Development of mental disorders one year after exposure to psychosocial stressors; a cohort study in primary care patients with a physical complaint

• Published in: BMC psychiatry 2012-08, Vol.12 (1), p.120-120, Article 120
• Main Authors: Herzig, Lilli, Mühlemann, Nicole, Burnand, Bernard, Favrat, Bernard, Haftgoli, Nader, Verdon, François, Bischoff, Thomas, Vaucher, Paul
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Ambulatory care; Analysis; Anxiety; Care and treatment; Cohort Studies; Comorbidity; Complaints; Confidence intervals; Depression; Depression, Mental; Development and progression; Diagnosis; Family physicians; Female; Health aspects; Health care; Health Status; Humans; Inventories; Longitudinal studies; Male; Medical research; Medicine; Medicine, Experimental; Medicine, Preventive; Mental disorder; Mental disorders; Mental health; Mental illness; Middle Aged; Practice; Prevalence; Preventive health services; Preventive medicine; Primary care; Primary Health Care; Psychiatric Status Rating Scales; Psychiatry; Psychological aspects; Psychosocial deprivation; Psychotherapy; Questionnaires; Risk factors; Somatoform disorders; Somatoform Disorders - complications; Somatoform Disorders - epidemiology; Somatoform Disorders - psychology; Stress; Stress (Psychology); Stress, Psychological - complications; Stress, Psychological - epidemiology; Stress, Psychological - psychology; Switzerland - epidemiology
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/1471-244X-12-120

Mental disorders, common in primary care, are often associated with physical complaints. While exposure to psychosocial stressors and development or presence of principal mental disorders (i.e. depression, anxiety and somatoform disorders defined as multisomatoforme disorders) is commonly correlated, temporal association remains unproven. The study explores the onset of such disorders after exposure to psychosocial stressors in a cohort of primary care patients with at least one physical symptom. The cohort study SODA (SOmatization, Depression and Anxiety) was conducted by 21 private-practice GPs and three fellow physicians in a Swiss academic primary care centre. GPs included patients via randomized daily identifiers. Depression, anxiety or somatoform disorders were identified by the full Patient Health Questionnaire (PHQ), a validated procedure to identify mental disorders based on DSM-IV criteria. The PHQ was also used to investigate exposure to psychosocial stressors (before the index consultation and during follow up) and the onset of principal mental disorders after one year of follow up. From November 2004 to July 2005, 1020 patients were screened for inclusion. 627 were eligible and 482 completed the PHQ one year later and were included in the analysis (77%). At one year, prevalence of principal mental disorders was 30/153 (19.6% CI95% 13.6; 26.8) for those initially exposed to a major psychosocial stressor and 26/329 (7.9% CI95% 5.2; 11.4) for those not. Stronger association exists between psychosocial stressors and depression (RR = 2.4) or anxiety (RR = 3.5) than multisomatoforme disorders (RR = 1.8). Patients who are "bothered a lot" (subjective distress) by a stressor are therefore 2.5 times (CI95% 1.5; 4.0) more likely to experience a mental disorder at one year. A history of psychiatric comorbidities or psychological treatment was not a confounding factor for developing a principal mental disorder after exposure to psychosocial stressors. This primary care study shows that patients with physical complaints exposed to psychosocial stressors had a higher risk for developing mental disorders one year later. This temporal association opens the field for further research in preventive care for mental diseases in primary care patients.