An International Study of the Effect of Physical Ill Health on Psychiatric Recovery in Primary Care

Objective: The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care. Methods: A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients’ family practitioners. Results: Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability. Conclusion: Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention. PPGHC = Psychological Problems in General Health Care; MES = medically explained symptoms; MUS = medically unexplained symptoms; GHQ-12 = 12-item General Health Questionnaire; CIDI-PHC = Composite International Diagnostic Interview–Primary Health Care; GSDS = Groningen Social Disability Schedule; FP = family physician; SPHERE = Somatic and Psychological Health Report.