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

BMC Psychiatry

Paul Vaucher³  Thomas Bischoff⁴  François Verdon⁴  Nader Haftgoli⁴  Bernard Favrat¹  Bernard Burnand²  Nicole Mühlemann⁴  Lilli Herzig⁴ 

[1] Department of Ambulatory Care and Community Medicine, University of Lausanne Rue du Bugnon 44, Lausanne, 1011, Switzerland;Institute of Social and Preventive Medicine, University of Lausanne, Route de la Corniche 2, Epalinges, 1066, Switzerland;Department of Health and Community Medicine, University of Geneva, Michel-Servet 1, Geneva, 1211, Switzerland;Institute of General Medicine, University of Lausanne, Rue du Bugnon 44, Lausanne 1011, Switzerland

关键词: Stress;    Psychosocial deprivation;    Mental disorder;    Longitudinal studies;    Primary health care;   

Others  :  1124311
DOI  :  10.1186/1471-244X-12-120

 received in 2011-11-24, accepted in 2012-08-01,  发布年份 2012

【 摘 要 】

Background

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.

Method

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.

Results

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.

Conclusion

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.

【 授权许可】

   
2012 Herzig et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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