S.Maj, M.Maselko, J.Phillips, M.R.et al.No health without mental health. Lancet 2007; 370: 859–87710.1016/S0140-6736(07)61238-0CrossRefGoogle ScholarPubMed
Fernández, A.Haro, J.M.Martinez-Alonso, M.Demyttenaere, K.Brugha, T.S.Autonell, J.et al.Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry 2007; 190: 172–173CrossRefGoogle ScholarPubMed
King, M.Nazareth, I.Levy, G.Walker, C.Morris, R.Weich, S.et al.Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry 2008; 192: 362–367CrossRefGoogle ScholarPubMed
Roca, M.Gili, M.Garcia-Garcia, M.Salva, J.Vives, M.Garcia Campayo, J.et al.Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord 2009; 119: 52–58CrossRefGoogle ScholarPubMed
Gold, M.R.Stevenson, D.Fryback, D.G.HALYS and QALYS and DALYS, Oh My: similarities and differences in summary measures of population Health. Annu Rev Public Health 2002; 23: 115–134CrossRefGoogle Scholar
Brazier, J.Roberts, J.Deverill, M.The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002; 21: 271–292CrossRefGoogle ScholarPubMed
Grandes, G.Sanchez, A.Ortega Sanchez-Pinilla, R.O.Torcal, J.Montoya, I.Lizarraga, K.et al.Effectiveness of physical activity advice and prescription by physicians in routine primary care: a cluster randomized trial. Arch Intern Med 2009; 169: 694–70110.1001/archinternmed.2009.23CrossRefGoogle ScholarPubMed
Grandes, G.Sánchez, A.Torcal, J.Ortega Sánchez-Pinilla, R.Lizarraga, K.Serra, J.et al.Targeting physical activity promotion in general practice: characteristics of inactive patients and willingness to change. BMC Public Health 2008 8 172CrossRefGoogle Scholar
World Health Organization, Composite International Diagnostic Interview (CIDI): version 1. 1 [Spanish]. Geneva: World Health Organization: 1993Google Scholar
Alonso, J.Angermeyer, M.C.Bernert, S.Bruffaerts, R.Brugha, T.S.Bryson, H.et al.Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; 420: 21–27Google Scholar
Goldberg, D.P.Lecrubier, Y.Form and frequency of mental disorders across centres.Üstün, T.B.Sartorius, N.Mental illness in general health care: an international study Geneva: Chichester:John Wiley & Sons on behalf of WHO; 1995 323–334Google Scholar
The W.H.O. World Mental Health Survey Consortium Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–2590CrossRefGoogle Scholar
Ustün, T.B.Tien, A.Y.Recent developements for Diagnostic Measures in Psychiatry. Epidemiol Rev 1995; 17: 210–220CrossRefGoogle Scholar
Wittchen, H.U.Robins, L.N.Cottler, L.B.Sartorius, N.Burke, J.D.Regier, D.Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry 159 1991 645–653 [658]CrossRefGoogle ScholarPubMed
Alonso, J.Regidor, E.Barrio, G.Prieto, L.Rodríguez, C.de la Fuente, L.Population reference values of the Spanish version of the Health Questionnaire SF-36 [Article in Spanish]. Med Clin (Barc) 1998; 111: 410–416Google ScholarPubMed
Ware, J.E.Snow, K.K.Kosinski, M.SF-36 health survey: manual and interpretation guide. Lincoln, RI: QualityMetric Incorporated: 1993Google Scholar
Alvarez Dardet, C.Alonso, J.Domingo, A.Regidor, E.La medición de la clase social en ciencias de la salud. Barcelona: SG Editores: 1995Google Scholar
Lunn, D.J.Thomas, A.Best, N.Spiegelhalter, D.WinBUGS – a Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput 2000; 10: 325–337CrossRefGoogle Scholar
Saarni, S.I.Suvisaari, J.Sintonen, H.Pirkola, S.Koskinen, S.Aromaa, A.et al.Impact of psychiatric disorders on health-related quality of life: general population survey. Br J Psychiatry 2007; 190: 326–332CrossRefGoogle ScholarPubMed
Eaton, W.W.Martins, S.S.Nestadt, G.Bienvenu, O.J.Clarke, D.Alexandre, P.The burden of mental disorders. Epidemiol Rev 2008; 30: 1–14CrossRefGoogle ScholarPubMed
King, M.Walker, C.Levy, G.Bottomley, C.Royston, P.Weich, S.et al.Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study. Arch Gen Psychiatry 65 2008 1368–1376[Erratum in: Arch Gen Psychiatry 2009;66:151].10.1001/archpsyc.65.12.1368CrossRefGoogle ScholarPubMed
Baca Baldomero, E.Sáiz Ruiz, J.Porras Chavarino, A.The detection of mental disorders by physicians who are not psychiatrists: usefulness of the PRIME-MD questionnaire [article in Spanish]. Med Clin (Barc) 2001; 116: 504–509Google Scholar
Spitzer, R.L.Williams, J.B.Kroenke, K.Linzer, M.deGruy, F.V. 3rd Hahn, S.R.et al.Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994; 272: 1749–1756CrossRefGoogle ScholarPubMed
Baca, E.Saiz, J.Agüera, L.Caballero, L.Fernández-Liria, A.Ramos, J.et al.Validation of the Spanish version of PRIME-MD: a procedure for diagnosing mental disorders in primary care [article in Spanish]. Actas Esp Psiquiatr 1999; 27: 375–383Google Scholar
Mitchell, A.J.Vaze, A.Rao, S.Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009; 374: 609–619CrossRefGoogle ScholarPubMed
Alonso, J.Angermeyer, M.C.Bernert, S.Bruffaerts, R.Brugha, T.S.Bryson, H.et al.Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; 420: 38–46Google Scholar
Moussavi, S.Chatterji, S.Verdes, E.Tandon, A.Patel, V.Ustun, B.Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851–858CrossRefGoogle ScholarPubMed
Pirkola, S.Saarni, S.Suvisaari, J.Elovainio, M.Partonen, T.Aalto, A.M.et al.General health and quality-of-life measures in active, recent, and comorbid mental disorders: a population-based health 2000 study. Compr Psychiatry 2009; 50: 108–114CrossRefGoogle ScholarPubMed
Fernández, A.Saameño, J.A.Pinto-Meza, A.Luciano, J.V.Autonell, J.Palao, D.et al.Burden of chronic physical conditions and mental disorders in primary care. Br J Psychiatry 2010; 196: 302–309CrossRefGoogle ScholarPubMed
Revicki, D.A.Wood, M.Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications. J Affect Disord 1998; 48: 25–36CrossRefGoogle ScholarPubMed
Weich, S.Twigg, L.Lewis, G.Jones, K.Geographical variation in rates of common mental disorders in Britain: prospective cohort study. Br J Psychiatry 2005; 187: 29–34CrossRefGoogle ScholarPubMed
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