Skip to main content Accessibility help

The Relationship Between Social Dysfunctioning and Psychopathology among Primary Care Attenders

  • Tamar D. Wohlfarth (a1), Wim Van Den Brink (a2), Johan Ormel (a1), Maarten W. J. Koeter (a1) and Albertine J. Oldehinkel (a1)...


The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.


Corresponding author



Hide All
American Psychiatric Association (1960) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.
Angst, J. & Dobler-Mikola, A. (1985) The Zurich study: VI. A continuum from depression to anxiety disorders? European Archives of Psychiatry and Neurological Science, 235, 179186.
Arrindell, W. A., Emmelkamp, P. M. G. & Sanderman, R. (1986) Marital quality and general life adjustment in relation to treatment outcome in agoraphobia. Advances in Behavior Research and Therapy, 8, 139185.
Asselbergs, L. J. (1989) Sociaal beperkt: een empirisch ondenoek naar het sociale functioneren van sehizofrenie-patiënten in het Psychose Preventie Project Rotterdam. (Socially disabled: an empirical study on social dysfunctioning among schizophrenic patients in the Psychosis Prevention Project Rotterdam.) Dissertation. Utrecht: NcGV.
Barrett, J. E., Barrett, J. A., Oxman, T. E., et al (1988) The prevalence of psychiatric disorders in primary care practice. Archives of General Practice, 45, 11001119.
Blacker, C. V. R. & Clare, A. W. (1988) The prevalence and treatment of depression in general practice. Psychopharmacology, 95, 514517.
Blumenthal, M. D. & Dielman, T. E. (1975) Depressive symptomatology and role function in a general population. Archives of General Psychiatry, 32, 985991.
Bothwell, S. & Weissman, M. M. (1977) Social impairment four years after an acute depressive episode. American Journal of Orthopsychiatry, 47, 231237.
Brink, W. van den, Leenstra, A., Ormel, J., et al (1991) Mental health intervention programs in primary care: their scientific basis. Journal of Affective Disorders, 21, 273284.
Bronisch, T., Wittchen, H-U., Krieg, C., et al (1985) Depressive neurosis: a long-term perspective and retrospective follow-up study of former inpatients. Acta Psychiatrica Scandinavica, 71, 237248.
Bronisch, T., & Hecht, H. (1989) Validity of adjustment disorders, comparison with major depression. Journal of Affective Disorders, 17, 229236.
Bronisch, T., & Hecht, H. (1990) Major depression with and without a coexisting anxiety disorder: social dysfunctioning, social integration, and personality features. Journal of Affective Disorders, 20, 151157.
Brown, G. W. & Davidson, S. (1978) Social class, psychiatric disorder of mother, and accidents to children. Lancet, i, 378380.
Casey, P. R., Tyrer, P. J. & Platt, S. (1985) The relationship between social functioning and psychiatric symptomatology in primary care. Social Psychiatry, 20, 59.
Cooper, B., Eastwood, M. R. & Sylph, J. (1970) Psychiatric morbidity and social adjustment in a general practice population. In Psychiatric Epidemiology (eds Hare, E. H. & Wing, J. K.), pp. 299309. Oxford: Oxford University Press.
Coryell, W., Endicott, J., Andreasen, N. C., et al (1988) Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. American Journal of Psychiatry, 145, 293300.
Curson, D. A., Barnes, T. R. E., Bamber, R. W., et al (1985) Long-term depot maintenance of chronic schizophrenic outpatients: the seven year follow-up of the MRC fluphenazine/ placebo trial. I. Course of illness, stability of diagnosis and the role of a special maintenance clinic. British Journal of Psychiatry, 146, 464480.
DeJong, A., Giel, R., Soloff, C. J., et al (1985) Sodal disability and outcome in schizophrenic patients. British Journal of Psychiatry, 147, 631636.
DeJong, A., Giel, R., Soloff, C. J., et al (1986) Relationship between symtomatology and sodal disability. Social Psychiatry, 21, 200205.
DeJong, A., & Molenaar, I. W. (1987) An application of Mokken's model for stochastic, cumulative scaling in psychiatric research. Journal of Psychiatric Research, 21, 137149.
Dohrenwend, B. S., Cook, D. & Dohrenwend, B. P. (1981) Measurement of sodal functioning in community populations. In What is a Case? Problems of Definitions in Psychiatric Community Surveys (eds Wing, J. K., Bebbington, P. & Robins, L. N.), pp. 183201. London: Grant McIntyre.
Dohrenwend, B. S., Dohrenwend, B. P., Link, B., et al (1983) Sodal functioning of psychiatric patients in contrast with community cases in the general population. Archives of General Psychiatry, 40, 11741182.
Finley-Jones, R., Brown, G. W., Duncan-Jones, P., et al (1980) Depression and anxiety in the community: replicating the diagnosis of care. Psychological Medicine, 10, 445454.
Goldberg, D. (1972) The Detection of Psychiatric Illness by Questionnaire. London: Oxford University Press.
Grayson, D., Bridges, K., Duncan-Jones, P., et al (1987) The relationship between symptoms and diagnosis of minor psychiatric disorder in general practice. Psychological Medicine, 17, 933942.
Hecht, H. & Wittchen, H-U. (1988) The frequency of social dysfunction in a general population sample and in patients with mental disorders. Social Psychiatry and Psychiatric Epidemiology, 23, 1729.
Hecht, H., Zerssen, D. von, Krieg, C., et al (1989) Anxiety and depression: comorbidity, psychopathology, and social functioning. Comprehensive Psychiatry, 30, 420433.
Hecht, H., Zerssen, , & Wittchen, H-U. (1990) Anxiety and depression in a community sample: the influence of comorbidity on sodal functioning. Journal of Affective Disorders, 18, 137144.
Hurry, J. & Sturt, E. (1981) Social performance in a population sample: Relations to psychiatric symptoms. In What is a Case? Problems of Definitions in Psychiatric Community Surveys (eds Wing, J. K., Bebbington, P. & Robins, L. N.), pp. 202213. London: Grant McIntyre.
Kane, R. A., Kane, R. L. & Arnold, S. (1984) Measuring Social Functioning in Mental Health Studies: Concepts and Instruments. Washington, DC: National Institute of Mental Health.
Kedward, H. B. & Sylph, J. (1974) The social correlates of chronic neurotic disorder. Social Psychiatry, 9, 9198.
Kraaijkamp, H. J. M. (1991) De Groningse Sociale Beperkingen School. (The Groningen Social Disabilities Schedule). Dissertation, Rijksuniversiteit Groningen.
Link, B. (1982) Mental patient status, work and income: an examination of the effect of a psychiatric label. American Sociological Review, 47, 202215.
Mokken, R. J. & Lewis, C. (1982) A nonparametric approach to the analysis of dichotomous item responses. Applied Psychological Measurement, 6, 417430.
Murphy, J. M., Oliner, D. C., Sobol, A. M., et al (1986) Diagnosis and outcome: depression and anxiety in a general population. Psychological Medicine, 16, 117126.
Ormel, J., Brink van den, W., Koeter, M. W. J., et al (1990) Recognition, management, and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychological Medicine, 20, 909923.
Pai, S. & Kapur, R. L. (1982) Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunctioning and burden on the family of psychiatric inpatients. Psychological Medicine, 12, 651658.
Paykel, E. S. & Weissman, M. M. (1973) Social adjustment and depression. Archives of General Psychiatry, 28, 659663.
Platt, S. (1985) Measuring the burden of psychiatric illness on the family: an evaluation of some rating scales. Psychological Medicine, 15, 383393.
Platt, S., Hirsch, S. R. & Knights, A. C. (1981) Effects of brief hospitalization on psychiatric patients' behavior and social functioning. Acta Psychiatrica Scandinavica, 63, 117128.
Schreurs, M. (1990) Over chronische psychiatric in Miden-Twente. Een epidemiologisch onderzoek in Midden-Twente naar het functioneren en de zorghehoefte van mensen met chronische psychiatrische problematiek. (Chronic psychiatric care in the region of Midden-Twente. An epidemiological study on social dysfunctioning and the need for care in patients with chronic psychiatric problems.) Hengelo: NFGV.
Serban, G. (1979) Mental status, functioning, and stress in chronic schizophrenic patients in community care. American Journal of Psychiatry, 136, 948952.
Serban, G. & Gidynski, C. B. (1979) Relationship between cognitive defect, affect response and community adjustment in chronic schizophrenics. British Journal of Psychiatry, 134, 602608.
Staal, J. L., Ormel, J., Schoenmacher, J. M., et al (1989) Het beloop van psychopathologie en sociale beperkingen. Een exploratieve studie onder psychiatrische polikliniek patienten. Tijdschrift voor Sociale Gezondheidszorg, 67, 14.
Sturt, E. (1981) Hierarchical patterns in the distribution of psychiatric symptoms. Psychological Medicine, 11, 783794.
Sturt, E. & Wykes, E. (1987) Assessment schedules for chronic psychiatric patients. Psychological Medicine, 17, 485493.
Tanner, J., Weissman, M. & Prusoff, B. (1975) Social adjustment and clinical relapse in depressed out-patients. Comprehensive Psychiatry, 16, 547556.
Tholen, A. J. (1991) Patient of Bewoner? (Patient or resident?) Dissertation. Rijksuniversiteit Groningen.
van Valkenburg, C., Akiskal, H. S., Puzantian, V., et al (1984) Anxious depression: clinical, family history, and naturalistic outcome - comparisons with panic and major depressive disorders. Journal of Affective Disorders, 6, 6782.
von Korff, M., Shapiro, S., Burke, T. D., et al (1987) Anxiety and depression in a primary care clinic. Comparison of Diagnostic Interview Schedule, General Health Questionnaire, and practitioner assessment. Archives of General Psychiatry, 44, 152156.
von Korff, M., Katon, W., Ormel, J., et al (1992) Disability and depression among medical patients: a longitudinal analysis. Archives of General Psychiatry, 49, 91100.
Waryszak, Z. (1982) Symptomatology and social functioning of psychiatric patients before and after hospitalization. Social Psychiatry, 17, 149154.
Weissman, M. M. (1975) The assessment of social adjustment. Archives of General Psychiatry, 32, 357365.
Weissman, M. M., Prusoff, B. A., Thompson, W. D., et al (1978) Social adjustment by self report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease, 166, 317326.
Wells, K. B., Stewart, A., Hays, R. D., et al (1989) The functioning and well-being of depressed patients. Results from the medical outcome study. Journal of the American Medical Association, 262, 914919.
Wiersma, D., DeJong, A. & Ormel, J. (1988) The Groningen Social Disability Schedule: development, relationship with ICIDH, and psychometric properties. International Journal of Rehabilitation Research, 11, 213224.
Wiersma, D., DeJong, A., Kraaijkamp, H. J. M., et al (1990) GSDS-II. The Groningen Social Disability Schedule. Second Version: An Interview Schedule to Assess Disabilities in Social Role Functioning: Manual. Groningen: Rijksuniversiteit Groningen, Department of Social Psychiatry.
Wilmink, F. W. (1989) Patient, Physician, Psychiatrist: Assessment of Mental Health Problems in Primary Care. PhD thesis, University of Groningen, The Netherlands.
Wing, J. K. (1989) The measurement of “social disablement”. The MRC social behavior and social role performance schedules. Social Psychiatry and Psychiatric Epidemiology, 24, 173178.
Wing, J. K., Cooper, J. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.
Wing, J. K. & Sturt, E. (1978) The PSE-ID-CATEGO System - A Supplementary Manual. London: Institute of Psychiatry.
Winokur, G., Clayton, P. J. & Reich, J. (1969) Manic Depressive Illness. St. Louis: Mosby.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

The Relationship Between Social Dysfunctioning and Psychopathology among Primary Care Attenders

  • Tamar D. Wohlfarth (a1), Wim Van Den Brink (a2), Johan Ormel (a1), Maarten W. J. Koeter (a1) and Albertine J. Oldehinkel (a1)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *