Burden of dysthymia and comorbid illness in adults in a Canadian primary care setting: high rates of psychiatric illness in the offspring.
BACKGROUND
The burden of comorbid dysthymia and other comorbid psychiatric illnesses in a Canadian primary care setting was measured. Two groups of primary care patients: those who scored positive for comorbid dysthymia versus those who scored negative for any psychiatric disorder were compared.


METHODS
This was a cross-sectional survey in a Health Service Organization (HSO) in Ontario, Canada. The subjects were patients of the HSO. The main outcome measures were: health status, mood, social adjustment, coping ability, children's psychiatric disorders, child development, family function, and health and social service utilization.


RESULTS
Of the 6280 eligible adults who were patients at the HSO, 68.9% consented to be screened for psychiatric disorders; 5.1% screened positive for dysthymia, of which 90% had at least one comorbid psychiatric disorder. The following statistically significant differences were found between people with dysthymia and other comorbid psychiatric disorders versus people without any psychiatric disorder. People with dysthymia were more likely to have worse health status, worry more about their health, and report levels of pain that impaired their function; they had higher MADRS depression scores, lower social role function scores, lower social adjustment scores, and lower coping ability. More children of people with comorbid dysthymia met criteria for one or more childhood psychiatric disorders and there were more families with a parent with dysthymia that were dysfunctional. People with dysthymia used a greater proportion of health and social services, had higher per person annual health care costs (excluding hospital services), and had higher per person annual indirect costs (lost wages).


CONCLUSIONS
This analysis demonstrated the burden of illness and costs that this disorder imposes on individuals, their families, and society as a whole.
Bell
Barbara
B
System-Linked Research Unit on Health and Social Service Utilization, McMaster University, Faculty of Health Sciences, 1200 Main Street West, HSC-3N46, Hamilton, Ontario, Canada L8N 3Z5.
Chalklin
Lori
L
Mills
Michael
M
Browne
Gina
G
Steiner
Meir
M
Roberts
Jacqueline
J
Gafni
Amiram
A
Byrne
Carolyn
C
Wallik
David
D
Kraemer
James
J
Webb
Michelle
M
Jamieson
Ellen
E
Whittaker
Susan
S
Dunn
Edward
E
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D016241:Child of Impaired Parents / Q000523:psychology*; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003710:Demography; D003863:Depression / Q000453:epidemiology*; D019263:Dysthymic Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D019966:Substance-Related Disorders / Q000453:epidemiology*