Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients.
OBJECTIVE
To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs).


METHODS
Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews.


METHODS
Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany.


METHODS
More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed.


METHODS
Not applicable.


METHODS
Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians.


RESULTS
The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians' diagnoses corresponded to the CIDI diagnoses.


CONCLUSIONS
The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.
Härter
Martin
M
Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, D-79104 Freiburg, Germany. Martin_Haerter@psyallg.ukl.uni-freiburg.de
Woll
Sonja
S
Reuter
Katrin
K
Wunsch
Alexandra
A
Bengel
Jürgen
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000534:rehabilitation