Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals
Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years) referred by their primary general practitioners (GPs) to an Urgent Referral Team (URT) based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays) for rapid assessments and early interventions to the outpatients referred by their primary family doctors.
Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.
Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.
Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613.
Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F. Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study. Psychol Med 2005; 35: 1175-1184.
Druss BG. The mental health/primary care interface in the United States: history, structure, and context. Gen Hosp Psychiatry 2002; 24: 197-202.
Verhaak PF, Hoeymans N, Garssen AA, Westert GP. Mental health in the Dutch population and in general practice: 1987-2001. Br J Gen Pract 2005; 55: 770-775.
Borowsky SJ, Rubenstein LV, Meredith LS, Camp P, Jackson-Triche M, Wells KB. Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med 2000; 15: 381-388.
Singh GP, Chavan BS, Arun P, Sidana A. Seasonal pattern of psychiatry service utilization in a tertiary care hospital. Indian J Psychiatry 2007; 49: 91-95.
Farrokhi F, Mahmoudi-Hamidabad A. Rethinking convenience sampling: Defining quality criteria. Theory and practice in language studies 2012; 2: 784-792.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571.
Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 1974; 42: 861-865.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370.
Zung WW. A rating instrument for anxiety disorders. Psychosomatics 1971; 12: 371-379.
Zanarini MC, Vujanovic AA, Parachini EA, Boulanger JL, Frankenburg FR, Hennen J. Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. J Pers Disord 2003; 17: 233-242.
Schifferdecker KE, Reed VA. Using mixed methods research in medical education: basic guidelines for researchers. Med Educ 2009; 43: 637-644.
Spratt C, Walker R, Robinson B. Module A5: Mixed research methods. Commonwealth of Learning 2004.
Wood DM, Dargan PI. Understanding how data triangulation identifies acute toxicity of novel psychoactive drugs. J Med Toxicol 2012; 8: 300-303.
Wilson CE. Triangulation: the explicit use of multiple methods, measures, and approaches for determining core issues in product development. interactions 2006; 13: 46.
Bhugra D, Till A. Public mental health is about social psychiatry. Int J Soc Psychiatry 2013; 59: 105-106.
Miller BF, Teevan B, Phillips RL, Jr., Petterson SM, Bazemore AW. The importance of time in treating mental health in primary care. Fam Syst Health 2011; 29: 144-145.
McCrone P, Dhanasiri S, Patel A, et al. Paying the price: the cost of mental health care in England. London: King’s Fund; 2008.