Outcome and impact of mental disorders in primary care at 5 years

Jeffrey L. Jackson, Mark Passamonti, Kurt Kroenke

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

OBJECTIVE: To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. METHODS: A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. RESULTS: At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%). CONCLUSIONS: Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.

Original languageEnglish
Pages (from-to)270-276
Number of pages7
JournalPsychosomatic Medicine
Volume69
Issue number3
DOIs
StatePublished - Apr 2007

Fingerprint

Mental Disorders
Primary Health Care
Depression
Anxiety
Panic
Anxiety Disorders
Panic Disorder
Outcome Assessment (Health Care)
Health

Keywords

  • Anxiety
  • Depression
  • Mental disorders
  • Outcomes

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Psychology(all)

Cite this

Outcome and impact of mental disorders in primary care at 5 years. / Jackson, Jeffrey L.; Passamonti, Mark; Kroenke, Kurt.

In: Psychosomatic Medicine, Vol. 69, No. 3, 04.2007, p. 270-276.

Research output: Contribution to journalArticle

Jackson, Jeffrey L. ; Passamonti, Mark ; Kroenke, Kurt. / Outcome and impact of mental disorders in primary care at 5 years. In: Psychosomatic Medicine. 2007 ; Vol. 69, No. 3. pp. 270-276.
@article{c37254b710d04135b8479b6d507cc3b3,
title = "Outcome and impact of mental disorders in primary care at 5 years",
abstract = "OBJECTIVE: To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. METHODS: A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. RESULTS: At baseline, 29{\%} of patients had a mental disorder (major depression: 8.4{\%}, minor depression 10.4{\%}, Panic disorder 1.4{\%}, generalized anxiety disorder 2{\%}, anxiety not otherwise specified (NOS) 11.4{\%}); of these patients, 26{\%} had more than one mental disorder. Over 5 years, 33{\%} were recognized. Threshold disorders were more likely to be recognized (major depression 56{\%}, panic 100{\%}, generalized anxiety disorder 88{\%}) than subthreshold disorders (minor depression 20{\%}, anxiety NOS 25{\%}). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12{\%}, anxiety NOS to generalized anxiety or panic 8{\%}). CONCLUSIONS: Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.",
keywords = "Anxiety, Depression, Mental disorders, Outcomes",
author = "Jackson, {Jeffrey L.} and Mark Passamonti and Kurt Kroenke",
year = "2007",
month = "4",
doi = "10.1097/PSY.0b013e3180314b59",
language = "English",
volume = "69",
pages = "270--276",
journal = "Psychosomatic Medicine",
issn = "0033-3174",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Outcome and impact of mental disorders in primary care at 5 years

AU - Jackson, Jeffrey L.

AU - Passamonti, Mark

AU - Kroenke, Kurt

PY - 2007/4

Y1 - 2007/4

N2 - OBJECTIVE: To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. METHODS: A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. RESULTS: At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%). CONCLUSIONS: Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.

AB - OBJECTIVE: To assess 5-year mental disorder recognition rates and determine the natural history of mental disorders in primary care. METHODS: A prospective cohort of adults presenting to a primary care walk-in clinic with a physical symptom were evaluated at baseline (n = 500) and at 5 years (n = 387) for mental disorders with the Primary Care Evaluation of Mental Disorders (PRIME-MD). Additional measures included functional status (Medical Outcomes Study SF-6; MOS-SF6), Patient Health Questionnaire-15, Satisfaction (Rand-9), unmet expectations, and symptom outcome. Patients self-reported whether their disorder was diagnosed or treated at the 5-year follow-up. RESULTS: At baseline, 29% of patients had a mental disorder (major depression: 8.4%, minor depression 10.4%, Panic disorder 1.4%, generalized anxiety disorder 2%, anxiety not otherwise specified (NOS) 11.4%); of these patients, 26% had more than one mental disorder. Over 5 years, 33% were recognized. Threshold disorders were more likely to be recognized (major depression 56%, panic 100%, generalized anxiety disorder 88%) than subthreshold disorders (minor depression 20%, anxiety NOS 25%). Correlates of recognition included having a threshold or multiple disorders; recognition was associated with greater likelihood of persistence. Most patients with subthreshold disorders at baseline had no disorder at 5 years and few progressed to threshold disorders (minor to major depression 12%, anxiety NOS to generalized anxiety or panic 8%). CONCLUSIONS: Mental disorders are common and their recognition and treatment remain low. Subthreshold disorders have a better prognosis. Patients with threshold or multiple disorders, worse functioning or persistence of their disorder were more likely to be diagnosed.

KW - Anxiety

KW - Depression

KW - Mental disorders

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=34247492855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247492855&partnerID=8YFLogxK

U2 - 10.1097/PSY.0b013e3180314b59

DO - 10.1097/PSY.0b013e3180314b59

M3 - Article

C2 - 17401055

AN - SCOPUS:34247492855

VL - 69

SP - 270

EP - 276

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

SN - 0033-3174

IS - 3

ER -