title: An international study of the effect of physical ill health on psychiatric recovery in primary care.
abstract: OBJECTIVE
  The aim of this study was to determine the association between physical morbidity and recovery from psychiatric illness in primary care.
  
  
  METHODS
  A total of 1252 psychiatric cases were recruited using a 2-stage design from 5447 subjects presenting for primary care in 14 countries. Cases were assessed at the time of screening and 1 year subsequently. Information on physical, psychiatric, and social status was obtained using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from the patients' family practitioners.
  
  
  RESULTS
  Medically explained somatic symptoms were strongly related to psychiatric outcome 1 year later. Whereas just over one half of patients (614 of 1078) with 4 or less medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 38% (67 of 174) in those with 5 or more medically explained symptoms. Patients with 5 or more medically explained symptoms had a 70% increase in risk of remaining a psychiatric case 1 year later after controlling for demographics, country, initial severity of psychiatric disorder, medically unexplained somatic symptoms, and social disability.
  
  
  CONCLUSIONS
  Physical ill health is independently associated with psychologic outcome 1 year after a patient has been seen. The needs of these patients should receive greater attention.
authors.affiliation: Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Halifax, Canada. Stephen.Kisely@cdha.nshealth.ca
authors.forename: Stephen
authors.initials: S
authors.lastname: Kisely
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
mesh_terms: D015897:Comorbidity; D003431:Cross-Cultural Comparison; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome