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Psychiatric disorders in primary care: why so many differences?

Published online by Cambridge University Press:  11 October 2011

Marco Piccinelli
Marco Piccinelli*
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)045-585.871
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Summary

Objectives - (I) To review the studies which investigated the frequency of psychiatric disorders among primary care attenders, using a standardized psychiatric interview as the case finding instrument; (II) to discuss the factors possibly explaining the different results found; (III) to highlight the central role of international multicenter collaborative studies, carried out in primary care settings. Method - the studies were reviewed, which were published in international journals between 1970 and 1993. The studies were located through a computerized search of the databases MEDLINE and Psychological Abstracts; in addition, the reference lists of the studies located in this way were examined and international journals were manually scanned in order to avoid possible omissions. Finally, the annotated bibliography, edited by Wilkinson (1985), was examined, since it included the studies having psychiatric focus, carried out in primary care and published between 1977 and 1985. Results - Thirty papers were traced, but 9 were excluded since they duplicated results or because of methodological limitations. So far, the overall frequency of psychiatric disorders among primary care attenders has been investigated using standardized procedures in 13 countries only. The frequency of psychiatric disorders ranged between approximately 10% and 50%. The possible reasons accounting for the differe- nces between the studies were discussed in the light of three factors: I) the research design and study characteristics; II) the reliability and comparability of different diagnostic categories and classificatory systems; and III) the different organization of health services across countries. Conclusions - In the light of the difficulties faced when the findings of independent studies, carried out in different countries or even in the same country, are compared, the central role of in- ternational multicenter collaborative studies conducted in this field is suggested.

Riassunto

Scopo - (I) Operare una revisione critica degli studi che hanno indagato la frequenza dei disturbi psichici tra i pazienti della medicina generale, utilizzando come criterio un'intervista psichiatrica standardizzata; (II) discutere i possibili fattori all'origine delle diverse frequenze riscontrate; (III) mettere in luce il ruolo di primaria importanza che possono assolvere in questo campo gli studi multicentrici condotti grazie a programmi di collaborazione internazionale. Metodo - sono stati selezionati i lavori pubblicati nella letteratura internazionale tra il 1970 ed il 1993. La selezione è stata effettuata grazie ad una ricerca computerizzata, nel corso della quale sono stati incrociati i databases MEDLINE e Psychological Abstracts; questa è stata a sua volta integrata da una ricerca manuale, consistente neU'esame delle bibliografie contenute nei lavori cosi individuati e nella consultazione degli indici analitici delle principal! riviste psichiatriche internazionali. Infine, è stata consultata la bibliografia commentata, curata da Wilkinson (1985), relativa a lavori di interesse e pertinenza psichiatrici condotti nella medicina generale e pubblicati tra il 1977 ed il 1985. Risultati - Sono stati individuati 30 lavori, ma 9 sono stati esclusi, dal momento che replicavano dati già riportati in letteratura o presentavano limiti metodologici. È emerso cosi che indagini sulla frequenza complessiva dei disturbi psichici tra i soggetti che si rivolgevano ai servizi di medicina generale sono state finora condotte secondo procedure standardizzate solo in 13 Paesi. La frequenza dei disturbi psichici variava tra il 10% ed il 50% circa. Le possibili ragioni all'origine dellem diverse frequenze riscontrate sono state discusse alia luce di tre fattori: I) le caratteristiche dell'indagine; II) l'affidabilità e la confrontabilità delle categorie diagnostiche e dei sistemi nosografici utilizzati; e III) la diversa organizzazione dei servizi sanitari nei vari Paesi. Conclusioni - alia luce delle difficoltà che si incontrano quando si tenta di confrontare i risultati forniti da studi indipendenti condotti in Paesi diversi o perfino nello stesso Paese viene suggerito il ruolo di primaria importanza che possono assolvere in questo campo gli studi multicentrici condotti grazie a programmi di collaborazione internazionale.

Keywords

medicina generaledisturbi psichiciclassificazionedisegno della ricercaaccessibilità dei servizi sanitariprimary carepsychiatric disordersclassificationresearch designhealth services accessibility
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 3 , Issue 3 , December 1994 , pp. 195 - 208
Copyright
Copyright © Cambridge University Press 1994

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